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IBX: The Cover Story – Workplace Changes and the Impacts on Behavioral Health

By August 19, 2021September 12th, 2021Employee Well-being Employers Podcast Spotlight
Graphic reading IBX: The Cover Story Episode 6: Workplace Changes and the Impacts on Behavioral Health

In episode six of IBX: The Cover Story, I am sharing the recording from a panel discussion recently hosted by Blue Cross Blue Shield companies on workplace changes and the impacts on behavioral health. The panel featured leading voices from the National Alliance on Mental Illness (NAMI); Business Group on Health; Morgan, Lewis & Bockius LLP; and the BlueCross BlueShield Association.

Take a listen to this month’s episode to gain insight into actionable strategies that will create a workplace culture of well-being and help support employee behavioral health.

Listen to our conversation here:

A full transcript of the episode is also available below.

Episode 6 Show Notes

Below you will find some of our favorite quotes from the sixth episode, sources that were mentioned, and a segment breakdown. As always, thank you for listening!

Quotes

“With most behavioral health issues that we deal with in this country, we tend to focus on what a person can do themselves. But a lot of these stressors are driven by the organization. So, one of the things that senior leaders can do is communicate. First acknowledge that there could be a problem with burnout. And change some of the organizational culture that has set up the burnout. For example, overwhelming number of meetings, how do we make more efficient meetings, less meetings, and also having senior leaders modeling those behaviors.” – Dr. Sonja Boone, Executive Director of Medical Policy Services, BlueCross BlueShield Association

“We can see each other’s calendars, and everybody’s got, you know, ‘dentist appointment.’ There’s no stigma against getting your teeth cleaned. When I would go see my therapist, I would always say private appointment… I don’t want there to be a question of if I can get my work done. And then I kind of made the decision, if I get gruff about this, I am going to consider maybe this isn’t the place that I want to work. And then I just started saying, you know, ‘therapy appointment.’ Let me tell you about how I think this is a great idea.” – Dylan Landers, Director, Business Group on Health

“In my mind, you can’t have inclusion if you don’t have well-being and you can’t have well-being if you don’t have inclusion. We think of those things as two sides of the same coin and something that should be thought about together and analyzed together from the perspective of developing programs.” – Amanda Smith, Chief Engagement Officer,  Morgan, Lewis & Bockius

“When I worked at BlueCross BlueShield of Massachusetts, we were the first plan to cover phone sessions and that was directly because of equity. It’s well established that video-enabled teletherapy is as good as in-person. Phone has not really been studied, but it was an equity act of faith, to just make a statement that those sessions would be covered the same as in-person. The Massachusetts legislature then got behind that and mandated that for all health plans going forward, after the pandemic emergency has stopped.” – Ken Duckworth, Chief Medical Officer, National Alliance on Mental Illness

Episode Segment Breakdown

1:37 – 7:22: Dylan Landers reacts to stats regarding workplace changes and the impact on employee behavioral health.

7:23 – 10:05: Amanda Smith discusses challenges employees face and how employers can address them.

10:06 – 15:05: Dr. Sonja Boone explains what employee burnout really is and what needs to be done organizationally to address it. Ken Duckworth gives examples on how employers can help prevent employee burnout.

15:06 – 18:49: Amanda Smith talks about the unique stressors for lawyers and how the ML Well-being program pivoted to help employees during the pandemic.

18:50 – 26:59: Dr. Sonja Boone and Dylan Landers discuss how senior leadership and managers can help employees face behavioral health challenges.

27:00 – 32:36: Dr. Sonja Boone and Amanda Smith offer strategies to address employees’ concerns when returning to the office.

32:37 – 39:10: Dylan Landers and Ken Duckworth address barriers employees face when seeking behavioral health help.

39:11 – 45:35: Dr. Sonja Boone and Amanda Smith offer their thoughts on how employers can communicate with their employees about behavioral health.

45:36 – 1:01:28: The group provides closing remarks and answers audience questions.

If you have a topic idea you would like us to cover in a future podcast episode, email us at thecoverstory@ibx.com.

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Full Transcript

Episode 6 Transcript: Workplace Changes and the Impacts on Behavioral Health

Peter Panageas:

Hi, this is Peter Panageas. Welcome to Episode 6 of IBX: The Cover Story. For our sixth episode, I want to share the recording from a panel discussion recently hosted by Blue Cross Blue Shield companies and other industry experts on workplace changes and the impacts on behavioral health. The COVID‑19 pandemic has amplified behavioral health challenges including employee burnout. It has affected the way we work, and as the vaccine rolls out, additional workplace changes will continue to impact the behavioral health of our workforces. That’s why it’s more important than ever to identify the right strategies to create healthier workplaces that will support employees — now and for the future. Take a listen to the panel discussion we’re about to play for actionable strategies that workplaces can implement to create a culture of well-being. I hope you enjoy!

Fara Palumbo:

Thank you all for joining us today, we are so thrilled to be here to discuss an incredibly important topic that many of us are faced with every day. Stress in the workplace is nothing new. However, the pandemic has created a new level of fatigue and burnout from many of our employees. This webinar continues our work to bring experts together, to tackle the important behavioral health challenges facing employers and their workforce. Earlier in the year, we hosted a round table and today we are joined by a panel of experts and practitioners for a very timely discussion on workplace changes that have seen both that we’ve seen throughout the pandemic. And they are now seeing now that the vaccine is rolling out, they’ll provide insight on how these changes could impact pandemic, amplified conditions, such as burnout and caregiving, as well as discuss the best strategies for addressing them while creating a culture of health that will support employees now and into the future.

Fara Palumbo:

So let me introduce our panelists for today. First doctor Ken Duckworth, chief medical officer national Alliance on mental illness, Dr. Sonja Boone, executive director of medical policy services, BlueCross BlueShield Association, Dylan Landers Nelson, who’s the director at business group on health. And finally Amanda Smith, chief engagement officer at Morgan Lewis. Before we get into questions, let me take a minute to share some data that we’ve gathered. In a recent pulse study that BlueCross BlueShield Association conducted with 38 participating employers. We saw some interesting insights surface as to what they’re facing and thinking about right now, 28 of 38 employers see behavioral health as a priority for the next 12 months, 36 of 38 employers have been affected by behavioral health challenges. And as you can see by this chart, there was a range of indicators. They identified including reduced productivity, increased absenteeism, and PTO usage, and higher utilization of behavioral health resources. Overall employers have seen that employees are wrestling with work-life balance, feeling disconnected and burnout, remarkable changes in a relatively short period of time. So now let’s turn to our panelists. Let’s start with you Delane. What are your thoughts on what I shared related to workplace changes in the behavioral health impacts on the workforce?

Dylan Landers:

Yes, absolutely. Thank you so much for having me and for the excellent question. I work at business group on health, which is a nonprofit member association and we have about 430 members. The vast majority of which are large self-insured employers. And we do a number of surveys throughout the year on several different topics. But our most comprehensive comes out once a year. And I realized, actually, this is coming out in a couple of weeks. So keep an eye out for it. And every year we ask, what employers are planning to do for the following year in the last year was the first time we were asking these questions in the context of a pandemic, which we all knew would continue to be a challenge in 2021. And the data that you shared very much resonates and aligns with much of what we’ve heard from our members.

Dylan Landers:

We ask what an employer’s top area of focus is for the coming year and the number one for 2021 was implementing virtual care access. But then number two was a focus on mental health, with 43% of our members saying that that was their top area of focus. You know, the only thing that I think stuck out as maybe a little bit different than some of this is anecdotal and members that we speak with is that many of them actually saw increased productivity with folks who went home, uh, who are working from home now. And, you know, I think traditionally there’s been a concern that people are less productive when they’re working at home, but when the  barrier or not necessarily the barrier, the kind of line between work and home was a blurred or in some cases totally erased.

Dylan Landers:

It turns out that people used extra time that they may have spent commuting previously or living their lives. They’ve got their work computer right in front of them. And that productivity has increased in some cases. And I think this is why you see some employers deciding that they’re not necessarily going to bring white collar workers back to the office in the future in the same way that they had previously, but absolutely mental health is a massive challenge. And we’re hearing from our employer members regularly that this is a challenge, I will say also just briefly on a personal level, this very much resonates. My daughter is currently in treatment for leukemia right now, and working from home, I get to be a part of the good and bad of her treatment, and it’s been a really rough week for her. And so for everyone in the audience, if I disappear at some point in the future, it’s, uh, cause our family needs help. And this is not a position I’ve been in previously before now. And I don’t think it would be if I were in the office, cause that would be totally focused on work. So, this topic resonates and uh, you know, I just appreciate being a part of it. Thanks.

Fara Palumbo:

Thanks so much Dylan. And we know you’re not going to disappear forever. You might have to step away from this call for a few minutes. You know, I agree with you. I hear so much from our own employees about that blurred line between work and home now that everyone’s working remotely. So totally can relate to that. Amanda, in your experience, especially as a large employer, what are some of the greatest challenges employees are facing as well as potential opportunities for employers and then what’s your role in helping address those? Sure.

Amanda Smith:

Yeah. Thank you for that. The law firm that I work for Morgan Lewis is one of the very biggest law firms in the world. We have 2,100 lawyers and about 5,500 total employees. So we see these issues playing out sort of in real time. And I could not agree more with Dylan that we’re just beginning to sort of grasp all of the implications of what, for many of us in many parts of, um, in different sectors of the economy is going to be sort of a permanent hybrid of, of work from home and work in the office. And, in addition to the background, obviously the stressors of the pandemic itself, um, we are certainly seeing that sort of concerns about dissolution of the boundaries between personal and professional life. I had a colleague who, who said, you know, I’m working from my bedroom and living in my office and, and that’s sort of perfectly encapsulates, I think what the pandemic experience has been.

Amanda Smith:

And so for us, we have really felt like we needed to make behavioral health and mental health in particular front. You know, we need to put that front and center. We had, uh, the benefit of having built out a pretty sophisticated well-being platform prior to the pandemic. And I’m so grateful that we did it really focuses, not only on sort of how to help people who are already unwell and who need a clinical intervention, but also giving people to very concrete, very proactive, very easy to implement interventions themselves that they can, they can take on themselves. And that’s very grounded in sort of empirical positive psychology. Like I can give some examples of that, but I really think that’s what employers can be doing right now is communicating. Communicating with empathy, communicating with transparency about just the existence of the issues and then giving their employees the tools that they can use. Those things together. I think creates a culture of well-being, creates sort of a baseline understanding of the different, um, the different aspects of well-being and how it’s not a fixed thing. It’s something that we can all influence ourselves.

Fara Palumbo:

Yes, that’s so fantastic. When you think about how a well-being has always been thought about as sort of this soft focus area, and yet companies have been so much more productive if they paid attention to this all along. So great, great job in what your organization is doing. 2020 created the perfect storm for burnout and two that the increase in unpaid caregivers, really who are susceptible to burnout as well as a host of other pressures. And in 2021 is trending to be another tough year for the workforce. There’s definitely a tendency to lean too heavily towards self-care as a solution to employee burnout. Yet the real causes of burnout are often organizational. So let’s talk about what employers can do to better address burnout culturally, by embracing it at the organizational and individual levels more equally. Sonja, describe a little bit for us, what employee burnout really is and talk about solutions requiring more than just self-care and then as well as the need for addressing burnout at the organizational level.

Sonja Boone:

That was a great question. Thank you for having me today. And one of the things that I want to point out is that BlueCross BlueShield Association is dedicated to providing services to all of the 34 plans. As you can imagine, there are different employer sizes, etc. But when we talk about burnout, I agree wholeheartedly with what Dylan and Amanda has said thus far, when you blur those lines between work and private life, people can feel overwhelmed very quickly. So some of the signs of burnout that managers and senior managers, senior leaders look for are people in their organization that are feeling overwhelmed, expressing emotional exhaustion, feeling burdened more than usual. And one of the results of that is depersonalization. So, whereas they may have been dedicated to what they’re doing before.

Sonja Boone:

Now, it’s just a number or just a project and you then see decreased motivation and decreased productivity. So those are some of the signs of burnout. Yes. I think that with most mental health behavioral health issues that we deal with in this country and then the world, we tend to focus on what a person can do themselves. But as you mentioned, a lot of these stressors are organizational and are driven by the organization. So some of the things that senior leaders can do, I think Amanda touched on this was communicate first acknowledge that there could be a problem with burnout, or there could be a problem with anxiety, especially all the stressors everyone is dealing with and then really communicate with their employees, what they’re doing about it. That they are teaching and training their frontline managers to recognize burnout and then to make, take action and do something about that burnout for those particular employees who are experiencing that. So changing some of the organizational culture that has set up for burnout. For example, overwhelming number of meetings, how do we make more efficient meetings, less meetings, and also senior leaders modeling those behaviors. Modeling work-life balance. I like to call it work-life harmony as opposed to balance. It feels like something’s gonna fall. But, I think those are some of the things that we need to think about as we talk to the senior leaders of different organizations

 

Ken Duckworth:

I am Ken Duckworth. I’m the chief medical officer for NAMI. Thank you for having me, uh, NAMI decided to give the staff a week off. And that was just a decision that the organization made, never did that before. Our leader of human resources suggested it, given that mental health has been quite an intense journey and working in a nonprofit, helping other people and doing media and helpline calls. I will say I was a word well received. It’s going to happen right after our convention. So the whole staff will be off. So even though you are off, you will also not be receiving emails from anyone else because everyone’s off. When I worked at BlueCross BlueShield of Massachusetts, the CEO, Andrew Dreyfus, decided to make all sick days into wellness days during the context of the pandemic, he just made a decision that you could take your time. Acknowledging both of these moves are major structural acknowledgement. That it’s been a hard time for people. And I think the third thing is to consider, having a health plan that covers things like phone sessions, which addresses both convenience and equity for people who don’t have privacy or may not have adequate internet.

Fara Palumbo:

Great, great ideas. I love that week off idea. I may need to steal that one.

Ken Duckworth:

You know we did not copyright it. Let’s go.

Fara Palumbo:

Amanda, Morgan Lewis, you mentioned before a very, very large global law firm talk about facing burnout in an entire profession. You know, there has been research among lawyers. I know you’re going to be talking about their share some examples of how Morgan Lewis is addressing this and I’m including what more you specifically hope to be doing.

Amanda Smith:

Yeah, thank you. And, you’re, you’re absolutely right. I come from a field where the research has really been strong, very strong recent research. Recently as 2018, 2019, the ABA produced a various, very important study on legal professionals that showed sort of off the charts behavioral health concerns, depression, anxiety, substance misuse. And so we as a law firm were facing over the last several years, a situation where we had a sort of a population, but the lawyers and the other professionals in our firm that were sort of predisposed right. To have these issues as, as lawyers do, it’s quite clear. Also, the pandemic. And then also these sort of follow on effects that we’ve all been talking about, that, you know, we have all of these sort of burnout issues that are exacerbated by the disillusion of this boundary between personal and professional life.

Amanda Smith:

And so, fortunately we had the platform built out, but what we really felt like we needed to do was tweak it and evolve it, and really recognize that there, we had to walk a middle road and address not only both the clinical and the proactive aspects of well-being, but we really had to make sure that our managers were informed, our senior managers were informed. And also, that we gave people, as I said earlier, the tools to sort of try to influence their own wellbeing. So, for example, we focus really quite a lot over the last year on the mind body connection, you know, people were trapped inside, um, physical activity dropped really significantly. So we launched what we call not a step challenge, but a movement challenge sort of inspired by all of those stories that we saw during the pandemic of people running a marathon on their balcony in Europe or in Asia, it sort of became a thing, right.

Amanda Smith:

And so we tried to sort of piggyback on that, but make it a very positive thing. That was also a team building activity where we could sort of share experience with each other and create a sense of having lived through this experience together. And so, you know, I think all of those things that sort of comprehensive and holistic approach, which, you know, entails giving people the tools, creating sort of a set of first responders that as Sonja said, can sort of be aware and identify people who might be in crisis, or at risk of being in crisis. And then also trying to create a culture that, it’s very intentional. And we communicated about it a lot. We communicated about it every time our chair, Jamie McKeon talks, she says something about ML Well, we have a senior partner who is very active in, and vocal about his own recovery and he talks. And so all of those things together, I think hopefully will put us in a position to work with our quite at risk population and move things forward in a flexible way as we headed into the, I don’t even want to call it the new normal, I guess it’s just the next new normal, because things seem to be changing at a, at an ever increasing

Fara Palumbo:

That’s fantastic, Amanda, we, you know, we all know that culture often gets created by the storytelling that occurs. So you want those stories to be the ones that really bring this message home to, to the workforce. Thank you for that. So, you know, we know that balancing positive employee health outcomes with a drive for excellent business outcomes is difficult, right? Especially given that the drive to focus on results often leads to increasing workloads that then result in behavioral health challenges like burnout and additional pressure on caregivers. So it’s like a vicious circle. So Sonja, let me go to you, how should senior leadership and you started to touch on this a minute ago, how should senior leadership be thinking about this and then effectively setting the tone at the top?

Sonja Boone:

That’s a great question, Farrah, and I did touch on it a little bit, and I think Amanda just touched on it as well. Not just thinking about it, but actually doing the research and making then a commitment to their employees, that they will focus on this, that they will have implemented various initiatives that are concrete ways to change the culture. And again, modeling it themselves. One thing I’ll say that I’ve seen in the literature over and over again, around interventions, that work. And one is when the frontline managers are able to not just model behaviors around work-life balance, but also share their stories. And Amanda touched on that with mentioning one of her senior leaders who was sharing a story that they’re working through. So being able to share, that humanizes what’s happening with them. And so it takes away the stigma of sharing that you may be having some problems with burnout or feeling overwhelmed because people want to be high achievers in their organization.

Sonja Boone:

So I think that the leaders can think about this differently. They can also start to model those behaviors differently. And again, communicate, over communicate as Amanda said. I think that’s key, to be able to have a touch base or, you know, organization-wide. One of the things that we do at the BlueCross BlueShield Association is our CEO, Kim Keck makes announcements that people pay attention to, so we see a newsletter post from Kim Keck and everybody’s paying attention because she’s paying attention to what’s happening in our organization and cares about every single employee. So I think that’s another thing communication is key. Yeah, I hope that really gets to the core of what’s going on and that’s, what’s in your leadership.

Fara Palumbo:

Exactly. You know we often talk about setting the tone at the top and senior leadership messages and so forth, but those messages at the top take some time and take a lot of energy to actually trickle down throughout the entire organization. So, what role should the frontline managers be playing in creating a healthy workplace culture? So Dylan, let me switch to you, tell us, or share some examples of leaders that really set the tone for culture and the impact that can have. And talk to us about the need for training managers to spot signs of issues, supporting employees and leading empathetically.

Dylan Landers:

Yes, I’m happy to do that. I was just thinking, I wanted to add one thing to the previous conversation, there’s some good data coming out recently about a very high level of turnover across industries, particularly domestically in the U.S. right now, as we think about, whatever that new normal is with people being able to work virtually with, you know, there’s been a zillion, different news articles about restaurants and other retail areas, having a hard time hiring people right now, the pandemic has really changed a lot of things, including people’s relationship with their jobs and trying to figure out what they want in life and how they keep themselves healthy. Physically and mentally. And I think that the tension between keeping people healthy and happy at work and supporting employee well-being is more and more aligned with productivity, because if you’ve got people who are getting overly burned out and they’re stressed out, a lot of them are leaving.

Dylan Landers:

They’re going to different organizations. They don’t have to move to another city to work for way more employers. Now there’s a lot of opportunity for workers. And so it really behooves employers to be really focused on having a workplace that is healthy, including supporting people’s mental well-being. I think we see that in employers that have some of the highest levels of utilization of mental health services, particularly through their employee assistance programs. Onboarding for people who are new to an organization, there’ll be a strong focus on what their EAP is, what kind of well-being programs they have in place. And also making it clear that it’s okay to share. If you’re having issues, it’s okay to use those programs and not feel like it’s going to impact your trajectory in an organization.

Dylan Landers:

I will say again, personally, I had been at Business Group on Health for a few years. We can see each other’s calendars as we’re scheduling meetings and figuring out when we can connect with people and everybody’s got, you know, dentist appointment, doctor appointment. There’s no stigma against getting your teeth cleaned. Well, when I would go see my therapist, I would always say private appointment because there was some level of, I don’t want people to know that I’m going to a therapist. I don’t want there to be a question of if I can get my work done. And no one would care if I had a broken ankle or if I had dirty teeth or something like that. There would be no question. And I kind of made the decision like, okay, if I get gruff about this, I am going to consider maybe this isn’t the place that I want to work.

Dylan Landers:

And I just started saying, you know, therapy appointment, let me tell you about how I think this is a great idea. It’s sort of just the snarky joke of like, I hope that someone sees this and feels more comfortable. So I think it doesn’t even have to be necessarily the senior leadership, but kind of just a general culture policy early on so that people understand that this is not going to reflect poorly. You know, that you can be a high-performing, career advancing a person, whether it’s white collar, blue collar, while also seeking support for mental health. And we see that, you know, those types of peer and manager trainings, you know, over 50% of our large employer members are doing those now, that was absolutely not the case just two years ago. So I think that there’s some deep recognition on the part of large employers, that this is something that they have to be supportive of and help their frontline folks be able to do it. Right.

Sonja Boone:

Can I touch on something that Dylan just said, I just want to work with really quickly. One of the things that the American Medical Association has just launched not too long ago is called a Stress First Aid toolkit. And it actually focuses on peers because you’re more likely to talk to a peer about some of the stressors that you’re having. It helps them identify what to look out for in their peers and what they say, just triggers, and then what to do, and then how to proceed from there in terms of engaging with managers, etc. So, it’s just a peer toolkit it’s called AMA First Aid Stress toolkit. Just wanted to give that to everyone as a toolkit.

Fara Palumbo:

And that’s a great piece of feedback. I will definitely go check that one out myself. Pivot to another topic here. We’ve got, scene’s rolling out and the new workplace models that we’re all talking about and exploring a lot of employees are stressed out about the idea of going back to the office even part-time. So let’s talk about what employers should be doing to address and support their employees. Many of whom have real concerns about their reluctance to return. So Sonja, tell us a little bit about flexibility, and including how to build flexibility, in how people should transition back to the office, their work schedules and the very important use of time off, as well as some inclusive access to care.

Sonja Boone:

Right. Thank you. That’s a great question. And, again, fairly, this is where communication is key. So being able to set expectations at the senior management level, but also at the manager level, who’s dealing directly on the frontline with the employees, letting them know sending messages that it’s okay to have a flexible schedule. It’s okay to not come back five days a week, but it’s come back slowly, two days a week, and then remotely three days a week. And they have to be sensitive to the fact that people are juggling the care of an elder or the care of a child, as every solution does not fit all. And so being flexible in the solution that fits that particular employee is important. What does that mean? It means that the managers have to be empowered. They have to be educated, but also empowered to make decisions that fit each employee that they’re working with. So, it’s not just about flexibility, but it’s also about communication and how the organization wants to provide that flexibility to the employees. That’s going to be really key in this time that we’re trying to figure out the flexibility for everybody coming back into the office.

Fara Palumbo:

Yeah, no doubt about that. Amanda, how is Morgan Lewis approaching return to office with workforce behavioral health in mind?

Amanda Smith:

Yeah, for us, it’s such a front and center question. Thank you for asking. I think like every employer, large and small out there, there’s obvious anxiety about returning to work. And so we’ve done a lot of education. We’ve done a whole set of sessions on vaccine safety, which we thought was really important to give people all of the information from very reputable sources. We did a whole separate set of sessions on other anxieties where we had a panel of psychologists who came in and we did what amounted to almost like role-playing of how you have that awkward first conversation. Those of us who have sort of reentered society after this long period, I think we’ve all had that sense of social awkwardness.

Amanda Smith:

So, we really tried to give people, more than anything, just a recognition that it might be weird for a little while. But the other thing that I think is really important and really, I think many, regardless of size of the employer, we have people that are, even if they feel anxious or really excited to get back and to see people, right. You know, if we made such an investment in employee engagement. That’s what is in my title. I’m essentially our talent person, but that’s the lens through which we see the entire relationship of our firm and the people who work at our firm. And so, we’ve really tried to lean into that to sort of emphasize, that there are great things about being back even, and not to not to dismiss the anxiety and the real fears that come from public transportation, all of those things.

Amanda Smith:

We’ve really tried to sort of lean into the positive too, because there’s, even prior to the pandemic, the way that we live in the U.S. at least is very tied up, and many of us, our identities are tied up in work, in our friends are at work, and that’s really positive. That’s a good thing, you know, and so we’ve really tried to emphasize that in our communications. On a more practical basis we gave vaccination days off. We’ve sort of had a very, very individualized approach to talking to people about hesitancy rather than blast emails. And I think all of that is it pays off. Some of what we spoke of earlier, my fellow panelists spoke of earlier as sort of over-communicating, showing vulnerability, transparency, acknowledging that these are unprecedented times, and we’re all in these unprecedented times together. There’s no one, no matter how many different crises you’ve led your organization through, this is different than all of them. And that goes a long way to sort of creating those feelings of trust and empathy and engagement that I think will ultimately alleviate the anxiety about returning to work. It will be weird for a while. I think it’s just important to recognize that for all of us.

Fara Palumbo:

There’s no doubt it’ll be weird for a while and it’ll make it even more weird when we have to start using our masks again. So that’s another thing we’re all faced with, on this whole notion of stigma and worrying about this, uh, Dylan, you’ve done a, Business Group on Health has done a lot of important research in this space, especially related to employers seeing stigma and access as the issues yet employees pointing to not having the time and not being able to afford care. Talk us a little bit about that.

Dylan Landers:

Yeah, absolutely. So, we have been doing a lot of work and with our employer members, and then I also reflect on what our own organization of about 30 employees has done with this exact conversation and anxieties that me and my coworkers have about returning to the office. And certainly, there are folks like myself with an immunocompromised family member for whom, it’s a different sort of calculus on you the level of risk of illness that I’m willing to take versus other co-workers. And what that means when some people are very excited to get back and others are a little bit worried. So, on that question, I think it’s really important to listen to your employees, frankly, whether that’s giving people forums to speak publicly about what they’re worried about or what they’re focused on, good and bad, anonymous surveys as well. You can be a small employer doing this as well.

Dylan Landers:

Just give people an opportunity to say what they’re excited or worried about, and that can really help guide your strategy and how you address some of that. And then, I want to just recognize the tremendous privilege that we all have clearly sitting at home. When I go to the grocery store and there’s plenty of people working there, interacting with people that they have no idea if they’re healthy or vaccinated or whatever else. We need to make sure that this is something that when we have these conversations about return to work, we’re not forgetting that, there’s half of the country, maybe not half of the country. I shouldn’t say percentages when I don’t know the exact one, but a lot of people have been continuing to work, interacting with a lot of other people.

Dylan Landers:

So just wanted to throw that out there, you in terms of access to services. So I think previously we’ve had conversations with the HR folks at large employers that we work with every day where they often cite stigma as a major reason why people don’t access services, which is absolutely true. I wanna make sure, and we’ve seen this in our data, when we’ve done some studies alongside other organizations where you interview workers and ask, what are some of their greatest challenges to accessing services. And it’s often the case that it’s getting time off of work to get them, and that it costs too much, both of which are absolutely true. And this is why it’s important to listen to your workers so that you can address them.

Dylan Landers:

You know, the worst thing that an employer could do in my book is put in anti-stigma campaigns and then have programs and policies that make it very hard to get services, because you don’t want people to get to a point where they say, all right, I’m finally ready to seek care and then hit 17 different roadblocks to getting it. So, you really have to think holistically, and this isn’t a shocking revelation, but just make sure that once someone has gotten to a point where they’re ready to seek mental health support, that they can do that. And it is a big challenge, but you just want to make sure that you’re working on both of those alongside each other.

Fara Palumbo:

Oh, that is so true. Really a tough thing to sort of balance as an employee. Before we move on, I just want to say that we will have a few minutes for audience Q&A. So, if you have any questions, send those in through the Q&A chat box and we’ll get to your questions as quickly as we can. So in the meantime, employers, in our recent study, identified low resource awareness, stigma, remote working as some of the top barriers to addressing behavioral health, but behavioral health inequities present another really important key barrier. So let’s talk about how those inequities have been amplified and how employers can and should be addressing them. So, Ken, let me start with you. There are so many challenges. Can you give us your insights in this space?

Ken Duckworth:

When I worked at BlueCross BlueShield of Massachusetts, we were the first plan to cover phone sessions and that was directly because of equity. It’s well established that video enabled teletherapy is as good as in-person. If you look at the evidence, the data, that’s well established. Phone has not really been studied, but it was an equity act of faith, to just make a statement that those sessions would be covered the same as in person. The Massachusetts legislature then got behind that and mandated that for all health plans going forward after the pandemic emergency has stopped. So, this is a substantive equity moment because not everybody has the internet. It doesn’t solve the core supply, demand mismatch. That is to say, for people’s concern about stigma, demand is overwhelming supply. And so I would encourage people to be honest about that and to provide ways to solve that problem. There are individuals that health plans who try to make appointments. There are telehealth companies that are separate and additional to the network, and then there are customized networks. Those are all solutions that you can put into play, because if you give people the ways to find help through equity, like phone sessions, you’re going to need to back that up with ways to execute it.

Fara Palumbo:

Yeah. Really, really critical to provide the right benefits to the organization. And, as we speak to the need for not just the right benefits, Sonja, let’s also talk about the right communication, you know, ongoing outreach to reduce stigma and privacy to make the care experience more inviting.

Sonja Boone:

Right? One of the things that I’ve worked on in the past is cultural competency, in medicine and in health care, it’s very important, but what it involves is actually talking to the person, asking them questions, not assuming, not making broad, sweeping assumptions or stereotypical assumptions around what a person may be going through. So I think it will be really important again, with that frontline manager who’s working with employees directly to be trained in talk and asking questions that are not illegal, but asking questions that are important to help them understand the employees and what barriers they may have to seeking help if they’re feeling burned out, or if they’re feeling anxious about returned to office, all of those things, again, it sort of creeps back up to the senior leaders to show acceptance, create those opportunities to communicate that it’s acknowledged burnout is in the organization.

Sonja Boone:

And then to allow those managers to be empowered, to talk with their employees in a way that takes, takes a stigma out of the conversation and creates a new normal, or a better organizational acceptance of initiatives that can make a difference. I think that the other part of this is that manager being able to feel comfortable in sharing and having testimonials, that they can humanize the whole process with their employees. It makes a big difference. And so, understanding cultural competency can also not, it’s not just for medicine, it’s just for the entire, you know, workforce. I think not just in the U.S. but in the world in having those managers be empathetic and compassionate in how they deal with their employees and the unique barriers they may be facing.

Fara Palumbo:

Thank you so much, Sonja, you know, we’ve talked a lot about communication sort of in general. Amanda, as an employer, we’re all trying to be very aware of how we communicate to the various employee segments within the company. So how critical is it to do that in ways that get through that are helpful and relevant rather than even more stressful?

Amanda Smith:

Yeah, I think this is such an important topic. It might be for an employer. I think it might even be the most important topic because we work really hard to have an inclusive, and an equitable and inclusive workplace. And in my mind, you can’t have inclusion if you don’t have well-being and you can’t have well-being if you don’t have inclusion. And so we think of those things as two sides of the same coin and something that should be thought about together and analyzed together from the perspective of developing programs. So, you know, communications are critical. I think what Sonja just said about cultural competence about that being sort of a requirement for managers now in the U.S. should have been always, but certainly is now, especially given what Dylan said earlier, which I want to endorse completely about how employers who don’t sort of try to understand and be culturally competent are going to lose workers.

Amanda Smith:

The great resignation is happening. Literacy, don’t sort of try to undergoing, accepting and understanding that yes, people within your organization are gonna have different concerns. One example I think that I just wanted to offer is we did a program this year that was focused on our black employees that was developed in cooperation with and collaboration with our black lawyer employee resource group, which is an incredible resource. Your ERG, if you have them, if you’re big enough to have them, can help you with this. And if you’re not big enough or quite big enough to have them consider starting them. And we developed a program to talk about black mental health and invited a very renowned psychologist, Rita Walker, to come in and talk to us about the sort of dual pandemic that has been, then happening in many communities of color in the U.S. and how, not only do we hopefully have a inflection point with respect to racial justice issues, but we also have communities of color who are disproportionately affected by COVID.

Amanda Smith:

And, we really just wanted to acknowledge that and provide some resources. And so we’ve tried to be very targeted in that way, but again, three ERG is, I would encourage everyone listening to look to those groups of interested and committed employees in order to sort of help you navigate this.

Fara Palumbo:

I a hundred percent agree with you, Amanda. I think we call them employee networks are critical to a, sort of be your conduit to the various employee segments. You know, I’ll just say one thing for those of you who may not be aware of several BlueCross and BlueShield companies recently launched a behavioral health employee communications toolkit to their employer customers. And this is just a free suite of internal communications that were designed to help employers foster more open dialogue around this topic and drive employee awareness. It tackles a number of different areas. That is available to you through your BlueCross BlueShield Association and through your local BlueCross BlueShield plan, most of them anyway. So with that, let’s talk about where we go from here. So, given the conversation today, we’re going to do a very quick fire. What are the top three actions employers should focus on now, and remember to go off mute when I call your name. So let’s start with you Ken, top three actions.

Ken Duckworth:

The number one thing is to remember that employees are experiencing mental health vulnerabilities or their family members, and to prioritize that. The number two thing, in my opinion, is select a health plan that has benefits that cover things that’s not universally true. And the third is to create a culture where the managers feel that they can be open when a conversation happens and the people being managed feel that they can go to their managers. So those are my three things. Thank you.

Sonja Boone:

Oh, great. Thank you. Farah one is, or the organization leaders of the organization to recognize factors that contribute to burnout and anxiety second to develop once they recognize the village solutions that can be concrete solutions that their employees can benefit from. And I echo what Ken just said about actually having benefits that support that, and then third empower your frontline workers, your managers, to take the step. And also, the peer employee input. Empower all of your employees to take the steps, to really help someone who’s in need. Who is experiencing burnout or depression or anxiety. So, thank you.

Amanda Smith:

This is going to be repetitive, but communicate, communicate, communicate, over communicate, communicate with intention and empathy and transparency. Develop a culture. That’s not something that you can do overnight. Of course. I think we all wish it wouldn’t be, but, start now to develop a culture that creates sort of a baseline knowledge of behavioral health issues, and then finally work on the protective and proactive side of things, as well as the, you know, sort of reactive intervention as clinical side of things. There’s things that you can do and tools that you can give your employees, no matter how small of a company you are, that will let them grapple with these issues more effectively.

Fara Palumbo:

Thank you so much, Amanda. And let’s wrap it up with Dylan.

Dylan Landers:

I would say listen to your employees. If you’re going to be intentional about your communication, your benefits programs, how you return people to work, how you support people who have been in the workplace for the last year and a half. Give people anonymous ways to give feedback about what they’re feeling and what they would benefit from would say. Secondly, just continue to push, you know, on mental health going forward, whether it’s now or in the future. Employers have had a tremendous challenge previously putting in programs, putting in strategies and communicating them to people who, could benefit them in a time of need. So, you’ve got, you know, one clinical area and you need people to get it at the exact time that they need it. Maybe they don’t know that they need it.

Benefits programs or benefits fairs are only once a year right now. Every single person in this country, you could argue on the planet, even if they think COVID is a total hoax, they’ve probably got other mental health issues that they could benefit from. Everybody is going through something right now. It is such a slam dunk, major focus for people to be communicating to their employees about. And then I would say finally, just make sure that you’re covering Medicaid assisted therapies for substance use disorder. We haven’t really talked about substance use disorders specifically this year, but opioid related overdose deaths were up 30% in this past year. And it’s something I think hits a lot of us personally and our families. And I just think it’s so important to make sure that employers are continuing to focus on that. Sorry, that was kind of long.

Fara Palumbo:

That was fantastic. I will just say ditto to everything you all said, such a great conversation that we’ve had so far. Let us turn now to the audience questions and I am going to start with Amanda. Let’s talk about frontline managers needing to be educated and supporting their teams, but it’s also important to acknowledge that they and senior leaders are also personally sometimes affected by behavioral health challenges. How did they get supported? Such a quarry question?

Amanda Smith:

I love it. I think this is such an important question because, like Dylan just said, there is no one who’s not impacted. And, I think somebody in the chat also said something about how, you know, what about HR. HR are the people that have been managing us through this. And so, there’s always, and not to mention the people who have been as still in said frontline workers, right. Who have not stopped working in the office. And we all have no matter, I think virtually all us have essential personnel, but where that’s been true. So, I think that there’s no easy answer to that question. I think you have to first understand that’s something you need to solve for as an employer. That you can’t have everything trickle up.

Amanda Smith:

So that then the people at the top of the pyramid are sort of trying to solve the problems of everybody else in the organization, but you also can’t ignore the fact that there are some people in different segments of your employee population who need more or different kinds of help. So I think the answer is to, in that sort of creation of the culture and just the acknowledgement that. Some of the peer to peer supports can be just as important as supports within the managerial structure itself or as, you know, the formal managerial structure. I think one of the amazing things about creating sort of an engaged and, and workforce that understands basic concepts of well-being is that it could be anybody. It could be a receptionist who is identifying a partner who might be having a mental health issue.

Amanda Smith:

And it could be somebody who works in my position who could be seeing that our HR person is really struggling. And if we’ve done it correctly, then it should be sort of a web of support instead of something that just works in the strict managerial roles. So that’s, again, something that has to be worked towards and is a continuous process that you have to sort of strive towards over time as an employer, but that’s the idea. And we heard that. And what Ken said and, that’s really the goal.

Fara Palumbo:

Yeah, totally agree. And so true about some of the HR people as well. I think we’re seeing a lot of that. This is another question from the audience, how can we help our frontline managers spot indications of burnout within their teams?

Sonja Boone:

Again, I think it’s really about education, but tit’s very easy to communicate to the managers. What to look out for. Those symptoms of burnout are classic. Studies show those symptoms over and over again. And so, being able to recognize them and then having interventions that they can deploy right away, be empowered to deploy them is really important. And then I mentioned there are other toolkits, but the AMA stress, first aid giving first aid under stress to your peer and then taking other steps is one tool that’s really helpful, but there are others out there. And I think that organizations can really do a great job for all of their employees to implement some of these toolkits.

Fara Palumbo:

That’s great. Ken, you talked before about virtual resources and we’ve had a lot of conversation with you about that. So, when one question, other than virtual resources, what are other tactics that employers can use to address behavioral health inequities?

Ken Duckworth:

Well, again, I think the phone sessions are the linchpin to an equity strategy. Therapists across America, made the quickest pivot in mental health history, doing video sessions within three days of the pandemic. Virtually no one was doing phone sessions because it wasn’t being paid for. So, across the country, a lot of health plans, including a lot of the BlueCross BlueShield plans are paying for video and phone sessions. That’s one example. You can’t make the workforce more diverse overnight, right? You have the workforce that you have, the people that are in the networks. So, to me, that’s the best example of how to get a more culturally competent services to more people. I think tele-health with video has helped with that. I think there’s some evidence for that because people are no longer relegated to the people they can drive to. And so, phone sessions are, again, very good around an equity perspective for all the people who either have privacy or the internet. So those are two important examples. And I think the EAP you select, the online resources you select, these are all decisions that employers are making. They should be approaching them from an equity perspective.

Fara Palumbo:

Great. Thank you so much. Here’s a question, I’m going to throw it out to Dylan. Any suggestions for what smaller employers can do?

Dylan Landers:

Yeah, Business Group on Health pretty much solely works with larger self-insured employers. So, the data that we have, in terms of trends for the employers that we work with are generally employers that have several thousand up to hundreds of thousands of employees. That being said, I think a lot of these things that we’ve been talking about apply even in a smaller workplace. So for example, making it clear when you’re onboarding someone that it is okay to talk about these types of things or make it clear that you’ve got services in place. If someone is struggling with burnout or other mental health challenges, you can listen to employees, give them anonymous opportunities to give you feedback on what they could benefit.

Dylan Landers:

Depending on what kind of industry you’re in, you can do things like give people a mental health day off. A week is a lot for most employers. And, if you’re a grocery store, you definitely can’t do that. But you know, a lot of other places you can look at flexibility in terms of where people are working. I saw another question about people’s physical space, you know, proximity to each other. Some of that, particularly when you’re a smaller employer, you can’t flex on that really easily. But if you’ve got people who can work from home and don’t need to be in an office, I would say don’t reflexively, bring people back because you think that’s going to be the most productive way to run your business because the past year and a half has suggested that maybe it’s not. Those are some things to, to consider.

Fara Palumbo:

Thank you so much, Dylan. I think we have just time for one more. So I’m going to throw this one out to Amanda, if you are a frontline manager and you want to approach your senior management about some of these ideas, especially when they are the opposite of how things have been handled so far, what would you suggest?

Amanda Smith:

I was hoping we would get to this one, cause I think this is really important. So there is what I think of in my head as the business case for doing all of this, right? And it relates to something that Dylan said earlier, which I would go out and assemble data because some of the people that we report to only really listened to data, and present on what’s coming out about what I refer to as the great resignation, but many people are starting to refer to as the great resignation. There is this enormous portability now where you’re not necessarily limited to work in the community in which you live, and that is going to change everything. And I think it’s going to change every, almost every aspect of our economy, right?

Amanda Smith:

So, the evidence shows, and this is a separate set of data, but it is certainly available in multiple places, including Gallup does. It has a lot of information on this. If you search for information on wellbeing, positive psychology, and productivity, you’ll find a lot of information about how well-being and productivity are interdependent. And so if you want your employees to be more productive, have fewer days off, sick days, rather than we should have, they should have more days off, but fewer sick days. And to ultimately be more goal-focused more task oriented and more productive. It is a business imperative, that you invest in this kind of well-being. And that includes talking about it on onboarding it. It extends to benefit selection, go out and get the BlueCross BlueShield toolkit on talking to different populations within your organization, and put together a strategy for your manager that says we will be more successful as a business. If we attend to these things, now people will stay longer and they will be more productive and ultimately it will benefit us. It is an investment in human capital. Thank you for that. That’s an important one.

Fara Palumbo :

This was fantastic. Many, many thanks to our panelists for their fantastic insights. And thanks to each of you for joining us today. If you are interested in more information, we have a full suite of behavioral health resources, including an ebook, white papers, infographics videos, and more, and you can find it all at smarterbetterhealthcare.com. Have a wonderful afternoon. Thanks everyone. Take care.

Peter Panageas:

I want to thank each of you for listening to such an important discussion and for making a commitment to improve the health and well-being of our workforces. Check out the show notes for more information at insights.ibx.com. Thank you again for joining us.

Peter S. Panageas

About Peter S. Panageas

Peter Panageas is senior vice president and market president — national for Independence Blue Cross. In this role, Mr. Panageas has profit-and-loss responsibilities focused on new business and retention for all groups 1,000+, including Large Local, National, Health & Welfare, Education, and FEP. Mr. Panageas joined independence as vice president of Sales in 2010. During his tenure with the company, he has implemented significant changes to the sales incentive program and improved the membership reporting capabilities to increase sales force effectiveness. Mr. Panageas is a respected client relationship leader with recognized expertise in new business creation, client relationship management, and innovative client solutions. Mr. Panageas received a bachelor of science degree from Rutgers University.