Fit for Duty Podcast: Episode 9.

Hello, and welcome to Fit For Duty, the Aetna International podcast for anyone interested in health and wellness benefits or international health care trends, or the many influences on the world of work. I'm Lorien Norden. And in each episode I meet with clinical and industry experts to discuss the health and well-being of workforces whether people are at home in the office in familiar surroundings, or on international assignment. Because no matter where they are, it's important that they're safe, healthy and happy, enjoying their work and pulling together to achieve the objectives of their organisation. We all know that COVID-19 is claiming lives and causing global economies to contract. It's also aggressively driving down workplace productivity and mental health according to our new research data. So in this episode we'll be discussing how employers can respond to the complex socio economic factors impacting workforces as they make bold decisions to help ensure that people are fully supported and at their best. Wherever you're listening to us. Don't forget to subscribe so you don't miss the next episode. You'll find Fit For Duty on your preferred podcast platform. And if you like what you hear. You can also keep pace with our latest health and wellness related advice and insights on LinkedIn.

Hello, and today I'm joined by Aetna’s Head of Health Services Kate Karwelies. I was wondering if you could please give our listeners a bit of background on yourself and your role at Aetna International.

Excellent. My name is Kate Karwelies, I'm based in Aetna International's New York City Office, and my current role is head of health services. Our department is focused on working with payers and corporate customers. We're working with governments that are sending people outside of their own country for care or working with insurance companies that have exposure to claims outside of their own country. And it's quite interesting to see where COVID has taken us for these times.

(2:11)

It certainly is and, and today's topic is really looking at the real cost of COVID on workplace productivity. So whether that's at population health level or at the corporate level. That's what we'll be focusing on today. So you may be aware that in Aetna international we conduct an annual survey that looks at employer and employee perceptions of health and wellness benefits, and this year's study revealed that there's a lot of stressors obviously impacting individuals which is impacting their mental health and their productivity. So some of those have very much focused on long working hours concerns over loss of income and job security which are really negatively impacting people, emotionally, in particular workers between the ages of 18 and 34 seems to be the most affected by this. Workers, aged 25 to 34 specifically have said that stress over those long working hours, has really hindered their productivity and just over three quarters of 18-to-24-year olds have said that they are really struggling to separate out their work and their home life, and again that's negatively impacting their performance. So those are really significant numbers.

And why do you think that those younger workers are more susceptible to these stressors than other age groups?

(3:50)

So I really, you've two things coming together and really colliding and it's unfortunate particularly for our workers in this in this age cohort. On one hand, people's ability to comprehend, manage and derive meaning from some of these stressors, such as being at home, limiting the time that you have with outside folks, other than your immediate family. The ability to do that only stabilises after the age of 30. So now you're taking some sort of genetic things coded things that you can't change. And I, at least in my opinion, I do think that there are some additional stressors for people in that cohort, you might have people who are living with roommates in tighter quarters than maybe their peers who are a generation ahead of them, and you also have in that cohort young families, and the ability then people who, all of a sudden have found themselves without childcare and trying to find ways to both manage work as well as childcare. And I think when you take all that together, people are finding that they're not getting the job that they wanted to get done during their normal course of business. And the way that they remedy that is just by working constantly between — not necessarily having another outlet, because some of those social aspects have been taken away. And the feeling that they're not getting enough done at work, I think, is just sort of colliding into the statistics that you're seeing right now.

(5:16)

And talking about the feeling that people aren't getting enough done at work and what the expectations of them are in this particular scenario, in today's day and age, I think that a lot of pressures are exacerbated for global workers who feel that senior leadership are perhaps not as available to discuss job concerns, their boundaries, etc that have really negatively impacted their work performance and we found that 33% of global workers feel that way. Plus even close to a quarter of people said that senior leadership not communicating about the health support that's available to them, has had a detrimental impact on their productivity as well since the start of the outbreak. So, not only have we discovered that employees think that employer provision for mental health and physical health is significantly more important than before, COVID-19, they want to understand more about how to access them if they want to, they want their employers to be investing more in this area for them. So, I mean in that whole context, what is your opinion of the role of communications and how large international organisations for example can use culture groups and different channels and platforms and human resources to counter this?

(6:37)

Yes, so it's interesting what I find resonates the most when it comes to senior leadership during this pandemic, is that the most successful senior leaders and the ones that resonate the most with folks is those that both acknowledge the difficult situation that we're in, and then show their own vulnerability, I think now more than ever, the human side of leading has become has come to the forefront, as one of the most important qualities for our senior leaders, someone that people can look up to and understand that yes, maybe the struggles are different, but they're having similar struggles as we all live through this pandemic together. It's funny, I, one of the things, companies used to struggle with the most was multimodal communication how to get messages out to people, town halls, emails, and then the feedback is we have too many town halls we have too many emails, we have too many news releases that now more than ever, people want every single component of that old communication strategy, the things that didn't work, the things that did work because people are really starved for that information. I think short term, communication on resources and what those resources are and how to access them to help. Even if people aren't using them, I think, employees are finding that it's a bit of a safety blanket it's comforting to know that you have this ability to use them if, when the time comes. And I think long-term communication on the health of the business, giving people some peace of mind that the business is still a running business, things might not look exactly like they looked 9-10 months ago, but how the business is pivoting in order to make sure that it's a viable sustainable company in the future.

(8:23)

Yes, I think that's an excellent point because it's a great counter to the economic crisis that has played out across the news if you've got that, that sense of stability and security from your own employer, then you're in a very good position. So, I also wanted to touch on, where people are working, obviously we've got people working from kitchen tables some people in offices. We've got people working in their country of origin at home and also abroad. But wherever they are. There's a number of things that are of concern to them that have come to the fore since, since the impact of the pandemic. So those who are working at home I'm particularly concerned about weight gain and 71% of people that we surveyed musculoskeletal conditions are coming in strongly as well at 52% and stress obviously 75% people worried about developing mental health conditions, such as chronic anxiety or depression. And while younger workers are particularly impacted as we said, those in the 45 to 55 age bracket and business owners in particular are really concerned about that kind of MSK the musculoskeletal conditions, and more so than stress per se, but because MSK issues can result in pain, chronic pain in some instances, that can be a stressor in its own right so there's a number of factors that are negatively impacting productivity. And then on the flip side, our data shows us that there are a number of factors that are positively impacting productivity. For example, people have said that knowing that their families, is healthy and safe 57% of people said that that was critical to them, knowing that their family health is covered by the employer 55% of people have said that that is positively impacting their productivity. So, with all of this in mind when we're looking across the global landscape, and because people no longer centralised organisations can't afford for out of sight to mean, out of mind. And whether you're separated by a mile or a continent.

(10:40)

So I think you have two sets of employers and that's probably oversimplifying it, but you have those where the employees are potentially back in the office, and this wouldn't necessarily work and you probably need to figure out, flexible work schedules, etc. I think for the vast majority of employees who are quote unquote stuck at home and have transitioned from the office to home. I think one of the best things that employers can do is recognising that family concerns and commitments can always wait until after work. And that might be an actual family commitment of taking a child to a sports practice that maybe previously there was a group bus that they could have taken, and that employee might need to log back on later in the evening, but it also could get back to some of the things that you said about weight gain and musculoskeletal. I know, for me personally, my preference historically was I would work out before after work because then I would go into the office and work my day and then come home. Now my preference is actually to do it at lunchtime. And I've found that since the beginning of the pandemic from about March until July, I was having significant musculoskeletal issues because I was still sitting in the same place, but instead of sitting in an office chair I was sitting on a barstool I was sitting on a dining room table and sitting on a couch and it really impacted, how my body felt. Now I'm finding that having that midday break and getting some exercise in, during the day has actually really improved my posture and how I feel throughout the day. So I think the number one thing employers can do is try to find ways to allow people to have some of that flexible work, whether they're in the office or not in the office and understanding that the commitments and scheduling that used to traditionally be done before after work might now, the reality is they might happen during the work day now.

(12:37)

I completely agree with everything you've said and we've touched on previously that people are much more keenly aware of the importance of their mental health and emotional wellbeing, their physical health than pre-COVID and the results of this research support that. So it's reflected in the expectations of their employer, say for example, 47% of people say that knowing that physical health support is available, 46%, knowing that mental health support is available should they need it is incredibly important and I know you mentioned that earlier that safety blanket. And as a result, globally employers are obviously looking at what they can do to be responsive in today's environment and our results show that employers are considering adding a host of benefits and services their plans in the future. And these are evenly spread across whole person, mental, physical health, and they include things like adding mindfulness apps, 39%, 48% of people looking at virtual, and in person counselling. Also diet and nutrition which plays back to that weight game concern, you know, 48% of employers looking at that virtual physiotherapy 57% of employers looking at that and access to gym memberships or discounted memberships 42% of employers looking at that. So there's a real mixed bag there, you know, as I said, in terms of whole person health. So is this consistent with what you're hearing from customers, and what are their offerings are employers interested in?

(14:13)

What we're hearing the most is some of the basic stuff that we found was most important from March until this time period, which is telemedicine EAP and shoring up some of the mental health benefits you know some employers, particularly those that aren't regulated by the United States Mental Health Parity Act did find that they do not include or had basic inclusion for mental health benefits in their product suite. And so I think there's, there's no widespread changes yet but I think people are aware of it and aware of some of those gaps on a go forward basis. International as well has rolled out an interesting app called Wysa. It's a third party app but we found that it was a great addition for some of our members, and it is sort of a chat bot, and so it was doing some personalised tools and activities based on a user's data. It provides activities based on you know what it's finding. And then there's the ability to activate a coach and chat anonymously. And while we thought that it was great, like other products in the past we found that, you know, there's a lot of interest in having programmes like this but again, that sort of security blanket idea that they weren't really used, but with this one, I don't have the exact statistics in front of me but we're hearing anecdotally that people are really embracing it, and probably just getting more familiar with the idea of having virtual and having tele anything visits. In addition to just the brick and mortar visits that we're, we're familiar with.

(15:48)

Absolutely. And I think that when you've got an internationally spread team or groups of people as well. There's going to be challenges in that global mobility, not least of which at the moment are border closures. But obviously, if we then think about enabling people to continue to do their jobs and travel internationally where, where they can, bringing it back to COVID and testing for COVID as well. What concerns and solutions are you hearing requirements from across the market?

(16:24)

There are two big issues that we're hearing the most in this area. Number one is the evacuation benefit. So, some of the issues that we're seeing right now with the evacuation benefit bring us back to the Ebola days of when we were trying to move people out of Western Africa, and we were finding borders closed, even for someone who needed to be transferred to a different country for just a complicated compound fracture. They were denied entry because of the risk and the fear of Ebola. We’re finding the same thing here, we still have numbers in very remote areas that might need to be evacuated for things beyond COVID, but with borders closed, it's really complicating the evacuation process. So I challenge employers to challenge their providers and to understand what the plan is in place, should they have a member who needs evacuation, you know, where would they go and what are some of the consequences to those decisions. The second thing is rapid testing, you know, not sure how much of this is available but on the wish list with some employers are finding is particularly for their employees who are going to more remote destinations. They have multi leg multi stop trips, and some of the testing that they receive before getting on the first aeroplane actually expires before they get to their destination. So how will people be able to get tested mid journey, if necessary in order to complete that stop to the assignment? And so rapid testing is incredibly important to employers who are sending people overseas.

(17:59)

Absolutely, access to care is something that, for anybody going on expat assignment or becoming an expat for the first time or even if they're seasoned expats, but they're moving to a new location, knowing how to navigate that health care system is a challenge, and you add COVID into the mix, and all of a sudden you've got findings from another survey that we conducted recently which shows that one in 10 expats are not even considering seeking care, even in the event of an emergency at the moment because of the fear of contracting COVID. So, this point we've also got layered on to this suspended or reduced care services across different health systems in this health crisis is resulting in unfortunately undiagnosed untreated conditions it's leading to a rise in condition related deaths as well specifically around, heart disease and cancer I've read recently. So, in terms of you know what employers have, those who are on international assignments, those who are going abroad for posts or who those who have lived abroad in their current pose for a number of years. How can we really kind of mitigate against this surge in conditions encourage people to get a care, enable them to get a care, and therefore keep the health in the optimum place, and keep those health care claims down as well?

(19:29)

I think first and foremost it’s communication, and we need medical providers as well to be in on this but communicating that all care should not be forgotten, until after this pandemic is over, but clearly there are some things that can wait, but there's also plenty of things particularly preventive care as well. That should not wait, or people who have chronic conditions should not wait and they should still be in touch with their providers. If the concern is catching COVID, I think it's up to health care professionals as well to talk about what their COVID protocols are so people can feel safe going to the office and knowing that they will be sitting in the waiting room right next to someone who is waiting for their COVID test to come back. And so to the extent that these providers can communicate what it is that they're doing. I think it will reap benefits for people who are very concerned to go. I also think employers were looking for additional testing, because people will probably feel more comfortable knowing that there's more testing in the community, most recently at an international announced in early December so that testing would be covered by the Summit and Pioneer plan subject to a couple of components, even for people who are showing with no symptoms and so I think making amends and changes to plan, such as this will also both help from a community spread perspective, but also help people feel competent to go and get a test, even if they're not having symptoms and feel more comfortable with, with the state of affairs right now.

(21:04)

One of the other things I wanted to ask you about as well as in what you're hearing from the market, do you think that attitudes to health have changed either at population health management level or individual level, since the onset of the pandemic.

(21:20)

Oh, 110% Yes, there's definitely me perhaps initially at the beginning there was a perception, particularly outside of the major cities you know I'm based in New York City. And I think people immediately knew people who were impacted by COVID. It was, it was a terrifying time to be in the city, watching this happen, but there were for folks who were not in such a crowded metropolitan area. There was definitely the perception that this might have been blown out of proportion, or it won't happen to me because I live on a farm or in a rural area. And I think now we're seeing the exact opposite. And we're seeing that it really can happen to anyone. And as a result, many many folks are feeling much more thankful for their health and taking it seriously that anyone can get sick and we really need to take. We really can't take our health for granted that it's something that we need to cultivate and something that we need to nurture, in order to make sure that we can maintain our best selves.

(22:26)

And as you said always related to that being proactive about finding ways to cope emotionally and mentally and one of the things I wanted to ask you about as well is really that the impact of financial implications on your whole-person health, on your mental state, your emotional well-being. So for example that the study that I referred to earlier, you know, we talked about younger workers being, and how these concerns are being keenly felt by that age group, and now nearly eight in 10, and that's 77% of workers who are aged 18 to 24, so that they're really anxious over furloughs and pay cuts and lose losing their job, for example, and that's much lower although it's still significant to those aged over 55 For example, 52% of people in that age bracket are concerned because we know that you know financial resilience is linked to whole-person health. What could or should government agencies or payers or bodies be doing to support employees in this respect, so that they can really focus on the task at hand, their career development and that sort of thing.

(23:39)

And sure you're taking the same cohort the 18- to 24-year-old workers and then you know the one after that and these the same workers that we've started off with talking about how they're, they're much more anxious, and not able to find that work life balance. And now we're compounding that by nearly eight and 10 of those workers have anxiety over furloughs and pay cuts and losing their job it's really, it's a tough situation for these folks to be in. But I think what organisations can do is, you know, similar to what we just talked about what the press release is showing what benefits are there. So, you open up the newspaper and some of what you see is someone in this age group that might not be covered by health insurance had COVID was in the hospital for a month, and is now faced with the reality of an extremely high hospital bill. And so while employers might not necessarily be able to promise jobs and say that you're not going to have furloughs or pay cuts because that's the reality of what a financial crisis is now going to be. They can do things by reiterating what the benefits are and how some of those concerns, can be alleviated because those, you know they have adequate health insurance that will cover them, and they have some other ways of not being concerned about that.

(25:00)

Absolutely. And I wanted to, in the last few minutes that we have just ask if again if you could just give your sort of maybe your top three areas that you anticipate being high on the list of priorities and in terms of what they need in place, are they globally mobile or their internationally placed staff. As we move through 2021.

25:25

I think the first one we haven't spoken about but is an interesting one. And those are the non expat expats. And so we're seeing a big shift and employers are starting to recognise this that people wanted to go somewhere and work remotely, they were 100% remote and the employer said okay. And so you now take the person who is locked away in a cabin in Canada, or on a beach in Mexico, or just applied for residency visa extended visa and Barbados. What do employers need to do now that they said yes, I mean legally you can go there, but is there anything else those employers now need to do from a duty of care perspective because they're actually let's say US based employees are now not in the US and theoretically it was company approved for them to go to these places So, do any of the programmes that are for the approved assignments need to apply for some of these non-approved assignments. We don't have an answer for that. It really depends. But I think it's something that employers really need to think about as they have people who might still be in some of these remote places or different places for another few months. And then the other two things are testing and taking a look at benefit plans, we've now found that mental health and telemedicine are more important than ever, from a benefits package. And I think it's time for employers to really take a deeper look and say, not only am I satisfying legal requirements for what we offer and what we don't offer, but is it enough, is it working. Is it the right mix for what our employees and members need?

(27:06)

And then finally I wanted to bring your thoughts in on your personal experience of managing your own team. Has your management style changed in response to the stressors impacting your team? I mean, have you acquired new skills? How do you feel that you and other managers directors those responsible for big groups of people need to kind of continue to adapt and grow to meet the changing needs of people in their teams and in their care?

(27:38)

In some ways it was easy because I was living through this, along with my team so as a working mother of two young children, I understood. All of a sudden, the need to adapt to the changing landscape, and I think that my management style adaptability was actually helped by the fact that I completely understood the position many of my employees were in. In addition to that, I just think that now more than ever checking in on people and just asking how they are and not just how the latest project is progressing has become more important than ever. And so again it's what we talked about at the beginning of trying to pivot and make your management style, more human versus, you know, just maybe the business management style than it was in the past.

(28:29)

I quite agree that this genuine empathy coming through is being seen across so many organisations and I think it's a massive step forward for the better. So with that case I'd like to say thank you ever so much for your time and your what your insights and your personal injections on your own reflections. In today's conversation and I look forward to hopefully connecting with you again soon.

(29:01)

In our next podcast episode, we'll be talking about the corporate health and wellness benefits trends, hitting the mainstream in 2021.

For those who don't know us Aetna International is a global health and wellness benefits provider, but we're more than just an insurance safety net, our skill lies in delivering the tools, services and resources that help drive health care costs down and people's health and well-being up. And that's something that's important to our clients, and self-funded members alike. And that's why we currently serve almost 900,000 members around the world from Shanghai to Seattle. Ultimately, we believe that when people thrive, their work and their personal endeavours strive to. For more information about us, you can visit Aetnainternational.com.