Volume 40

COVID crisis will eclipse any changes to ACA

5 Mental Health Employee Benefits Trends for 2021

Cyber Wars on the Rural Frontlines

COVID crisis will eclipse any changes to ACA

Changes to the ACA may be of little consequence in 2021
By Brant Couch, CIC, CPA

Little has changed with the ACA in the last four years, even though healthcare reform is a constant news item.

As of January 2019, the federal penalty for non-compliance with the individual mandate has been $0. That’s about it for changes. Certainly, if the Supreme Court rules the individual mandate can’t be declared unconstitutional on its own, separate from the entire ACA, then we may have to deal with major changes. Until mid-2021, the ACA is virtually a non-issue for rural and community hospital leaders, their teams, their hospitals and the communities they serve.

Looking forward, the challenges facing rural healthcare providers in 2021 will be unprecedented.

In a time when rural hospitals and most healthcare providers are expected to do more with less, successful hospitals meet these five fundamental challenges:

  • Cost control
  • Communication effectiveness
  • Wellness that works
  • Compliance certainty
  • Administrative efficiency

Sound familiar? Yes indeed, these are the same challenges you faced in 2016, 2015… you get the picture. The order of priority may shift from year to year but these five are always on your plate.”

Has the order of priority shifted?

A review of rural healthcare news, and studies from big consulting and the projections of industry leaders, seems to indicate “wellness that works” might now be taking two or even three of the top five spots. No exaggeration, healthcare worker wellness is now, and will for many more months be, one of the most significant challenges facing hospital leaders.

Anecdotally, the picture is grim. For instance, Jenn Schmid, the assistant director of nursing at Livingston HealthCare in rural Montana, told NPR, “My job consisted of 24/7 begging people to try to come in to get help, coming in to try to staff it myself, just because we didn’t have enough nurses.”

And, the Department of Health and Human Services (DHHS) reported in mid-December 2020, that across the country, the percentage of rural hospital patients who have Covid-19 increased from about 10% during the first week of October to about 25% in late November and early December.

If the order of priority has truly shifted… now what?

In the introduction to the American Hospital Associations “2021 Environmental Scan”, President and CEO Rick Pollack says, “…for 2020, the total projected financial losses to hospitals and health systems is $323.1 billion. Put simply, this is an unsustainable hit.”

And, you have to seriously consider what will happen when people who are avoiding medical care due to the pandemic become too sick to put it off any longer, or decide it is safe enough to get the care they need. (AHA’s report says as of June 30, 2020, 41% of U.S. adults had avoided medical care due to the pandemic.)

According to a study conducted by the North Carolina Rural Health Research Program before the pandemic, rural hospitals with between 25 and 50 beds only have cash on hand to cover 21.3 days of operations… five years ago, they had twice that amount.

This precarious financial footing is not new to rural hospital leaders. Historically, 70% of their reimbursements come from government health insurance and 30% from private insurers. This ratio is exactly the opposite for urban hospitals. Plus, rural hospitals tend to treat a higher number of uninsured patients.

These factors and others beg the question: If wellness that works is our top priority for the immediate and medium-term future, how are we going to pay for it?

And so, once again, we find ourselves staring cost control square in the face.

Spoiler Alert: Hope is a Strategy

In the face of what may seem like insurmountable challenges, human kind has always turned to hope. In the Bible, hope is the confident expectation of what God has promised and His faithfulness. Albert Einstein said, “Learn from yesterday, live for today, hope for tomorrow.”

In my work with rural and community hospital leaders across the country, I have never met a single one who does not see the glass as half full. I have seen hope engender the trust these leaders need to come together to survive and thrive despite everything that’s thrown at them.

The simple truth is, with hope, hospital leaders are much more successful when they never go it alone.

Never Go It Alone

Years ago when we took over management for the TORCH Insurance Program, we began championing “never go it alone.” Sure, we had the power of our conviction and hope behind us, but how could we prove rural and community hospital leaders would enjoy greater success when they collaborate with others; when they never go it alone?

After several years of successfully bringing rural and community hospitals in Texas together, we partnered with the NRHA to create a program, Rural Hospital Insurance of America (RHIA). RHIA brings the opportunity for rural and community hospitals together across our nation to never go it alone.

Although we had no idea what 2020 would bring, in early 2017, we decided to prove our thesis once again by conducting a collaborative experiment called the Community Hospital Insurance Coalition – or more fondly, CHIC.

In the beginning, we asked participating CEOs, “Why rent your insurance when you can own it?” And, we challenged them to come together to take back control from big insurance.

CHIC’s driving mechanism is a medical stop-loss reinsurance program. Simply, it is an insurance company owned by the participating hospitals. And, as the experiment continues, it has become increasingly apparent that this driving mechanism – the insurance company – is the substrate upon which all sorts of other forms of collaboration is growing. (Think of it as the agar in a Petri dish.)

And, by providing a healthy dose of financial wherewithal – the coalition paid $750,000 to its participants in 2020 – CHIC is empowering many other significant collaborative initiatives and outcomes… a boon during one of the most challenging episodes in rural healthcare history.

Directly addressing the challenges COVID-19 presents, and now in part because they have more skin in the game (effective wellness leads to fewer and smaller health insurance claims), and because taking back control from big insurance has given them access to their own health benefit performance data, they are all participating in a new, strategically designed wellness program that will help their teams find their way through to the other side of the COVID crisis.

By constantly sharing their concerns, frustrations, and ideas for overcoming the non-stop challenges facing rural and community hospitals, hospital CEOs are able to tap into shared wisdom as well as their collective buying and negotiating power.

Hope is a strategy, even in the face of our current crisis. We are here to make sure your hospital never goes it alone.

Brant Couch is the CEO of HealthSure

HealthSure manages the Rural Hospital Insurance of America program in collaboration with the National Rural Health Association (NRHA). It is the insurance program manager for the Texas Organization of Rural and Community Hospitals (TORCH). And, the insurance program manager for the New Mexico Rural Hospital Network (NMRHN).


5 Mental Health Employee Benefits Trends for 2021

Since the onset of the COVID-19 pandemic, Americans have reported increases in anxiety, depression and thoughts of suicide. The toll that the pandemic takes on mental health increases daily. Before the pandemic, 5% of employed workers reported poor or very poor mental health. Now, 18% of employed workers struggle with mental health issues.

The COVID-19 pandemic has forced mental health and wellness to become mainstream topics of discussion. While nobody knows what this year will look like, building resiliency will likely remain a priority. Employers are in a unique situation and may be able to champion mental health and well-being in the workplace.

Employers should focus on employees’ mental health needs—otherwise anxiety, fatigue and burnout could further impact employee engagement, productivity and absenteeism. This article explores trends for employee mental health benefits and why safeguarding employees’ overall well-being has become fundamental in 2021.

What’s Trending?

By taking a proactive approach, organization leaders and HR professionals can focus on building a resilient workforce, increasing the comfort around mental health conversations and designing benefits plans to meet current employee needs. The overall goal is to help today’s employees survive and thrive during uncertain times, by cultivating a workplace that reduces the mental health stigma and demonstrates employee support through tangible benefits.

To develop a supportive and successful employee benefits strategy this year, consider prioritizing the following five mental health benefits trends.

  1. Employee Assistance Programs (EAPs) An EAP can be tailored to a workforce to provide critical employee resources. Initially, the focus of EAPs was drug and alcohol abuse, but many employers have expanded programs to include a variety of issues. Consider offering an EAP that incorporates behavioral health counseling, mental health resources or therapist appointments. Depending on how an EAP is structured, it could offer employee education, evaluation, hotlines, counseling and/or referrals. The most effective EAPs offer more comprehensive services and integrate with the employer’s health plan, prescription drug plan, disability benefits and wellness program. Integration can allow the EAP to serve as a preventive measure to address mental health and lifestyle issues that could lower health care and disability costs in the long run.
  2. Telemental Health Coverage Telehealth options have been expanding for years to offer employees opportunities to seek nonemergency care from the comfort of their own homes. Similarly, telemental health, or online therapy, can be useful to employees during the pandemic and beyond. Employers should encourage employees to use telemental and telehealth services to gain access to mental health providers for quick, convenient and affordable care.
  3. Online Mental Health Support Resources For additional support, consider expanding employee access to virtual mental health and emotional well-being services and resources—such as apps, videos and articles. Online resources can address provider shortages and reduce the stigma of seeking mental health care.
  4. Caregiving Support As the baby-boom generation continues to age, more and more workers will become caregivers for elderly parents, in addition to the others who will take on caregiving responsibilities for a number of different reasons. Employees may also be faced with child care and home schooling as a result of the pandemic. Balancing work and caregiving responsibilities can be difficult and can contribute to poor mental health and increased stress among employees. Caregiving benefits can take many forms, so consider the following common caregiving policies:
    • Paid leave exclusively for caregiving
    • Paid family medical leave
    • Sick, vacation or personal days
    • Flexible scheduling
    • Leave-sharing programs, which allow employees to “donate” accrued paid leave time to their co-workers who are in need of additional paid leave
  5. Flexible Scheduling Creating, expanding and promoting a workplace flexibility policy may help reduce the number of leave requests and support employees during the pandemic. With flexible scheduling, employers set designated “core” hours that an employee must be working (location irrelevant) and otherwise let employees work whenever they like. Alternatively, an employer may not have core hours and instead allow employees to work any combination of 40-hour workweeks. This can be a great way to accommodate working parents who must also act as stay-at-home teachers or day care instructors. It can also free up time for parents so they can work earlier and see their families more in the evening. Additionally, an unlimited paid time off policy can give employees the guilt-free time off needed to take the vacation, sick and mental health days necessary to take care of themselves and their overall well-being.

Other Considerations

To be most effective, mental wellness offerings should be holistic and address all types of needs that contribute to employee well-being. Prioritize focusing on the health of the whole body and employees’ mind-body connection.

Before introducing new benefits, it’s important to understand how current offerings are being utilized to find potential gaps. As with any benefits changes, it’s crucial to share those updates with employees so they’re aware of all available resources. Educating employees to take more ownership of their mental health and well-being helps reduce costs for them and the organization overall.

Contact us today to learn more about 2021 trends and how to develop an employee benefits strategy that meets employees’ evolving mental health needs.


Cyber Wars on the Rural Frontlines: A Survivor Tells Their Tale


Small but important print
This communication is designed to provide a summary of significant developments to our clients. Information presented is based on known provisions. Additional facts and information or future developments may affect the subjects addressed. It is intended to be informational and does not constitute legal advice regarding any specific situation. Plan sponsors should consult and rely on their attorneys for legal advice.
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Take the Community Hospital Insurance Coalition (CHIC) for example. With our expert support and management, more than 30 rural hospitals who have come together to own this medical stop-loss reinsurance company. They are paying less for their insurance, improving benefits program performance, and receiving their share of a significant annual surplus cash distribution (~$2.5 million since inception in 2018).