Fit for Duty Podcast: Episode 14.

Welcome to Fit for Duty, the award-nominated podcast brought to you by Aetna International.

The world we’re living in now means that people are not only victims of the virus itself but we’re also seeing increasing levels of non-communicable disease, comorbidities and worsened health outcomes. The interplay between conditions is undeniable but often not front of mind for employers trying to help individuals prevent and manage conditions.

I’m Lorien Norden, Global Thought Leadership Strategist, and today I’m joined by Dr Rasul-Syed, Aetna International’s Global Medical Director and Jesse Lahey; Consultant, Speaker, Author and Co-Founder of Workforce Communication. Together we explore how organisations can supercharge their care management strategies to meet the increasing and complex needs of today’s employees. Join us as we take a look at the co-morbidity burden for businesses and at the strategies that employers via workplace health and well-being programmes and occupational health strategies can put into place to help maintain productivity, create happier and healthier workforces and retain talent. I hope you enjoy the episode.

So, today I’m really really pleased to be joined by Dr Nairah Rasul-Syed and Jesse Lahey, hello to you both. I’d like you both to give a bit of background to yourselves if you don’t mind, starting with you, please, Nairah.

Hi Lorien, I'm Dr Syed and I’m a UK-qualified General Practitioner. I’ve been in the UAE now for more than five years and in the last three years, I’ve been working with Aetna. I’m currently their Global Medical Director and I lead their virtual telehealth services in Dubai.

Fantastic, thank you. And to you Jesse… could you please give us a bit of background about yourself, what you do and the organisation?

Sure, hey Lorien. Hi Dr Nairah. My name is Jesse Lahey and I’m a co-founder and strategic partner of Workforce Communication and we are a team of consultants and creatives helping organisations enhance the performance and well-being of their people.

Fantastic. So, that’s exactly where I want to start today in talking to you both about the strategies and challenges that we can help organisations overcome to help their people maintain their productivity, to help them retain talent and help to foster those healthier, happier individuals within the workplace. So, what I wanted to start with in fact is that we know that in the first six months of 2020, when the world was in the grip of the pandemic, life expectancy fell by a full year and that’s the most dramatic decline since World War Two. And more than the toll of the pandemic, this decline is also linked to conditions and health events such as heart attacks. Globally, we’re now looking at millions more instances of non-communicable diseases such as heart disease and related mortalities. And in a discussion hosted by the World Heart Federation in early May, the organisation stated that as a global community we’re facing a global cardiovascular disease tsunami and other health organisations and institutions are forecasting the same for other non-communicable diseases, so it’s a pretty bleak picture. And among the rising incidents there are those of us who have more than one acute disease or condition or, as it’s known, comorbidity. So first things first, Nairah, could you please describe in broad strokes what comorbidity is and maybe give us a few examples?

Sure, so comorbidities are essentially chronic health conditions that often coexist, as you said, with main medical conditions.They often describe a wide range of disorders, this could be physiological or psychological. They’re an important aspect of a patient’s health because they need to be considered very carefully when you’re managing and treating patients because they can often influence underlying symptoms and how you manage that patient. So, for example, obesity might be viewed as a comorbidity and this might impact the treatment of a patient with Type 2 diabetes. Or, how depression as a comorbidity might impact the recovery of a patient with low back pain.

Absolutely. And as you say the single acute condition needs careful management, let alone when individuals are coping with more than one. And it’s widely known that it’s also more costly from an employer perspective to treat conditions than it is to prevent them. That’s also relevant as far as entire health systems are concerned – prevention is better than cure – and it’s particularly when you consider all the moving parts related to condition management, you've got planning a treatment journey, you’ve got personalised health support, you’ve got making sure that their post-treatment experience and needs are met and filling in any gaps in care. Are they taking their prescribed medication in the correct way, are they missing any routine screenings? So it’s a really complex picture for each condition. And care providers are always trying to proactively manage people, aren’t they, who are at risk and who have diagnosed conditions and, yes, they want to ensure the best use of their labour and resources but ultimately it's all about ensuring the best health outcome for the individual, isn’t it? Nairah, with that in mind how and why have comorbidities become such an important issue in workplaces? And what can employers do to help curb the trend that we’ve spoken about?

So, as you’ve said, it’s hard to ignore the COVID pandemic. It's unprecedented and it’s had a significant role to play in the recent increase that we’ve seen in comorbidities and also the reduction in life expectancy. The fact that many employers have had to shift their employees and business practices to a remote work from home model has had a significant impact on patients’ health and in fact about 88% of organisations worldwide felt it was either mandatory or strongly encouraged their employees to work from home. Now, whilst the shift to work from home has brought positive work/life balances to many of us, e.g. increased family time and flexible hours, for some this imposed change has actually been a lot more challenging and finding resilience has been quite hard. And in fact the impact of working from home as you’ve already described has been really well evidenced globally across many international journals. And I think many subsequently face both psychological and physical difficulties in adapting what’s normally a home, relaxed environment to one that’s more suitable for work. And I think very broadly some of those key challenges are physical in nature, so building the right home office ergonomics, having the right equipment, chair, desk. All of those things can impact musculoskeletal conditions, and if you spend long hours of poor posture at your desk then this can often lead to a lot of issues like back, neck and wrist pain, we see those a lot. And for many also I think there’s blurred work/life boundaries and pressures to adopt an ‘always on’ mindset, if you like, because of the access to remote technology, employees sometimes feel that they have to be available online all the time, they have to be responding to emails and this can lead to fewer breaks and burnout.

And, I think this leads onto the second problem that a lot of people are facing which is psychological, especially anxiety and stress often triggered by uncertainty about the future but also triggered by concerns around personal health. And I think as a frontline health worker, I’ve often experienced fear about becoming sick with COVID, it’s become a big problem. People want to avoid visits to medical facilities even when this has become medically necessary, and this extreme level of neglect can sometimes affect the ability to manage an existing health condition and cause more complications further down the line, which as you mentioned, increase costs to care as well. I think finally there’s a problem around healthy lifestyles and diets. For many, longer work hours at home, the absence of a work commute or travel or even exercise in general have made eating habits a lot harder to control and this has sometimes led to overeating, frequent snacking which can often lead to weight gain issues.

Yeah, I think I can certainly relate to some of that and think we probably all can. And Jesse, I wanted to bring this more into your wheelhouse now and talk about… well, there’s been an upward trend in the annual change in health benefits costs since 2019 which I think we can understand and it’s still outgrowing the consumer price index and employee wage growth which have fallen to zero according to a 2020 report by Mercer at the tail end of last year. In terms of implications of having an increasing percentage of the workforce who are managing multiple conditions simultaneously, what will be of most concern to organisations? I’m thinking of corporate health strategists, chief people officers and HR.

Yes, well first of all I just want to acknowledge that, yes. As Dr Nairah was saying, there’s all these different factors that the pandemic has added and as she was talking about some of those I was concurring with neck and back pain and weight gain! There’s all these different factors and many of us have an increased level of awareness of them and our employees are talking about them more, so it’s easier to see but a lot of these situations that have already been there but they’re kind of more pronounced and visible and so there’s one truth I think is still appropriate is that a programme for the day is not going to solve the problem and I talk to a lot of employers who hear a new thing that’s going to solve it but for sustainable success we need a more integrated approach to workforce health and engagement. These conditions are being driven or supported in an unhealthy way by multiple sources of influence and so we need an overall strategy that addresses the key drivers of behaviour including personal, social structural and that includes things like the employer’s culture and leadership messaging as relates to health and well-being, content strategy for wellness education as well as data-driven interventions and programmes and technologies led by partners like Aetna, CVS, Caremark and more.

Absolutely, I completely agree. We’ve talked about adding new benefits and things and also I think that employers can really start to leverage those digital and remote access pathways and Jesse, actually, could we dig into it a little bit more? I’m just wondering if you have any thoughts on cost-saving measures and how organisations are looking at that? And I've read that some organisations are shifting more responsibility to the employee in terms of deductibles and copays to help offset some of the costs. But also that others feel that that approach could be decentivising people to seek treatment which is just going to exacerbate that cost scenario, so I was just wondering if you had any thoughts on that at all?

Yes, well we found that organisations that take a whole person approach are more effective in terms of health outcomes. Both physical and mental and as Dr Nairah talked about comorbidity involves both – multiple types of physical conditions as well as mental health conditions. And tackling the problem of cost increases by deductibles and copays and so forth is certainly worth looking at but if we do that it’s important to educate employees on what’s the context, the overall reason why, how did the choices they made affect their costs. But if we do that in an overall way, like I said, talking to them and viewing them and treating them like real human beings and taking a whole-person approach and most companies aren’t just changing deductibles they’re also adding new benefit features, more telehealth, more availability to get, let’s say mental health therapy remotely over video, lots of new richer things and then we can talk about that in a way where the overall goal is to support the employee and their family whereas, if we’re not careful we can send mixed messages and these things come across as takeaways and then it’s actually going to hurt things like how the employee feels about the company or organisation and the energy and passion they feel towards the organisation and their overall wellness is going to go down and it’s ultimately going to cause the organisation’s costs to go up if turnover is increasing and employee engagement is going down. So looking at some of those individual costs in a vacuum I think is missing the overall picture.

I quite agree. It’s a delicate balance. Nairah, did you want to say something there?

Yeah, I think this is a really valid point. I think also, Jesse, apart from increased costs that employers are facing, that’s largely consequent of patients actually taking time off work, right? And actually visiting hospitals or clinics, attending medical appointments so it’s also worth employees thinking about prevention measures, how you can actually reduce those visits, reduce those unnecessary costs but also think about accessibility and I say that obviously from personal experience of what I do in terms of telemedicine. Telemedicine has sort of revolutionised how we all access care, especially during the COVID pandemic, but it also is so convenient and it reduces time off work in sickness and absence so thinking about those sort of measures are really valuable as well.

Yes, absolutely as you say that convenience and access to affordable quality care has been incredible recently. I wanted to actually refer to your own podcast ‘Engaging Leader’, Jesse. You recently interviewed the Deputy Chief Health Officer at IBM, Dr William J Kassler, about workplace health challenges resulting from the pandemic and in particular those around anxiety, depression and other mental health challenges and how coping with stress can really aggravate other underlying conditions and you also touched on the fact that in a lot or organisations mental well-being continues to take a back seat, when compared with physical well-being. So I’d like to ask you more about your experience of working with business leaders about tackling comorbidities and that parity between physical and mental well-being. What’s your particular experience here and what have you seen or heard?

Well it’s well known that a key challenge is stigma. And I’m not just talking about the stigma that often applies to mental health problems; in many organisations there’s a stigma about all health conditions and actually anything less than superhuman endurance and resilience and capacity for work and that seems to have been exacerbated in a lot of organisations during the pandemic. We’re all working from home and so you should be always on and accessible. And so that’s been particularly challenging as organisations are experiencing more people working from home and then companies now starting to implement return to work strategies. But, if we think about this issue of stigma, there’s stigma to all health conditions in organisations or any experience where I might be operating at less than maximum capacity and competence and so forth, and then the added stigma that we’re just afraid to acknowledge that hey we all experience mental issues at times. We all have way more stress now, as a result of the pandemic, than we used to. And so one thing we’ve done a lot is help companies normalise talking about problems, health issues, mental wellness situations and challenges and that it’s not just something that happens to an isolated few and people with problems. This is just life is a spectrum, we all go through challenging times, so we’re doing things… coaching leaders to ‘how do you talk about it’ how do you be a little bit more vulnerable and authentic about it, your own health journey as well as your journey and mental wellness and then using different types of education channels like videos and story-telling models and visuals that just give people the language to be able to talk about it in a safe way, just hey I’m human I’m an imperfect human being and we all need help and there’s lots of great way and a health plan can support our well-being from a whole person perspective and recently this is one that we have beefed up or this is one that I as a leader have used and I would encourage you all to try it out to.

Absolutely, and I think there’s a few things that I picked up there in terms of communications and helping employees to understand just what is available. So just continuing on that theme as well, what are some of the other key challenges for businesses and employees when looking at comorbidity in the workplace. As you said, you touched on return-to-work strategies, other people are still managing fully distributed populations so just thinking about how employers can ensure employees are getting the support they need from their line managers, for example, what are your thoughts on that, Jesse?

With pandemic and many more people working from home, people have experienced a new level of flexibility. Dr Nairah talked about the greater work life integration that a lot of people have been able to experience. And they’ve also experienced their co-workers showing more of their real selves, being more authentic and they’re seeing their boss working from a spare bedroom and their boss’s boss working from a kitchen counter, their CEO working from home. And so they’ve both experienced the new traumatic stresses that pandemic has brought as well as this interesting aspect of hey we’re all people too and I don’t necessarily need to hide the messiness behind me, my dog just ran in, my kids ran across the screen, maybe I’m still in my pyjama bottoms, I don’t know and so this idea that just because this person is a CEO doesn’t mean that they don’t put their pants on one leg at a time. So now you have return to work strategies being implemented and it’s helpful to think about the challenge that that’s going to bring. It’s great people are coming back to work in more traditional settings but does that mean we go all the way back to the way things were before or do we encourage people to bring your whole self to work and let’s quit pretending that we’re all fine all the time, we’re not robots or superheroes, we’re real people doing our best and we have strengths and weaknesses and challenges and so it’s helpful to just expect that people will not tolerate the fakeness anymore and they will welcome greater levels of vulnerability and authenticity as their leaders both bring their own whole self to work and encourage people to be who they really are at work.

Oh, that was so well said and actually Nairah I just wanted to pick on something Jesse just said there about authenticity and also to a degree transparency as well. So shifting the conversation ever so slightly to an emphasis on value-based care where providers are reimbursed, remunerated, paid according to patient health outcomes… I read recently, for example, that Boeing, as a really large employer, has completely redesigned their employee benefits plan. They are encouraging employees to seek second opinions and to expense travel to health care providers that can offer better care at lower costs. And the pandemic has also highlighted the incredible ways that technology can help employees seek and manage care. We've touched on that before, so it’s really gaining traction, isn’t it? So what needs to be done now to tackle comorbidities in the workplace with regards to technology, communication, access to care and supporting services as far as you’re concerned, Nairah?

I think there are several strategies here. I think as an employer it’s a good time for employers to start looking at health plans but not just in a general way but actually trying to understand the demographics and unique needs of their workforce. So, for example if you are an employer and you have a lot of labourers working outdoors, their physical needs are going to be very different to office-based workers. So, I think this is a great opportunity and Jesse touched on it already. This has to come from leadership, they have to be engaged, they have to be listening and understanding what their employees want. But it’s also taking a step back and looking at the demographics of your population: age, gender, all these things and looking at how can we best provide for them? Do they need wellness checks in this age group? Maybe they need better access to medical visits or they need to ensure they can get their prescriptions refilled without unnecessary visits to expensive secondary care specialists. Mental health as well is a huge problem at the moment; maybe you’ve seen a spike in absence or depression or anxiety so maybe you need to think about what other mental health services your employees can tap into and this doesn't have to be expensive specialists, it could be something as simple as access to digital health apps and technology just giving people a way to access these services in a very confidential way without stigma.

Yeah, absolutely. You mentioned a couple of things there and I'm so glad you did because you talked about the needs of a population, really looking at your demographics and in Aetna’s own research, Tackling Polarised Perceptions and looking at the difference of opinion about benefits from an employer’s perspective, from an employee’s perspective… AI really discovered that there are so many more strata and levels appearing within an organisation, you’ve not only got specific differences and preferences in terms of gender but you’ve got such a range of needs according to age group as well so you’ve obviously got people staying longer in the workforce than ever before because we have an ageing population but also the younger aspects, elements, cohorts are much more vulnerable in other ways as well. So, really speaking to those needs and those different strata. Jesse, I was wondering if this is something you’ve really seen organisations really home in on, and to what end, and also just to add on to that what are the barriers to success and successfully rolling out strategies that cater to all those different cohorts?

Yes, we typically start with helping the employer develop their overall strategy for behavioural change. So, let’s make sure we’re addressing all the most effective levers for enhancing health outcomes as well as overall performance and well-being of their people. So, for example, one of the barriers to success is a culture that’s sending mixed signals, so let’s equip senior leaders to actively model and champion the healthy culture and behaviours, including being willing to address some of the comorbidity types that have more of a stigma and we’re afraid to talk about. Let’s also make sure we're engaging all of the key audiences and influencers. For example, how are we connecting with the spouses of our employees? Spouses often represent more than half of an organisation’s health care costs and often make the health care decisions for the family – both in the decisions that get made, the actions that get taken and the things that don’t get acted on so ‘we’re not going to worry about this yet, we’re going to ignore it’, so let’s make sure we’re using the best methods and content strategy to effectively educate spouses and effectively prompt them to make the best decisions and take the healthy actions when the moment of truth comes. You can educate them all you want but then when an actual health situation comes up and the decision is going to be made, are they going to make the right decision in that moment of time?

Another barrier to success is just breaking through all the noise. In a pandemic there’s lots of noise, it’s amazing when you talk to people about what’s going on in their lives, there’s just days where people spend glued to the news, for example, or social media so there’s so much noise going on more than ever before. So let’s make sure we have an overall strategy of both communicating and educating that includes proven education methods like storytelling and visual metaphors and things like that using multiple channels, like video and mobile and social media.

So, just thinking about what Jesse has just said there, and you raised a really excellent point there, around the need to educate spouses. And Nairah from a vHealth and telemedicine perspective you’ll be able to speak for this much better than I can. But from what I understand, it’s quite often the children, the dependents, the spouses of the primary insured who use that service, so I just wondered if you wanted to come in on that?

I think it’s incredibly important. I think when we look at who we consult with, probably about 50% maybe more of the members we consult with are exactly those primary dependents and I think as a primary care physician, it’s so important that whenever you’re talking to a patient you have to take a very holistic approach and that means not just listening to the symptoms or looking for the signs but actually trying to understand socially what’s happening in that person’s life. I can’t emphasise it more especially with the coronavirus, if any individual is affected it impacts that entire household and that entire household is having to self-isolate and so there’s a lot of worry with members, and as an example of how we recognise the importance of dependents, back in February Aetna actually had a vaccine drive campaign for all their employees regardless of return to work in the future , vaccines were quite tricky to get hold of at the start of this year so Aetna partnered with a health care provider and they were offering free vaccines to all their employees and their primary dependents which I thought was absolutely great. It had a great response and a great initiative but it was also a reminder from the employer to the employee that they really care and it’s not just the employees who are important but the entire family unit.

Yes, absolutely and hats off to the organisation for doing that and for all organisations who are really going the extra mile at the moment. And I was thinking about it from an individual perspective, Jesse, what is it that an individual should be asking their employer at the moment whether they’re suffering from one condition or multiple conditions at the moment or suspect that they have an issue.

I think the key word is connection and this comes to mind especially in areas of mental wellness. It’s been said that the opposite of addiction is not sobriety, it’s human connection and I think that’s true in so many aspects of our health and well-being. So individuals should be asking themselves and their employer, ‘what’s available to help me move from isolation into human connection or community?’. There’s so many more technologies and opportunities than ever before for people to connect in healthy ways, but it often feels more like hyper connectivity, not meaningful relationships. And so people often feel less connected than ever with their co-workers, family, boss, health care providers and even with themselves. There’s such a thing as healthy solitude but within that you’re connecting with what’s important to you and getting to know yourself and not being afraid to look inside yourself and so forth. But most employers now, the progressive employers have all sorts of opportunities for the employees to connect with each other, with the purpose of the company, for example and with their coworkers and all this telehealth and ways to get this healthy type of connection because it’s the isolation that things like pandemic, illness, challenges and stress tend to It’s almost like it’s trying to get us to be all by ourselves and feel like we’re alone and like i’m the only person this is happening to.

Hm, when in fact the opposite is true. This is a question to both of you, in terms of measuring the success of some of the workplace wellness initiatives that we’ve talked about, how can we build business cases for the C suite for example to ensure that HR and wellness teams are able to provide those well-being benefits that really move the needle for the people they look after, so I don’t know who wants to go first?

I think really I'm just going to reiterate a lot of what Jesse’s already said. I'll probably just highlight three key points. I think the first thing is engaging and listening is absolutely key and i can’t over-emphasise how important it is for top leadership to be seen and to make sure that yes they’re seen through zoom meetings, they need to be connecting with their employees, but also they need to be listening and that might be through employee surveys to facilitate engagement but also to understand what it is that employees are most concerned about at the moment and what changes they want to see.

We’ve talked about employers, especially health benefit organisations like Aetna, trying to understand the demographics and the needs of their population because these health plans can have probably one of the greatest impacts on well-being and productivity and this might be through screening and wellness checks and the numbers will speak for themselves, you know, I think at the start of the coronavirus outbreak and for a couple of months after that claims costs were very much down because people were avoiding hospital visits and things like that. That will change, so the short-term savings that a lot of health benefits firms have seen now will probably catch up in the future. So, it’s about planning, being strategic, anticipating that and looking at what you can do in terms of health prevention and also looking at how you can improve better access to care for patients. And also health digital technology can be leveraged and for the benefit of both employers and employees through less time off work, better health outcomes, I have to mention telehealth services because this is what we do and it’s well evidenced that it can improve health outcomes, it doesn’t have to compromise the quality of care and it does reduce a lot of unnecessary costs associated with expensive hospital visits and unnecessary tests and investigations. And also to look at the basic health apps and technology. There are so many health and fitness apps available that employees can tap into. It’s a really nice way of empowering patients, giving them better access to health information and I think it encourages more control and autonomy over their health.

Yes, absolutely. And Jesse, again just coming back to that piece around building business cases, I don’t know how many organisations that you come across that aren’t bought into the fact that there needs to be a culture of well-being and a really robust strategy in place. But what do you think that businesses should be doing to build that business case for investment in those areas?

To just add to something one of the things that Dr Nairah touched on, one of the biggest impact of all these initiatives in terms of workplace wellness and health is on the organisation’s business results so as she mentioned employee engagement and I think that when employees believe the company cares for them as a whole person and when they feel healthy and energised, it’s just good for the bottom line so metrics like employee engagement scores, employee turnover, recruiting results and profitability, different measures of profitability those should be included in success measurement as an important part of the business case to senior leadership as well as metrics around employee health and well-being, the cost of health care and related costs like absenteeism. And then I think it’s also important to include participation rates, I have seen data for example from Gallup showing that a lot of organisations, well under a quarter of employees are even using the company’s wellness benefits and I’ve seen data that in a lot of company mental well-being resources like EAP are used by five or maybe ten per cent or fewer of employees. And so these are things that at the companies that have a more energised and passionate culture, employees are taking advantage of the resources more and they just feel more a part of the organisation and it all pulls together not just to manage health care costs but to make the company more productive in terms of what its overall purpose is and when those things aren’t being used it tends to affect all of the programmes as well, including taking care of customers, so I think those are all helpful metrics to look at and include in the business case.

Totally, can I just ask you to elaborate a little bit, Jesse… you mentioned EAPs there and something that just sprung to mind was as you mentioned Aetna International has also found that employee take-up and awareness of EAPs is a challenge, so what is it about EAPs do you think that poses such a challenge for employees to get their heads around?

Part of it is the stigma that we talked about, so nobody’s talking about it enough. A lot of employees are surprised it’s available or maybe they’ve heard about it but they don’t really know what it is because nobody talks about it. And part of it is that it doesn’t feel very human, you know the way that it’s been communicated in the past is just a phone number and ‘am I going to get stuck in a phone tree’ and a lot of companies now are making it more human, especially with the available telehealth resources, it’s a lot easier to make it human. Now you can talk to a real therapist and see who you’re talking to. Telling the stories of the types of situations that EAP can help with. We’ve been doing, for example, a two-minute video that makes it more human, talks about it in a caring but light-hearted way ‘you don’t have to be on the window ledge about to jump off before you call and ask for help, go ahead and start reaching out for help when life’s smaller speed bumps come and you’ll get more comfortable with the idea of i don’t have to go through this alone’. So it’s the storytelling and using some visuals to make it seem more human, approachable and more normal has been very helpful.

And Nairah, can I ask you from your experience from a vHealth and telemedicine perspective does vHealth take that vHealth-first approach whereby you would have that conversation with the individual, member and then be almost like a point of triage to other EAP available solutions and things. What is your experience of that?

Definitely. In fact, only recently in the last month, we’ve been specifically focusing on accessibility to mental health services and what we’ve now established is a number of health care partners so we’ve got some very good reputed global health care digital partners who offer chatbot and life coaching for those individuals who prefer to have a bit more autonomy and more anonymity as well, it’s great for that. We’ve then looked at the next tier of service which is your vHealth GP, so again at the moment we don’t offer video consultations in Dubai which actually works in favour for a lot of patients seeking mental health services, it gives them more trust and confidentiality. And the doctors at vHealth are all qualified to assess and diagnose individuals and thereafter we can definitely either offer coaching or direct them to more specific services. The last year was really your specialist psychiatrist of psychologist and we’ve specifically identified one preferred provider so all our patients have a choice in access to many, many providers within their network but we’re working specifically with one because they also offer telehealth services like us and they’re very reputed and they’ve got a very good skillset in terms of languages and culturally they’re very experienced in this region. So that’s what we’ve done, we’ve really looked at our pathway and EAP definitely is in that pathway and not everyone has mental health services within their benefits, so that’s definitely a good service to turn to.

The other thing I just want to add is I completely agree with what Jesse said about EAP. I think the two issues with that are poor marketing and accessibility and I can say from my own personal experience of the patients I have referred to, all the patients have spoken really highly, this is a global team of very highly trained experienced counsellors available at all times in many different languages. So, I think the service is great. I think it’s marketed very poorly, as a health care professional, employee assistance programme doesn’t really mean that much to me and if you don’t really understand what that service involves, you’re not going to contact it. And I think also, Jesse touched on how do you actually reach the number and recently somebody asked me about the EAP services and I was always under the impression that it was on the back of the UAE insurance cards, but it’s not, which creates an additional barrier for those patients who want to access a confidential service. They have to first talk to a stranger, a non-medical professional in the insurance team before they get directed, so I think there are a number of probably quite simple things that can be done to remove those barriers and make EAP a much more valued service.

That’s a very candid view of it and I don’t disagree. And before we wrap up, is there anything that you would like to add to the conversation at this point, Jesse? Anything that I've missed?

No, I think that I mentioned earlier just the idea of making it more human and I think just about any of the different types of interventions we can do around comorbidity, that we can implement, if we can think about how to make it more human in the way it’s both delivered as well as marketed. So, for example, an organisation can have a terrific care coordination programme or care navigation programme but if it’s marketed or delivered in a way that it all suggests this is going to be dealing with a phone tree or I’ve got some kind of a robot that’s reaching out to me, it’s not going to be embraced. So if we can think about it as real people who are going to be using this and ultimately they’re going to be talking to real people and make the whole experience more human and then make it clear in the way we market it and educate people about the availability, whether it’s putting the phone number on the card that’s going to get them to the human more quickly or showing them these are some of the real life care navigators that are assigned to our organisation and once you start working with them, they’re going to help you all the way through the process and these are some stories they have and how much they care about our people, we found that type of an approach to be a lot more effective. So a lot of it is boiling it down to making it more human and especially the human connection, focusing on that.

Hm, absolutely. In terms of final thoughts, the same question to you, Nairah. And also what personally would you like to see change in the organisation so say we’re looking five years down the line what would you like care management and handling comorbidities and that whole person health experience to be like for an individual?

I would approach this from two directions. I think firstly employers have to rethink what going to work actually means and I think that’s really relevant, it can’t be ignored in these times because it has had and does have such a huge impact on the psychosocial of everyone. And, yes, some will be very much looking forward to going back to work and that’s absolutely fine but for others it really has made one realise that actually there is a new way of working and you can get back a better work-life balance. Partners at home have kind of shifted how they manage childcare and things like that. I think for a lot of people this is going to be really important and this will change and I think employers will have to engage with their employees and understand how to best support those employees who might not want to go back to work full-time, so I think that’s the first thing.

The second thing is that I hope as an organisation we’ll see much better integration of innovative health care models, whether that’s implementing chronic disease management programmes alongside care management. I’ve talked about mental health services but we’re also looking at management of diabetes, some of these really high-cost conditions, musculoskeletal programmes, can we get people doing more home physio, can we support them with patient information leaflets, education about home ergonomics to prevent those expensive MRIs or unnecessary radiology tests, those things are going to be really important. And I think definitely we will see a change in the regulatory landscape of telemedicine; we’ve already seen it expedited in the UAE, we’ve seen it in the UK and a lot of regions. I think even in those countries where telemedicine was less well established, that will now change because governments, health authorities all realise we can’t just rely on physical services. And telehealth remote services is a great way of providing safe and convenient care, so I think in the future we’ll see more defined regulations that support the quality and development of much better telehealth services but also the integration of better technology, tele diagnostic tools, tele monitoring just to really ensure we’re treating the patient really holistically and most importantly improving health outcomes in the end because that’s what it all comes down to.

Absolutely. Wonderful, what an invigorating conversation, I’ve so enjoyed myself and I really hope that our listeners have got as much out of it as you both have, I can see big smiles on your faces, so hopefully that is the case. Thank You so much and I hope to be able to connect with you both again soon.

We really enjoyed making this episode and hope you got a lot out of it as well. Don’t forget you can follow Fit for Duty on your preferred podcast platform. Coming up next are discussions on mental health stigma, diversity and inclusion and a conversation about the ways the world of health care and well-being will be shaped by the Internet of Things and tech innovation in the coming years.

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