Please Stay: How Companies Answer the 'Great Resignation'

BY Michael Stahl | September 12, 2021

In a recent job posting, a Tennessee trucking company offered pairs of qualified drivers a $30,000 signing bonus to join their team. Amazon has offered more than 750,000 U.S. workers the opportunity to pursue a fully paid bachelor’s degree. Microsoft said it would delay its return to the office “indefinitely” because forcing employees back to the workplace prematurely during the pandemic would be “shortsighted,” its CEO said. Meanwhile, according to a new Benefits Trends Survey, 69% of employers say they plan to “differentiate and customize their benefit programs over the next two years.”

This heightened level of care and concern about workers is emerging in the midst of the “Great Resignation,” the recent mass exodus of workers from their jobs, in which 11.5 million U.S. employees quit in just the three months of April, May, and June. It left the country with a record-high number of job openings in July and a huge question looming over Corporate America: What are employers going to do about it?

Coinciding with wide vaccine availability this past spring, the pent-up wave of resignation letters is being received as a referendum on business management, suggesting that many organizations during the Covid-19 crisis failed to meet the changing needs of workers.

Before the pandemic arrived, employers competing in a tight labor market were already actively improving conditions for employees. They’d learned that happy workers are more productive workers, which in turn can improve customer satisfaction. To combat employee burnout, organizations enhanced paid time-off programs and began providing mental health coverage. They also supported important social causes to help build brand reputation and boost employee morale.

However, the conditions wrought by the pandemic compelled new employee demands, and reinforced a growing sense among workers that they deserve better treatment. For working parents in particular, greater flexibility and better benefits became necessities.

“People were at home for a long period of time and they began to see their life differently,” Jason Walker, chief people officer at Thrive HR Consulting, told From Day One. The labor force was being asked to work “tremendous amounts of hours because they were at home,” Walker observed, and companies “intruded on that personal time.” Eventually, he said employees seemed to collectively realize “there’s more to my life than my work,” setting off a wide-scale reprioritization.

As we progress toward a post-pandemic world, organizations that prioritize the employee will be best positioned to hire and retain top talent. Here’s how leaders can respond to this reinvigorated spirit of employee empowerment:

Pay at Least the Market Rate

Not only has the labor market been flooded with dissatisfied workers, thousands of businesses have also reopened since spring, providing candidates a glut of opportunities. For hourly laborers as well as highly trained and experienced specialists, it is now definitively an employees’ market.

Job candidates are already cashing in on their leverage, which means it makes good economic sense for an organization to retain the best workers they already have. In addition to the time and effort spent on the hiring process, there are fees for recruiters and advertisements for open positions. There could be travel costs accrued, too, and expenses for training. Furthermore, there’s a loss of productivity while the search for a replacement plays out, among other detrimental effects from turnover.

To keep good employees around and attract the finest candidates on the market, companies have to be in tune with current pay rates and eagerly meet them. “If you’re under-paying, you’ve got to fix that fast,” said Amy Zimmerman, chief people officer at Relay Payments, a digital compensation platform. “It’s going to be a lot more expensive to get people in to replace the folks that you’re losing.”

In response to the current labor market conditions, Syndio Solutions, a platform that measures pay equity across organizations, is posting the salary ranges for all open positions in the company. CEO Maria Colacurcio said this maneuver gives “​​prospective hires consistency that reflects our values” and “respects the staff already at Syndio.”

If employers are not aware of market rates, Colacurcio said, when new hires engage in work comparable to that of other employees, they risk generating “potentially unlawful disparities, if you slice that by gender, race or ethnicity.”

Colacurcio posed an additional concern: “What happens when someone who’s been at the company realizes someone in their same job who was hired three months ago is making 30% more?” That, she said, could lead to more employees writing letters of resignation.

Adi Ignatius, editor-in-chief of Harvard Business Review, said his organization recently asked managers to identify the most important members of their team and determine whether they’re compensated adequately, compared to their peers inside and outside the organization.

“Instead of waiting for somebody to say, ‘You know, I just got a job offer from Fortune,’” Ignatius said, HBR wants to avoid “scrambling to make a counter offer” and is doing its best to “get ahead” of the head hunters.

Increase Flexibility, Day-to-day and Long-term

While fair compensation remains a focus for many members of the workforce, in pandemic times, pay is not at the top of everybody’s priority list. Instead, job flexibility appears to be of utmost concern.

“Covid really accelerated remote-work adoption,” said Clay Kellogg, CEO of Terminal, an employment-services platform that focuses on remote engineering teams. “It really went from an early-adopter market for remote work–you had some very forward-leaning companies [embracing it]–to now it’s mainstream. We did that within a 12-month period. It’s incredible.”

Study after study reveals that the overwhelming majority of workers want some semblance of remote work in their schedules, whether it’s a hybrid model, with both remote and in-office hour requirements, or the achievement of complete work-from-home status. After social distancing necessitated the shift, people are more familiar with remote work, and apparently appreciate its benefits, of which there are many.

“You really can’t unring that bell,” Kellogg said. “The old model was the result of legacy [thinking] and now we have people who say, ‘Look, that’s what I want. If I’m not going to get that flexibility option from my employer, I’m going to look around.’ And it’s a lot easier to look around when you’re working from home.”

Kellogg points out that if companies are willing to have their employees work remotely, leaders have to come to grips with new costs, covering necessities like laptops, Wi-Fi, and comfortable workspaces in the home.

But employees today want other kinds of job flexibility too. For them, staying with the same company over an extended period of time, while remaining fully engaged in what they do, means changing roles. Jeanne Schad, talent solutions and strategy practice leader at Randstad RiseSmart, a corporate consultancy firm, said many of her company’s customers are now interested in building internal-mobility programs.

Having adjusted to working from home, employees are reluctant to give it up (Photo by Visualspace/iStock by Getty Images)

“We often talk about the ambitious employee who has mastered their role and is ready for something new being a big retention risk,” Schad said. “By making internal roles easier–and safer–for employees to find, you can solve the needs of the ambitious, bored, burned out, and looking-to-downshift career employees.”

According to a Prudential report, 80% of workers who are planning to switch jobs post-Covid are choosing to do so out of concern over career advancement. More than a third of workers polled in a Robert Half survey say they feel “stuck” in their careers since the pandemic began. Providing employees the chance to change jobs within an organization inspires them to learn new skill sets, leading to more motivated, engaged, and productive workers, among other benefits.

“The biggest barrier for most companies to internal mobility is the mindset and orientation of managers,” Schad said. “Managers aren’t incented to share talent and in some cases, they can be penalized for unwanted turnover on their team–even if the employee moves to a new role internally.” Some clients she has worked with have created KPIs for managers who develop and then redeploy workers, “encouraging managers to share talent,” Schad said, “and bonusing them when they do.”

Adapt to the Presence of Different Generations  

Though this figure has been disputed by some, in 2014 the Brookings Institution predicted that 75% of the global workforce will be of the Millennial generation. One way or the other, the Millennial professional presence is growing, and Oxford Economics reported this year that within a decade, roughly one-third of the workforce will be members of the next generation: Gen Z.

These younger employees are already effecting change, says Brittany Hale, CEO of BND Consulting, a firm that focuses on retaining talent and developing company culture. Some Millennials are old enough to have attained senior management positions, while many Gen Zers–people born between 1997 and 2012–are either finishing grad school or making their way up the chain of command themselves.

Their value systems are notably different from those of previous generations, and they’re apt to evangelize about them on social media. There, Hale said, “you can see any number of skits about what a ‘fast-paced environment’ means.” In Millennial and Gen-Z minds, she said, that kind of approach to work means: “Goodbye to your life.”

“It’s not that they don’t have a good work ethic, it’s not that they don’t take pride in their professional integrity, but they’re looking for more of a work-life balance,” Hale said. She added that when corporate leaders don’t realistically consider “the changes and trends of your talent pool, and you’re expecting them to adapt to you,” the result is “mismanaged expectations.”

Given those conditions, in a time of crisis like the current pandemic, Hale said, work is not seen as a place for support, but instead as a stressor. And that leads to turnover.

However, not all members of the older generations have bought their retirement homes just yet. “There are some companies that have five different generations in their workforce right now,” says Suzanne Rohan Jones, a talent-management specialist at Graybar Electric, a Fortune 500 company that specializes in distribution and supply-chain management. Older employees might not understand why Gen Z workers would want a hybrid-work model or robust flexibility in career paths, she said. Leaders need “to be sensitive to the strengths and challenges of each of those different generations,” said Jones, who is also an adjunct professor of psychology at Maryville University.

Be More Transparent Than Ever

With the emergence of younger generations in the labor force and the prospect of radical changes to the workplace, which will include less time spent among peers and managers at the water cooler or snack bar, employees of today expect transparency from their leaders. “In the absence of it they’re making stories up,” said Amy Zimmerman from Relay. “In the absence of information, people assume the worst, unfortunately.”

Zach Jones, managing partner of the Phenom Consulting Group, an executive-search and talent-optimization firm, suggested that managers lead by example and “be living proof” of whatever they’re delegating to their team. “Being involved is critical to someone knowing, Alright, this person is in the trenches with me; I have confidence in them and what our direction is,” Jones said. It’s no longer acceptable, he added, for workers to hear from managers, “Here are your marching orders, report back to me.”

Jones believes managers must be open to scheduling more one-on-one facetime with their employees, even if the meetings are held over video-conferencing platforms. Leaders need to discuss not just the performance metrics, but how their workers’ careers are going and the ways in which they want to grow, hopefully within the company.

Another way leaders can earn the trust and confidence of their employees, especially given recent events, is to construct what author Diana Hendel calls a company-wide, rapid-response process. “Companies don’t do a very good job, frankly, of preparing for catastrophe,” said Hendel, a pharmacist and former CEO who worked for years in a hospital setting, where she once experienced an active shooter event. She recently co-wrote Trauma to Triumph: A Roadmap for Leading Through Disruption and Thriving on the Other Side, an undertaking that began prior to the pandemic, and became even more urgent once Covid-19 struck.

A rapid-response process can look different from organization to organization, but Hendel describes it as simply a set of protocols that ensure company leaders will be able to meet with each other when disaster strikes, make informed decisions, and assign responsibilities. When a crisis emerges, she said, a signal such as a “code blue” can be relayed to workers.

“What it does for employees, even people who aren’t involved directly in having to respond to the code, when they hear ‘code blue,’ they know things are being taken care of,” Hendel said. “They can expect information to come when it’s available. They’re not left wondering, Who’s taking charge? They know.” Even if the rapid response process is never engaged, having it in place and understood by employees provides perpetual peace of mind for everyone in the workplace, she said.

Be More Compassionate Than Ever

More than fair pay and perks like unlimited cappuccinos, young workers today want respect. But employees of any age can appreciate that sentiment, considering the collective trauma Covid-19 delivered. “Think about the authenticity of your leaders,” said Mina Morris, a partner in the Human Capital Solutions practice at Aon, the professional-services firm. Leaders should strive to be “more connected” and “more humble,” Morris said, and consider how they can “simplify work” in ways that help people remain “better connected with their tasks.”

At the same time, he added, leaders should try whenever possible to remove the “urgency when we don’t have that ability to be in person, and really sift through priorities,” he said. “So really connecting on an individual level, a human level,” Morris continued, “is a really important part of the journey.”

Evoking that spirit of empathy, leaders at Emtrain, which provides training on workplace ethics and culture, recently shortened the company’s workweek to four days. “It’s giving everyone a beat so that the temperature and the pressure starts to simmer down a little bit,” said CEO Janine Yancey. “People’s internal pressure barometer is just too high [right now] and it just starts to become an emotional reaction where they have to leave.”

Yancey believes the emergence of younger generations of workers has made issues like mental health more prominent. She says the pandemic, as well as the murder of George Floyd and, more recently, the events in Afghanistan, have all spurred a shift in priorities for workers.

“When you see the traumatic consequences of this pandemic and losing people that you love, losing people that you know in the community,” Yancey said, the thinking becomes: “I’m not just going to be a mindless robot with my nose to the grindstone every single day. I’m going to think about what’s important because life is precious.”

Michael Stahl is a New York City-based freelance journalist, writer, and editor. You can read more of his work at MichaelStahlWrites.com, follow him on Twitter @MichaelRStahl, and order his first book, the autobiography of Major League Baseball pitcher Bartolo Colón, at Abrams Books.


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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