One Year Later: Is Corporate America Anti-racist Yet?

BY Emily Nonko | May 13, 2021

When a group of business leaders decided to launch a new organization to respond to last year’s cries for racial justice, they knew that small, earnest measures weren’t going to cut it–they wouldn’t succeed where so much has failed. So the executives raised their ambition and recruited 37 major corporations from Allstate to Walmart in a campaign to provide life-changing opportunities for 1 million Black Americans.

With prominent Black executives at the forefront, including Merck CEO Ken Frazier and former American Express CEO Ken Chenault, the OneTen coalition is pushing for nothing less than business transformation in support of diversity and inclusion, “literally woven into the DNA of a company,” the new coalition’s CEO, Maurice Jones, told From Day One. “Diversity initiatives were all focused on this north star of hire, hire, hire,” he said. However, “you’ve got to hire, retain, create career pathways, promote, provide wraparound supports–you’ve got to change your corporate culture.”

OneTen, with the specific goal of hiring and advancing 1 million Black Americans without four-year college degrees into family-sustaining careers over the next decade, is just one of the initiatives launched by Corporate America in the year since the police murder of George Floyd. Amid the protests that followed, corporate leaders promised to “do more” and “do better,” to make diversity, equity and inclusion (DEI) a genuine priority. PepsiCo promised to increase its number of Black managers by 30% by 2025, while Facebook pledged to double the number of Black and Latino employees by 2023. America’s largest bank, JPMorgan Chase, committed to a $30 billion, five-year plan to provide economic opportunity to underserved communities.

Yet such promises stand against tough realities and deep-rooted inequalities embedded into the capitalist system. A Bloomberg report released this March found that only 4 of the 37 companies surveyed had Black employees in 10% or more of executive and management roles. And while companies made promises, they don’t want to be pushed. In March, five of the biggest U.S. banks–including JPMorgan Chase–asked their shareholders to reject calls for racial-equity audits, arguing that they’re doing enough already.

But are they? With the approach of the one-year anniversary of George Floyd’s death on May 25, From Day One surveyed experts across the equity field–in human resources, DEI, academia, consulting and corporate leadership–to assess the progress made, and the challenges that persist.

The First Response Was Conversation

Dionne Poulton, an HR and leadership consultant, has been speaking and writing about topics like unconscious bias since 2003. In late 2019, she took the inaugural position of chief diversity officer for Care New England Health System, just in time to support the company as it navigated the Covid-19 pandemic and protest movement. Her immediate takeaway, as employees talked about George Floyd and the meaning of Black Lives Matter: “The conversations have become deeper,” she said. “I’ve been talking about bias and racism for a while, but it’s more acceptable–so to speak–to go deep into the issues.” In response, Poulton organized targeted training sessions, discussion groups, and company-wide town halls.

In George Floyd Square in Minneapolis, a mural marks the spot where he died outside Cup Foods (Photo by Stephen Koepp/From Day One)

Other experts testify to the emerging role of companies in mediating and providing intentional space for conversations that can be emotional and put people on the defensive. Laura Sewell, executive vice president and North America HR leader for the IT company Avanade, said the company’s predominantly-white leadership held “listening sessions” to hear from employees and discuss how the company's core values should tie into diversity initiatives. Alexandria Ray, the DEI leader for the law firm Hinshaw & Culbertson, now distributes a monthly “Culture Corner” article among the firm’s employees, followed by action items on issues including gender identity.

Employee Resource Groups (ERGs), which have historically been underfunded and under-resourced, suddenly rose in prominence for their role in such conversations. A June 2020 survey by the Institute for Corporate Productivity (i4cp) found that 9 out of 10 large companies were taking some kind of action on racial equity and almost half were tapping into one or more ERGs, asking for the group’s participation in developing action plans. Such reliance on ERGs has led to demands for more resources, mental-health support, and formal validation from leadership.

New narratives supported in the workplace may seem like just talk, but they represent a huge shift in how Corporate America has engaged with diversity, according to Janine Yancey, founder and CEO of the workplace-culture company Emtrain. “It’s treating these topics as competencies to be learned over time and developed,” she said. “Previously, it was treated like policies and rules to be memorized in one sitting.”

The Rise of the Chief Diversity Officer

Between 2015 and 2020, corporate diversity and inclusion jobs increased 71% globally, according to LinkedIn. The racial-justice movement further accelerated demand for these leaders, but left room for concern about how seriously companies were taking this role. “Many CEOs were scrambling, without recognizing this is a significant position and that person has to be qualified to do this,” as Poulton put it. A second concern, which she discussed with the CEO of Care New England Health System before she accepted the role of chief diversity officer, was: “Am I a figurehead, or am I here to do the job? It’s important to get the answer.”

Research shows diversity roles have an impact: LinkedIn found companies with a DEI team were 22% more likely to be seen as “an industry-leading company with high-caliber talent” and 12% more likely to be seen as an “inclusive workplace for people of diverse backgrounds.” Experts stressed to From Day One that the role must come with power. “The work requires you not only to speak it, but have actions that follow,” says Jamal Lopez, senior director of institutional equity for Weill Cornell Medicine’s Office of Institutional Equity, a department created last summer as part of a set of actions by Weill Cornell to advance equity.

Lopez says he has support from leadership as well as significant backup for future initiatives, including a second dedicated office for DEI and a Staff, Equity and Inclusion Council composed of senior leaders. The company-wide embrace of DEI roles, he said, shows that “diversity today is trending away from the moral-imperative argument. While it's still the right thing, these are businesses that need to fully understand how the diversity, equity and inclusion agenda is going to impact the bottom line.”

New Thinking on Early Skills Development

There’s a growing acknowledgement that companies must change how they’re recruiting a diversity of talent and supporting those people in the workplace, with the goal of uplifting them into leadership roles. For Jones, at OneTen, that means rejecting the a four-year college degree as a prerequisite for career advancement. “In our country, we have been obsessed with the four-year degree,” he said. “It turns out 80% of jobs that pay $70,000 or more require four-year degrees.” OneTen’s program instead focuses on skills training, mentors and sponsorship. The organization has also kicked off discussions with CEOs and HR leaders to change the expectations and culture built around the college degree.

This year the HR consulting firm Randstad launched the program Transcend with the goal of training 40,000 Americans for high-demand jobs with a skills-first model similar to OneTen’s. “A four-year degree no longer directly aligns with success,” Keith Brown, Transcend’s community-impact director, told From Day One. “There’s a huge opportunity in terms of the skilling platform. That is going to change the entire framework of how organizations see talent transition into an organization.”

What that looks like for Transcend is no longer requiring a degree on a job application, with a stronger focus on in-office mentorship and sponsorship, specific skills training, and partnerships with companies to help with job placement. Cisco, for example, is both a founding member of OneTen and the first major corporate partner of Transcend. “We believe Cisco will be able to deliver this program in a very comprehensive way based on its commitment to OneTen,” said Brown. “That is huge.”

Facing the Need for More Diverse Leadership

As Avanade leadership held employee-listening forums that acknowledged the mainly white leadership team, they began thinking about initiatives to change that. “Our senior leadership team fully committed and engaged in a reciprocal mentorship program with mid-career diverse talent,” said Sewell. “The reciprocal nature of it was us as senior leaders reaching in the organization to build this population up, but their role was to help us as leaders become more empathetic and have better understandings of diversity.”

According to a McKinsey & Company report, the U.S. population is 13.4% Black, but only 7% of management roles are filled by Black people. The effort at Avanade reflects an emerging commitment among leaders to diversify leadership through active measures. At Hinshaw & Culbertson, the firm’s chairman took part in the development of a Black Attorneys Matter Referendum, which Ray called “the foundation to holding the firm accountable to what we wanted to implement,” including career development.

The development of Black leaders is a business opportunity as well, recognized by the founders of Valence, a social network with the mission of creating new pathways to success for Black professionals. The startup, which recently launched an executive-development program called BONDS, has funding from venture capitalists including Upfront Ventures, GGV Capital and Silicon Valley Bank.

The Communities Beyond the Corporations

As part of the mainstream embrace of the racial-justice movement, a Who’s Who of American companies made financial commitments to greater economic equality as well. Airbnb announced in a tweet it would donate $500,000 to the NAACP and Black Lives Matter; Etsy announced a donation a total of $1 million to Equal Justice Initiative and Borealis Philanthropy’s Black-Led Movement Fund; Walmart announced a contribution of $100 million over five years to create a new center for racial equity; Target pledged $10 million to advance social justice.

All well and good, but statements and donations in the name of social justice should not be mistaken for real systemic change, according to Erica Licht, a senior fellow with the Institutional Antiracism and Accountability Project at Harvard University’s Shorenstein Center. (Walmart, for example, is well known for suppressing unionization efforts by employees.) “There are real gaps between the claims of companies and their history of actively exploiting and oppressing Black, Indigenous and people of color,” Licht said.

Not far from George Floyd Square in Minneapolis, the "Say Their Names Cemetery," created by two young artists, commemorates people who died in infamous episodes of police violence (Photo by Stephen Koepp/From Day One)

She noted that more investments will be needed for companies to make an impact: “That’s time investment, personal investment–especially for white people putting in the work–and more generally it’s financial investment to address and advance racial equity.” That means making direct investments into marginalized communities more akin to reparations than one-off donations, Licht said. "It's not just about statements or numbers, it's about substance. It's also not about short-term thinking," she said. "Racial-equity work, working toward anti-racist structures, systems and values, is long term Take, for example, in grassroots philanthropy, the journey of the Haymarket People's Fund in Boston."

Taking Stronger Stands on Social-justice Issues

As Licht points out, “companies have always been weighing in on politics, in ways we may or may not know about.” She pointed to the history of corporate donations backing candidates who support explicitly racist policies. She noted a shift triggered by Georgia’s new election law designed to suppress Black voters. When Black business leaders spoke out against the laws, as well as similar GOP-proposed bills in statehouses across the U.S., the leaders of major corporations headquartered in Georgia began to take a stand for voting rights. “They’ve been actively pressuring politicians to block these harmful policies,” Licht said.

That led to an even larger coalition of business leaders stepping up their efforts to oppose such laws and defend voting rights across the U.S. In Texas, for example, two broad coalitions of companies and executives released letters calling for expanded voting access after Republican legislators’ proposed new restrictions on balloting. While the emerging boldness of corporations to take stands on these issues led to a wave of Republican outcries about "woke capitalism," corporate leaders have come to realize they answer to a much more diverse collection of stakeholders than most GOP politicians do.

The Urgency of Public Pressure–and the Question of Accountability

Ultimately it wasn’t the C-Suite that spurred change–it was citizens pressuring companies, and society at large, to address the longstanding issues of racism and inequality. In the workplace, that meant greater cries for companies to follow through on their commitments and statements of racial justice. There are new accountability tools, like the Corporate Racial Equity Tracker, to help stakeholders gauge how companies live up to their promises.

Public pressure tends to translate to investor pressure. In April, a record 30 resolutions focusing on DEI were on the ballots at annual company meetings–and advocates were closely paying attention to how companies asked shareholders to vote. In the same season, U.S. securities regulators turned down an exemption sought by Amazon to stop its investors from considering a shareholder proposal on racial equity.

At Hinshaw & Culbertson, public pressure has translated to the firm’s bottom line. “The clients we’re serving are demanding this, not just our direct clients but potential clients,” Ray said. She pointed out how the Coca-Cola Co. now requires its law firms to staff its matters with diverse lawyers or risk losing fees and business.

The promises of 2020 come down to accountability and longstanding commitments to equity, Licht said. “We have to be very careful that the momentum doesn’t fizzle out,” she said. “I think the real question is if people, especially white people and white people in power, are actually interested in undoing these systems of harm and systems of oppression.”

Emily Nonko is a Brooklyn, NY-based reporter who writes about real estate, architecture, urbanism and design. Her work has appeared in the Wall Street Journal, New York magazine, Curbed and other publications.


ADHD in the Workplace: What You Should Know–and What Can Help

Pete came to our weekly psychotherapy session frustrated with work. He had just returned to his office, post pandemic, and found the new, open plan noisy and overwhelming. Pete, which is not his real name, has attention-deficit/hyperactivity disorder (ADHD) and is easily distractible and sensitive to noise. He had trouble concentrating, was irritated by the constant chatter of colleagues, and, as a result, was feeling less productive.“Could you talk to your manager about getting some accommodations?” I asked.“No way!” he said. “That would be a career killer.”Pete’s wariness is not uncommon. A few of my psychotherapy patients with ADHD have confided in their managers, but most feel it’s unwise to do so. They fear they will be stigmatized and sidelined.Edward Hallowell, M.D., agrees with their concern. The founder of the Hallowell ADHD Centers and one of the leading authorities on the disorder, explained to From Day One: “We’re not there yet. Most corporate professionals think of ADHD as some kind of mental illness.”Given that ADHD is not well-understood in the workplace, how can employees speak up about their needs in a way that feels safe? And how can managers and HR leaders better understand how to respond to those needs–whether employees want to name their ADHD, or not? A well-accommodated employee is, after all, a happier and more productive one. “It’s in everyone’s best interest to remove obstacles to someone’s performance,” said Hallowell. Here’s what experts recommend:Know What It IsADHD is a neuro-developmental disorder characterized by symptoms of restlessness, impulsivity and difficulty sustaining attention to boring tasks. It tends to run in families and is often inherited from a parent. There are three types: inattentive (dreamy and distractible), hyperactive-impulsive (restless and talkative), and a combination of the two. Most adults with ADHD have the inattentive type. Though it was long considered to be a childhood disorder affecting mostly boys, research has shown that it persists into adulthood—about 30% to 70% of children with ADHD continue to have symptoms later in life.Ned Hallowell, M.D., a pre-eminent expert on ADHD (Photo courtesy of the Hallowell ADHD Centers)An undiagnosed adult may think of themselves as spacey, messy, or undisciplined—and they often suffer from low self-esteem. A recent study found that only 10% to 25% of adults with ADHD receive an accurate diagnosis and adequate treatment. “They are often inaccurately diagnosed with anxiety or depression, which are really just the fallout of untreated ADHD,” said Ari Tuckman, a psychologist in West Chester, Penn., who specializes in the treatment of ADHD. As Hallowell puts it: “It’s like driving on square wheels.” In dealing with tasks, you will make progress, but it may take longer.And That the Diagnosis Is On the RiseWhile children are still the most likely group to be identified with the disorder, the number of adult diagnoses has been rising for decades. The pandemic accelerated the trend: the overall incidence in adults (30 to 49 years old) nearly doubled from 2020 to 2022, fueled mainly by an increase in diagnoses among women, according to Epic Research, a medical-record software company. While it’s not clear exactly why women are being diagnosed more often, experts theorize that it may be due to increasing smartphone and technology use, which can amplify distractibility and stress, as well as a greater awareness that ADHD can be also be a women’s issue. As more adults are diagnosed, they—like Pete—often face workplaces that are not ADHD-literate.How It Affects Work Performance–But Not Always in a Bad WayPeople with the disorder may have difficulty with organization, time management and procrastination—all of which can make it hard to meet deadlines and work within teams. They find tedious tasks, such as scheduling and filling out expense reports, unusually challenging and have a different sense of time than others. “People with ADHD have more difficulty seeing time and feeling the future,” notes Tuckman,More than half (56%) of adults with ADHD said they believe the disorder “strongly impacts their ability to succeed at work,” according to a 2008 survey by McNeil Pediatrics. A more recent survey by Akili, a therapeutic-technology company, interviewed 500 adults with ADHD and found that employees with ADHD felt the disorder had a negative impact on their career.     And yet, people with ADHD often display qualities that work in their favor, notes Hallowell, who himself has ADHD. He sees the condition as a trait, not a disorder, that has positive benefits like creativity, humor, and spontaneity. “There’s more to it than most people realize,” he said. “ADHD is terrible term. We have an abundance of attention. Our challenge is where to put our focus.” People with ADHD can spend hours on topics that interest them and see details that others might miss, a trait sometimes called hyperfocus. Many successful people have talked openly about their ADHD, including Michael Phelps, Simone Biles, James Carville, astronaut Scott Kelly and JetBlue founder David Neeleman.How to Get DiagnosedIf you persistently miss deadlines, are chronically late, and feel like staying organized is a big effort, first ask a trusted friend or colleague if they find you more scattered than others. Then, make an appointment to see a psychologist or psychiatrist who specializes in treating the condition. There is no one standardized test—instead a professional will take a thorough history and may ask family members and friends to complete questionnaires about your behavior. You may be asked questions like, How often do you misplace items, feel bored and restless, or lose track of what needs to be done? If you meet the criteria, your doctor may talk to you about medication, therapy or coaching and, if needed, provide a diagnosis so you can receive accommodations at school or at work.Understand What HelpsMost people diagnosed with ADHD rely on medication to control their symptoms. Typical medications include stimulants such as Ritalin and Adderall, which increase the levels of the neurotransmitters dopamine and norepinephrine in the brain. There are also non-stimulant drugs such as Strattera. Stimulant medications that treat ADHD are the “most effective of medications in psychiatry,” said Tuckman, and help tame distractibility and impulsivity. About two thirds of people with ADHD diagnoses are prescribed stimulant medications, and that percentage has remained fairly consistent since 2013, according to Epic Research. Some people can help manage their symptoms by exercising regularly, getting proper sleep, and implementing strict organization and reminder systems. Or they hire very competent assistants.Once you are diagnosed and have figured out the best treatment, it’s like “getting fitted for the right eyeglasses,” said Dr. Hallowell. “Things come into sharper focus.”How to Make the Workplace More ADHD-FriendlySmall modifications can go a long way to helping people with ADHD perform better on the job. Tuckman suggests considering adjustments in the three domains described below. As an employee, you can make tweaks on your own or ask your manager for help. As for managers, if you have a worker who is struggling with organization and meeting deadlines, you could take the lead at putting these practices into place.Make distractions softer. Quiet spaces, headphones, and working on off-hours (say, early or late), can help mitigate the clatter of a bustling office. Often working from home is a good solution.Make important information stand out from the chatter. Putting assignments in writing, recording meetings, and highlighting deadlines can help workers whose focus is not great to stay on task.Bring the future closer to the present. Those who struggle with adhering to deadlines will benefit when big projects are broken into smaller chunks, and check-ins are on the calendar with frequent reminders of when tasks are due.So, Should You Tell Your Boss?If you have ADHD, you may be covered under the Americans with Disability Act (ADA). However, you might not want to play that card unless you absolutely must, says Belynda Gauthier, a retired HR director and past president of Children and Adults with ADHD (CHADD). “The first time I did a presentation on ADHD in the workplace, I launched into detail about how the employee should approach his supervisor or manager and suggested that he might want to go directly to HR first. An audience participant interrupted to tell me that her HR office actually is the problem for her. Oops! I took this to heart, did some serious thinking, and revamped my presentation. I no longer recommend revealing one’s diagnosis until and unless it’s necessary.” Indeed, 92% of surveyed adults with ADHD believe that their colleagues hold misconceptions, the most common of which is “people with ADHD just need to try harder.” A better strategy might be to simply approach your manager with a positive attitude and a few solutions. “Be sure to tell them what you are good at,” advised Hallowell.Gauthier suggests something like: “I am really enjoying processing these widgets, and I think I’m doing a good job. I believe I could do an even better job if I could move to that cubicle that’s farther from the copy machine. So many co-workers use it all day and everyone stops to say hello.” Avoid the use of the word “but” to qualify your suggestions and don’t be whiney, she says.      Accommodations can help, but sometimes the best solution is finding the right job in the right environment with the right supports. “When I finally figured out I had it, it was a relief,” David Neeleman said in a recent interview with Forbes. “I was just really careful to surround myself with people that could complement my ADHD. I have people around me that help implement a lot of the ideas I have.” When you can turn your intense focus on something that truly fascinates you, ADHD can be a bonus rather a deficit.Lesley Alderman, LCSW, is a psychotherapist and journalist based in Brooklyn, NY. In her therapy practice, she works with individuals and couples. She writes about mental health topics for the Washington Post and has been an editor at Money and Real Simple magazines and a health columnist for the New York Times.(Featured photo by Valentin Russanov/iStock by Getty Images) 

Lesley Alderman, LCSW | May 15, 2024

Workers Want Weight-Loss Drugs, But How Can Employers Pay the Bills?

When consumers see splashy TV commercials for weight-loss drugs, they often find the the pitch irresistible. But for HR and benefits executives, they may trigger an uneasy feeling. That's because the revolutionary weight-loss drugs like Wegovy bring with them both magic and mystery–the magic is how well they can work; the mystery is how to pay for them.GLP-1, or glucagon-like peptide-1, drugs have historically been used to treat diabetes. But the development of stronger drugs like Novo Nordisk’s Ozempic in recent years, and now the approval of Wegovy and Eli Lilly’s Zepbound specifically for weight management, has led to a sharp increase in demand. That’s particularly true as more research emerges showing the drugs may also reduce the risk of cardiovascular disease, stroke, and potentially bring other long-term health benefits. Yet the medications can cost as much as $1,000 to $1,500 per month–a price that few Americans can afford unless they have generous health-insurance coverage.And unlike expensive drugs for rare conditions, the potential number of patients for GLP-1s is vast. More than 40% of Americans have obesity, according to the Centers for Disease Control and Prevention, and that is expected to reach 50% by 2030.Many doctors are thrilled about the potential for GLP-1s to change how obesity is treated, but that puts employers–where nearly half of Americans get their health insurance–in a tricky position. Here’s what employers need to know as they consider coverage for these drugs in the quickly changing landscape:High Costs, Low CoverageWhile employer health plans widely cover GLP-1s for the purpose of treating diabetes, coverage for weight-loss purposes is much more spotty right now. A survey last fall by the International Foundation of Employee Benefit Plans found that 27% of 205 employers covered GLP-1s for weight loss and another 13% did not yet cover them but were considering adding coverage. Meanwhile, Willis Towers Watson (WTW), a global insurance benefits-consulting company that serves many large employers, found about 38% of employers it surveyed cover the weight-loss drugs. Those that do cover them are seeing significant cost increases. The retail price for Wegovy comes out to $15,000 to $16,000 per year, and after rebates and discounts from manufacturers, health plans still pay about $9,000 per year, says Cody Midlam, a director at WTW’s pharmacy practice. The cost per member per month for GLP-1s has doubled each of the last three years, according to WTW’s analysis, amounting to an extra $11 per member per month last year, or about 9% of all pharmacy costs.Companies are aware of the research showing the drugs’ effectiveness at tackling obesity. Yet while doctors say that helping people lose weight could lead to less cardiovascular disease, fewer mental health issues, and savings from avoiding knee replacements or other surgeries related to obesity, long-term data on clinical outcomes remains limited. With high employee turnover in many industries, it’s tough for these employers to factor in potential future savings in healthcare costs over the life of the employee.“Those outcomes take a very long time to manifest,” says Midlam. “It’s not something that’s easily measurable on a short timescale when plan decisions are being made.” Andrew Witty, CEO of UnitedHealth Group, the largest U.S. insurer, said his corporate clients see the benefits, but first have to deal with the short-term costs. “We’re very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits,” Witty said in the third-quarter earnings call last year. “But we’re struggling.”Employers Meet the DemandDespite the high costs and headlines about some insurance plans scrapping GLP-1 coverage, plenty of employers see the upside to covering the new obesity medications. Ninety-nine percent of companies already covering GLP-1s said they planned to continue doing so next year, according to a fall survey from Accolade, a healthcare navigation and advocacy company. Employers reported that after they added GLP-1 coverage, they saw higher employee satisfaction, increased engagement in other well-being programs, and improvements in other or comorbid health conditions. Midlam of WTW says his firm’s corporate clients want to “avoid member disruption” wherever possible.Doctors agree that should be a priority. Dan Azagury, M.D., medical director for the Stanford Lifestyle and Weight Management Center, says GLP-1s have been a “game changer” for many of his patients. “If you stop it overnight, whether it’s insurance, or financial, or shortages, the rebound is ferocious,” he said. “So it’s really very frustrating that they encounter that situation.” Some companies have expressed concerns about the idea of paying for a drug that employees essentially have to take forever to maintain its benefits. But while side effects, including vomiting and gastrointestinal issues, can be unpleasant for some people, doctors like Azagury say they know how to help patients manage them, and that they are seeing more patients have a positive response to GLP-1s than to previous generations of weight loss medications. Holistic Care, Not Just PrescriptionsEven when employers decide they want to help their employees lose weight, there are still lots of details to consider. As companies approach designing their insurance plans for 2025 and beyond, they are trying to figure out how many employees are likely to use GLP-1 drugs if coverage is offered, whether there should be limits on who can get the drugs, and what kind of requirements they should use to prove the drugs are medically necessary. Most companies that cover GLP-1s use some cost-control strategies, according to the International Foundation of Employee Benefit Plans survey. Many use prior authorization, step therapy during which patients must try lower-cost drugs first, or specific eligibility requirements.Typically, eligibility requirements have been tied to the standards on the FDA labels for these medications. But some employers are considering restrictions such as only covering the drugs for people with obesity but not those who are overweight, says Tracy Spencer, a pharmacy practice leader for benefits consultant Aon. If they add those limits, she warns that employers should be aware that could change or jeopardize the rebates they get from the drug manufacturers, so they need to predict whether the savings they get from limiting the drugs’ use will offset the loss of the rebates.Benefits consultants like Aon and WTW are also seeing employers shift the way they look at GLP-1 drugs to view them as one piece in a broader strategy to address cardio-metabolic issues.That might mean employers choose to cover the drugs for targeted indications, such as covering Wegovy not for weight loss on its own, but for people with increased risk of cardiovascular disease, which Medicare recently announced it would do. It can also mean pairing GLP-1 coverage with required lifestyle modifications or participation in a virtual weight-loss or coaching program. Employers often have access to virtual health programs through their pharmacy benefit managers, and many have tried these to target diabetes in recent years. The biopharmaceutical company Moderna, which offers coverage of GLP-1s for diabetes and weight management, is one company that has tried this strategy. “In 2023 we saw a spike related to weight-loss management: We looked at claims data, and after mental health, obesity and weight management were the second drivers,” Jeffrey Stohlberg, Moderna’s director of corporate benefits, said at a From Day One conference earlier this year. So the company started using the virtual weight-loss management program Wondr Health, where an employee can work with a physician specializing in weight loss. “It’s not a path to GLP-1s, but [the physicians] can provide medication for that person,” Stohlberg said. Labcorp also announced in February that it would provide U.S. employees on GLP-1s with virtual care and medication management through WeightWatchers for Business. Other companies such as Omada Health and telehealth providers like Teladoc and Ro have launched similar offerings over the last year. Medical providers agree that a holistic approach is needed, but Angela Fitch, M.D., president of the Obesity Medicine Association and co-founder and chief medical officer of the obesity-focused primary care startup knownwell, worries that requiring a standard weight-management program for every person is another barrier and potentially a waste of money if the program doesn’t have solid evidence behind it.“You can offer lifestyle [strategies] in addition to medication,” she said, “but it should be driven by that shared decision making discussion with the clinician.” If insurers want to make sure patients are getting holistic care, she would rather have them require patients to get their prescriptions from a qualified physician who does a true evaluation so that solutions can be personalized. In her role with the Obesity Medicine Association, Fitch often advises employers on their health plan designs, so she understands that costs are a major concern for companies. But in her primary-care practice and others like it, she says her staff are “burning out” as they spend hours each day trying to navigate all the new and often strict and confusing insurance requirements for these medications. “We have got to deal with costs,” Fitch said. “But it should be transparent and flexible.” She worries that overly rigid restrictions are “adding to the bias and stigma of obesity” by signaling to patients that their weight is their responsibility to treat on their own. Her major advice is to view obesity with the nuance that people view other chronic conditions. “You do not need a GLP-1 management solution. You need a comprehensive obesity-care solution.”Abigail Abrams is a health writer and editor. Currently she is the senior manager of content operations for Atria. Previously, she was a staff writer on health and politics for TIME magazine. Her freelance work has appeared in the Washington Post, the Guardian, and other publications.

Abigail Abrams | April 15, 2024

What Transparency Can Expose: an Obvious Need for Organizational Change

In the realm of corporate values, few terms have been more universally embraced in recent years than the notion of transparency. Among its many applications, organizations have deployed it to contend with sticky social matters and public scrutiny of corporate ethics.  At the World Economic Forum’s annual conference in Davos this year, speakers repeated the term like a mantra, reflecting a movement that has been building for a while. Fast Company reported that at the summit in 2021, more than 60 businesses announced a “commitment to transparency” about their effects on society and the environment. In response to pressure from stakeholders on all sides, executives from TikTok, Glassdoor, Google, YouTube, Zoom, Boeing, Twitter, and the White House have all made public commitments to transparency in recent years.Yet lately it has been dawning on leaders that this magic, window-cleaning solution can make things worse, especially if what has been exposed seems to be hypocritical, poorly thought-out, or further obfuscation rather than moral clarity. The most notorious recent example came last December, when the presidents of Harvard, MIT, and the University of Pennsylvania gave hedged, lawyerly responses when asked in a congressional hearing whether calls for the genocide of Jewish people would violate their school’s conduct rules. Their answers frustrated stakeholders on many sides of the issue.Seeing the havoc that failed transparency can wreak, Harvard is second-guessing the value of transparency, and is considering keeping mum on divisive matters altogether. The Harvard Crimson reported in February that the school’s interim president is expected to announce that the school is considering a policy of “institutional neutrality,” in which it will make no statements on politicized matters. Leaders at other universities are in favor, it appears. During a recent panel discussion on the matter, Yale Law School professor Robert C. Post remarked that “when we speak outside of our lane, we invite reprisals, we invite regulations, which we cannot defend in terms of our mission,” he said. “There may be reasons to do it. But they have to be pretty good reasons because we’re vulnerable, we're especially vulnerable right now.” The public is not ready to retire the notion of transparency, however, so organizations need to take a more considered approach to it and the policies that it exposes. “Corporate values aren’t optional, and they’re more controversial and contested than ever,” writes Alison Taylor in her new book Higher Ground: How Business Can Do the Right Thing in a Turbulent World. “[Yet] aiming to base your values on commitments on the full range of stakeholder pressures and demands is a recipe for incoherence and fragmentation.”This has become the principal dilemma for leaders who want to run an ethical business, argues Taylor, a clinical associate professor at the NYU Stern School of Business. “It shows up in HR teams doing employee engagement surveys and trying to make themselves look good. It shows up in these glossy sustainability reports about all the wonderful things [the company] is doing,” Taylor told From Day One. “The thing that has changed is that those defenses don’t work anymore.”The Age of Clarity and CandorThe theory is that if you bare it all, the company will be rewarded for its candor. “If a single concept drives today’s businesses, regulators, journalists, and NGO activists, it’s that transparency is the route to accountability,” Taylor writes in her book. Yet all this new data-dumping, press-releasing, and report-publishing hasn’t necessarily reconciled what companies say vs. what they do, though trust in business has generally grown over the years, especially when compared with trust in government. Yet company after company, ranging from Boeing to Wells Fargo, have taken a shellacking for saying that they’ve fixed problems when they haven’t actually changed the culture or system that caused harm in the first place.In fact, disclosure is easily weaponized, Taylor argues. The companies that release details of their ethical transgressions or corporate misconduct can put the target on their own backs. In her book, Taylor tells of the story of a clothing company, operating in an industry known for its negative environmental effects and human-rights violations, that published a list of its suppliers in the spirit of transparency. They were among the first picked off as the target of a class-action lawsuit alleging forced labor. “The retailer making a good faith effort to be responsible and accountable was first in line for denunciation and punishment,” Taylor writes.Contending with a Public Wary of Good IntentionsAs companies see that their attempt at transparency can get them in trouble, many flatten their reporting into glossy packets and palatable stories. Some disclosures are required by law, yet by and large, these reports are voluntary. To steel themselves against criticism, especially involved tricky issues, many organizations appoint leaders charged with improving company culture and creating a more equitable workplace: chief culture officers, heads of compliance and integrity, and leaders of diversity, equity, and inclusion (DEI). To be sure, many who sit in these offices are formidable forces. Figures like Yelp’s chief diversity officer, Miriam Warren, and Bumble’s founder Whitney Wolfe Herd set high bars for the influence executives can have on equity and integrity inside and outside an organization.But some of the leaders installed in these roles are faced with the uncomfortable truth that their position is corporate PR. Taylor sees this often: People take jobs and think of themselves as organizational change agents, only to find that senior leaders think of them as defense mechanisms to protect corporate reputation and, in the case of compliance teams, to deflect regulators.For instance, the chief diversity officer is typically charged with making the business more demographically diverse and equitable for people across every department at every level of the business, yet many of them work with very limited resources. It's no wonder that turnover for the job is high.From Token Hire to Meaningful InfluenceOnce a company decides that it won’t favor transparency more than change, good things start to happen. This is when those leaders originally appointed as tokens can use their positions. If Taylor were to find herself in a role and learn that her presence was manipulative PR, she said, “I would make an argument about transparency needing to adapt the organization to a new generation. You can’t control the narrative, so hiring a load of people to do window dressing has become a waste of money. We can’t rely on confidentiality agreements, and we can’t rely on telling a good story.”Companies have to assume that young workers in particular are ready to undercut nice, neat stories and pounce on corporate misdirection, she says. Where a glossy report no longer suffices, those once-impotent appointees can play a valuable role, holding the company accountable from the inside before an angry public holds them accountable in the open air.Now that the public is suspicious of public declarations of corporate goodness, “no one believes it. There’s a total ‘gotcha’ mindset. Everyone rolls their eyes, and now there’s all this greenwashing and woke-washing litigation,” Taylor said. “It’s a pointless investment. You need to stop treating these as messaging challenges and treat them as organizational strategy challenges.”‘A Less Varnished Assessment of Activities’Taylor’s Higher Ground is loaded with case studies, action outlines, and advice. Not only for avoiding corporate blunders, but also correcting the bad habits and outright crookedness that cause them. Be a “first mover,” setting the example for peers, she writes. Companies often wait until a public scandal to start talking, but this tends to create chaos. She cites the example of Google releasing its transparency report on how it works with law enforcement in 2010. “This was not the result of a specific scandal but an effort to correct widespread misunderstanding.” Its success was due in part to the company being clear about what it can and cannot influence.Sure, there will be companies that invite scrutiny with their reporting, but that’s why Taylor warns against bending too deeply to public opinion and impatience that lures firms into dangerous waters. Don’t succumb to the pressures of social media, which turn companies into reaction engines, she advises. Wait long enough, and sensationalized social-media storms pass. Similarly, transparency often generates “impatient calls for an issue to be addressed instantly,” when real change takes time.Finally, forget about having 100% control over the stories told about your company and control over the behavior of your employees, which some companies increasingly see as liabilities, as evidenced by the new popularity of surveillance tools.Taylor believes that many corporate leaders sincerely want to avoid superficial reporting and put-on commitments to transparency. In five years of speaking to investors about sustainability reports, Taylor writes, “they told me again and again how much they–and their companies–would benefit from a less-varnished assessment of activities.”Emily McCrary-Ruiz-Esparza is a freelance journalist and From Day One contributing editor who writes about work, the job market, and women’s experiences in the workplace. Her work has appeared in the BBC, the Washington Post, Quartz, and Fast Company.(Featured illustration by Fermate/iStock by Getty Images)

Emily McCrary-Ruiz-Esparza | March 24, 2024