What Strategies, Factors Are Employers Considering to Safely Return to the Workplace Amid COVID-19?

Amid the coronavirus disease 2019 (COVID-19) pandemic, employers have had to design strategies to ameliorate potential revenue loss from forced closures. However, as states begin to ease social distancing measures nationwide, employers are now being provided with the option to return to the workplace.

Creating safe accommodations for employees is no easy feat, as testing, individualized risk, and employee comfortability all serve as primary points of emphasis. Moreover, there is also the psychological impact of COVID-19, with nearly 7 in 10 employees indicating in a survey that the pandemic is the most stressful time of their entire professional career.

To assist employers during this ever-changing environment, the National Alliance of Healthcare Purchaser Coalitions (National Alliance) has conducted a series of employer town halls aimed at unraveling the science of the virus and solutions to addressing mental health and well-being. In a recent survey, the National Alliance polled employers on their return-to-work strategies, with 90% considering a phased re-entry and 88% having a multidisciplinary task force in place.

In an interview with The American Journal of Managed Care^®, Michael Thompson, president and CEO of the National Alliance, discussed the survey findings, as well as long-term ramifications of the pandemic.

Transcript

AJMC^®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences News Network, The American Journal of Managed Care^® is pleased to welcome Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions, or National Alliance. Can you introduce yourself and tell us a little bit about your work?

Thompson: Yeah, so I am president and CEO of the National Alliance. We are the umbrella organization for employer coalitions across the country. We're really the only organization that is led by purchasers, employers, and other purchasers like Taft Hartley organizations, union groups that provide benefits to employees and their families that has both a national and a regional structure. With that we're able to affect change both nationally and regionally to improve health and improve health care value across the country.

AJMC^®: As US employers work to safely accommodate the return of their employees to the workplace, what advice has the National Alliance provided for partnered employers in optimally addressing this issue?

Thompson: This has been a period where the need for information has never been greater, and we have accelerated our educational efforts over this period. We've held, I think we're coming up on our eighth employer town hall, looking at issues as it relates to science and the issues around the virus itself, issues around benefits policies, lead policies—things like that around the virus, and for employees that are affected by the virus; but we've kind of moved on looking at issues related to mental health, issues around social determinants of health, population health. More broadly, the fact that there's a lot of underutilization of care, but most recently, we've kind of pivoted and we pivoted with an eye towards return to work.

We actually did a survey on behalf of employers of all the various strategies we're hearing out there and understanding where are they in their planning. What we found is employers are very far along in their planning, that they actually see themselves returning to work probably within the next 60 days, but doing so on a phased basis. Some of the things that people may not have anticipated are if people can work at home, they're likely to encourage them to continue working at home. If they are going back to work, we're going to see much more investment in the clean workplace—improving cleaning, big emphasis on social distancing and reorganizing the workplace to support real social distancing, the wearing of masks, and increasingly, we're also looking at testing. It might be testing for symptoms or it might be testing for the virus.

What we haven't seen too much of so far is a high reliance on antibody testing, but generally, these are some of the strategies that employers are focusing on, and frankly, it's very clear that they're taking this very seriously because they know they need to protect their workforce, particularly those who are coming back into their work sites.

AJMC^®: In the National Alliance’s survey of more than 200 employers as you just alluded to, participants detailed strategies as well as factors being considered in reopening. Can you discuss how the study was conducted, and what was the most surprising finding for you?

Thompson: The survey was conducted across coalitions across the country. I think we had over 25 coalitions participate in the survey; we had over 200 employers represented in the survey—about 20% of them were employers with over 10,000 employees so those are very large employers; and about 30% of them were employers under 500 employees, so more midsize and smaller employers.

So, it's a wide range of employers, wide range of geography, and a wide range of industry, and with that, we got a lot of excellent insights. One of the big insights besides the issues around kind of workplace readiness—those issues around safety and using masks and things like that, was also how they're thinking about their employees themselves in this return to work. Some of the factors that they are looking at, for example, are age of the employee, whether or not they have conditions, chronic conditions—those people who are more at risk, not that they're necessarily creating them in a separate class, but looking to accommodate employees that might have a legitimate reason. Childcare issues that employees might have, even things like are they ready to go to work. Some employees may actually fear coming back, and I think employers are looking to accommodate at least in the short term, until more and more people are comfortable with the environment as we move forward.

So this is going to be a gradual move, 1 that will be built on accommodation, but with a clear eye to try to get people back, productive at the worksite. For those who don't need to be at the worksite, probably a continuation of the same, and looking at what they need to do to better support them for a much longer period than maybe they anticipated.

AJMC^®: The survey found that 97% of employers with over 1000 employees have a multidisciplinary return to work task force in place. Can you explain what this task force entails and if this strategy could also be beneficial for smaller workforces?

Thompson: Yeah, we haven't heard a lot of employers, in fact, we confirm that not many employers have communicated what their return-to-work strategy is even to their own workforce yet, but that doesn't mean they're not working on it. They actually have these multidisciplinary teams going on that have representatives from a lot of different areas. So, first and foremost, it's senior leadership, the people who run the company. I mean, this is core to the success of these companies, and so it's not a small issue, it's a big issue and a very complex 1; but then you've got HR and the operations people, the building’s people, the safety people, really a very strong cross—finance.

One of the areas we were a little bit surprised by was the fact that probably only about half of the companies that had these task forces actually had clinical advisors in there. They are relying very heavily on what they're getting from external sources—at the federal, at the state, at the local level, and in particular, what they get from the CDC. The CDC is a trusted resource in this COVID-19 environment, and they're relying very heavily on that; but many of the employers, and certainly the larger ones, do have clinical advisors, and that's very, very important as we think through where are the biggest risks, and how do we mitigate them?

AJMC^®: In the survey, testing was found not to be a major factor as only 43% indicated testing capability is currently in place. Do you see this growing as more testing options come to the market?

Thompson: There's no doubt there's a lot of interest in testing, and even while some may not be in place, there was interest to move to more testing, but I think it's the reality of where we're at today. The idea that we will be testing every American who is in a workplace every day, which is what we would ultimately have to do, seems bigger than the capacity of what we're able to do right now. I think employers would be interested in it, but I don't think it's ready for primetime yet.

I think what they are doing is doing testing of COVID-19 symptoms. So, temperature and the like, and using that as their first line of defense, but they recognize, of course, there's a gap because you could still be carrying the virus, even if you're asymptomatic right now. I think this is an area that will continue to develop and we’ll get better and better at; but I think it clearly is an area where social distancing and the use of masks is really their first line of defense right now. If we keep our social distance, and all of us are wearing masks, the likelihood of transfer is very, very low.

AJMC^®: As employers and employees adjust to this new normal caused by the COVID-19 pandemic, can you discuss the significance behind the use of virtual support for emotional and physical health?

Thompson: Well, it's amazing how quickly everything has turned virtual. I mean, if you talk about telehealth or telebehavioral health, the use of those services has exploded. It's probably 10 times what it was a year ago since COVID-19 has occurred. At the same time, people's willingness to go to the doctor's office, go to the emergency room, go to the hospital, has plummeted.

In fact, we're seeing crises, financial crises for many of our medical providers, where people aren't visiting them as regular or even close to as regularly. Frankly, that has longer-term ramifications if they don't get necessary care, if they don't go to the hospital or the emergency room, if they have symptoms of a stroke or a heart attack, right? If they don't attend to something that could be cancer we're going to see them in a later stage of cancer later down the line, and mental health. Obviously, if they don't address their mental health issues early they get harder and deeper and more difficult to deal with.

So, all of that suggests that we need to mobilize our solutions virtually as well and promote them. What we see is a heavy emphasis by employers to mobilize virtual solutions, even before we actually get back to some sort of new normal with providers. We are not going to be able to solve it all with virtual solutions, but it's amazing how much we are able to solve. Frankly, I don't think we'll ever go back to the old way of doing things. I think virtual care is here to stay and a lot of the gains that we've made in very few months will be locked in for the future. Having said that, our concern is not about over utilization now, it's about under utilization. People not getting the care they need, even with these virtual solutions at bay. So, I think you're going to see a renewed emphasis by employers, and, frankly, public health officials to push to make sure people get the care they need when they need it.

AJMC^®: Lastly, are there any topics that you want to address that have not yet been talked about?

Thompson: All I would say is that we are in the early stages still, and it's moving at what I'm calling COVID time. What's happened in the last 2 months is equivalent to what's happened in the last 2 years. The pace of change, the pace of knowledge, the pace of engagement, it's unprecedented in my lifetime.

I think that's going to continue. I think you have to be activated and operating on COVID time to be relevant going forward. I don't think we're moving back to normal anytime soon. In fact, I don't know that we ever will return back to normal. I think we are positioning ourselves for a new normal—before we have a COVID-19 vaccine, and frankly, after as well. I don't think we'll ever be the same because of this virus.

AJMC^®: Thanks, Mike!

Thompson: Thank you!

AJMC^®: To learn more, visit our website at ajmc.com. I'm Matthew Gavidia. Thanks for joining us.