Wellness Plans, Retirement and Adjunct Health Care: A Survey of Chief HR Officers

Benefits are a burgeoning battleground in higher education -- Pennsylvania State University's effort to impose monthly surcharges on employees who smoke or don't get regular physical exams, for instance, and colleges restricting the hours of adjunct instructors to avoid a new federal requirement to give them health insurance -- and human resources officers are in the thick of it.

Three in five chief human resources officers support a Penn State policy, now suspended, that would have imposed a $100 monthly health insurance surcharge on employees who didn't have annual physical exams, and more than two-thirds favor another Penn State policy that imposes a $75 monthly fee on smokers.

Nearly half of senior HR administrators say their campuses have limited the work of adjunct faculty members to keep them under the number of hours at which the Affordable Care Act would require their institutions to provide health insurance, and a third of the remainder say they are considering imposing or enforcing such limits.

And while more than half of CHROs say their institutions compensate adjunct instructors fairly, they are divided on whether the benefits they give to adjuncts are appropriate.

Those are among the major findings of Inside Higher Ed’s second Survey of College and University Human Resources Officers, released today in advance of this weekend’s annual meeting of the College and University Professional Association for Human Resources, in Las Vegas. The survey presents the views of campus chief human resources officers on a range of timely topics. The online survey, conducted by Gallup in September 2013, was completed by a total of 399 college and university HR leaders. A copy of the survey report can be downloaded here.

Among the highlights of the survey, in addition to the CHROs' perspectives on wellness surcharges and adjuncts:

• About 7 in 10 HR officers say they are very or moderately concerned about health care costs for retirees.
• Just one-quarter of HR officers say employees at their institutions "have sufficient knowledge and understanding about issues related to retirement."
• Asked to rate a set of issues to which they are now paying more attention than they have in recent years, implementing performance evaluation measures ranked high. But while HR leaders were evenly divided on whether they have the data they need to effectively evaluate employee performance, less than a quarter said they believed their colleges use the data they have to make planning and policy decisions.

Wellness Plans and Penalties

Penn State’s faculty shredded the wellness promotion plan almost as soon it was announced this summer. The university said it was an attempt to rein in out-of-control health care costs, but employees cited privacy concerns and objected to monthly surcharges, including: $100 for not completing a biometric screening, annual physical exam and online, third-party questionnaire; $100 for covering spouses or domestic partners eligible for health insurance through their own employers; and $75 for tobacco use.

Despite faculty outcry and negative national media attention, 60 percent of head HR officers say they favor a policy such as Penn State’s, requiring “annual health exams” and charging those “who do not get the screening” $100 a month. Responses varied by college or university type, however, with only 38 percent of officers at public doctoral institutions favoring such a plan, compared to 76 percent of HR chiefs at private nonprofit baccalaureate-level institutions.

Brian Curran, professor of art history at Penn State and president of the American Association of University Professors advocacy chapter that formed there in response to the embattled plan, said he was encouraged that at least 40 percent of those surveyed opposed it. “Hopefully, the rest of them will read up on the Penn State disaster before they make the same kind of mistakes,” he added. (Inside Higher Ed and Gallup conducted this poll as Penn State was reassessing “Take Care of Your Health”; due to faculty objections, elements of it were suspended (awaiting further study by a university committee) while the survey was in the field. It’s unclear whether that change affected responses.)

Penn State has maintained that its online data provider followed all health care privacy laws and that questions were supposed to help raise employee awareness about personal health, based on the belief that it’s cheaper to catch and treat illnesses early rather than later, or prevent them altogether. And wellness programs are becoming standard in many sectors, experts say, including in higher education -- and in those institutions represented in the survey. Eight in 10 respondents (81 percent) said their institutions offer wellness programs. However, most remain voluntary, offering free health services or incentives for healthy behaviors – not punishing employees for deviating from them. (Just 30 percent of survey respondents whose institutions offer wellness plans give direct benefits or rewards to "healthy" employees.)

But there’s scant data to support to support that return-on-investment “thesis,” said Vik Khanna, a national health care consultant who co-wrote a chapter on Penn State’s plan with Al Lewis, president of the Disease Management Purchasing Consortium International, in their forthcoming book, Workplace Wellness: How to Survive Obamacare's Biggest Blunder With Your Dignity and Organs Intact. (The book takes its name from a provision in the Affordable Care Act that raises limits for wellness incentives for insurers – another reason experts say wellness plans are on the rise. Maximum rewards or penalties are now capped at 30 percent of the total cost of coverage, including both employer and employee contributions, up from 20 percent -- except for tobacco, with a maximum differential now at 50 percent.)

The research on the effectiveness of such programs is inconclusive at best and, as the Penn State case illustrates, programs that coerce employees into certain behaviors drive a “wedge” between them and their institutions, he added.

Perhaps most importantly, Khanna said, wellness programs, often administered by third-party vendors and heavy on preventive care, are at odds with current dialogues in the medical profession about overdiagnosis and overtreatment. A relatively healthy, symptom-free adult probably only has to get a physical every five years, according to current industry standards, for example.

Khanna said the most effective workplace wellness plans don’t do things “to” employees but rather “for” or “with” employees, such as promoting lunchtime breaks for walks, and offering free, fresh foods and drinks. Such plans can’t be imposed from the top down, but rather must “cut across silos” to make any impact, he said – making them harder to sell and enact. Deliberately using a mixed metaphor to describe the survey's 60 percent approval rate of Penn State’s plan, Khanna described administrators looking for ways to control their health care costs “a herd of elephants grasping at straws.”

Matthew Woessner, an associate professor of political science at Penn State’s Harrisburg campus who helped organize opposition to “Take Care of Your Health,” said he attributed the survey's high approval rate to a probable lack of familiarity with the details of the program.

More understandable, Woessner said, were responses to a survey question addressing Penn State's tobacco use surcharge in particular. Some 68 percent of chief HR officers said they favored its policy charging those who "used tobacco products five times or more in the previous three months” $75 per month. Response rates were similar across institution types.

Lewis agreed. The smoking surcharge makes "tons of sense," he said, noting that regular smokers lose about 10 minutes every hour to smoking breaks. "The surcharge is smokers paying colleges back for lost productivity."

While tobacco use surcharges have been common in private-sector insurance plans for some time, they are relatively new to higher education. But there are precedents, including within the University of Pennsylvania's Health System, or "Penn Medicine.” It announced earlier this year that it would no longer hire smokers. The controversial policy -- which has been outlawed in dozens of other states as discriminatory -- followed an earlier $15 biweekly insurance surcharge for smokers.

Unlike other aspects of its plan, Penn State did not suspend its new smoking surcharge.

But at least one expert wasn’t surprised by the survey results regarding Penn State.

Robert Conlon, a senior vice president at Sibson Consulting who works with colleges on employment and other issues, said "the handwriting's on the wall" when it comes to health care plans pushing healthy lifestyles.

"Is this a direction they're going to head?" he said of human resources departments. "I think they're going to have to." Wellness plans resembling Penn State's are becoming "absolutely commonplace" in the private sector, he added, based on the idea that one needs to "earn" benefits by practicing the "right things behaviorally."

Adjunct Benefits and Compensation

Starting last year, adjuncts across the country began to see their teaching hours capped as institutions attempted to limit the number of employees working 30 hours or more each week – what is considered “full time” and therefore benefits-eligible under the Affordable Care Act.

Higher education groups, such as the American Association of Community Colleges, advised institutions not to act on the plan before the Internal Revenue Service offered guidance on what would constitute full-time under the law in academe, where professors work credit hours, not standard work hours. But such advice was slow in coming, and short on detail -- the IRS eventually asked colleges to use “reasonable” metrics for determining what’s full-time -- when it arrived. Consequently, many institutions continued to act on their own -- even as the Obama administration delayed by one year the so-called employer mandate, under which large businesses will have to offer full-time employees health insurance or be fined, until January 2015. 

Inside Higher Ed’s survey reveals just how widespread the practice has become. Some 48 percent of respondents say their institutions already have placed or enforced limits on adjunct faculty to avoid having to meet new federal requirements of employer-provided health insurance. Respondents from public and private institutions were equally likely to say they had imposed limits, but responses varied by sector among public institutions. More than two-thirds of officers at associate degree-granting colleges say they have imposed caps, compared to just 29 percent of officials at doctoral, master’s and baccalaureate institutions.

Just 38 percent of human resources chiefs said they’re delaying such caps due to the White House’s extended deadline for employers to offer insurance to full-timers. For those whose institutions have not already capped hours, 35 percent say they are considering doing so.

That didn’t surprise adjunct advocates, including Maria Maisto, president of the New Faculty Majority, a national organization promoting adjunct issues. She said the results were consistent with the group’s own data on the matter.

Conlon, the employment consultant at Sibson, said he was unsurprised that institutions were taking advantage of the "glaring" loophole provided in the federal health care law, and that doing so was understandable from a competitive standpoint. "If you don’t, you’re behind, and you can’t compete. You're now taking on additional costs, and unless you’re an Ivy or other rich institution, you can’t afford to do that."

He added: "Am I saying it’s the right thing to do? No. But is it the logical thing to do? Yes."

But it’s “a shame” nonetheless, said Gary Rhoades, professor and director at the Center for the Study of Higher Education, in an e-mail. “[Instead] of modeling best practices in the employment of contingent employees, most colleges and universities are moving to violate the spirit of the [Affordable Care Act] and modeling the worst of private sector practices in not paying health benefits to valuable members of their instructional work force.”

When it comes to overall compensation for adjunct instructors, a little more than half of respondents strongly agree or agree that their institution pays such faculty members fairly. Those at public institutions were twice as likely to “strongly agree” (31 percent) than were their counterparts at private institutions (15 percent), and respondents at public, associate-degree-granting institutions were most likely to “strongly agree” (38 percent).

Adjuncts are largely excluded from employee benefits: Just a quarter of respondents (24 percent) say their institution offers health care insurance for such faculty. HR officers appear divided, though, about whether their policies are appropriate: 17 percent strongly agree and 21 percent agree that their institutions provide adjuncts “an appropriate benefits package,” while almost as many do not (18 percent disagree, and 15 percent strongly disagree).

Despite those numbers, Rhoades said adjuncts remain “the working poor,” and that their pay in relation to full-time faculty “diminishes us as a profession and an academy.” 

Adrianna Kezar, a professor of higher education at the University of Southern California and director of the Delphi Project on the Changing Faculty and Student Success, which studies adjunct issues in relation to student outcomes, said that unions could explain why adjuncts seemed to fare better over all at public institutions, according to the survey; adjuncts at public institutions are more likely to be unionized than are their counterparts at private colleges and universities, and unions lead to better working conditions for adjunct faculty.

Still, she said via e-mail, “it is surprising to hear anyone say adjuncts are well paid as report and data set after data set show pay is inequitable, so their views do not match reality.” That is especially true for the many adjuncts who string together courses, sometimes at multiple institutions, to work full-time. That is in contrast to the traditional notion of moonlighting adjuncts -- such as lawyers or doctors who teach one or two classes a week on the side -- that human resources leaders may have in mind.

“I guess what we need to know is what they consider a fair or equitable wage,” Kezar added.

Like Kezar, Maisto pointed to a “clear disconnect” between the survey responses and reality for many adjuncts. The survey "really seems to show that HR managers really do not seem to understand the nature or importance of faculty work -- why benefits, job security and due process for faculty are critical components of quality education for students,” she said.

Beyond benefits and pay, 18 percent of respondents strongly agree that their institution has appropriate job security and due process protections for adjunct professors. Some 27 percent agree, while 10 percent strongly disagree.

John Curtis, director of research for the American Association of University Professors, took issue with that finding. "In my experience, very few institutions without a union for part-time faculty members provide any real job security or due process protections," he said via e-mail. "We need to bear in mind that most part-time faculty members are defined by their institutions as essentially 'temporary' employees, with an appointment for a single term and a specified course or courses -- even when they may be hired on that basis again and again."

So, he said, institutions may not frequently remove an adjunct in the middle of a term, but "generally feel free to simply not rehire him or her without providing any reason or notice."

Retirement Issues

With its aging work force, higher education also faces many pressures surrounding retirement -- and campus HR directors are on the front lines. Asked how concerned they were about five possible issues, HR leaders expressed the most concern about retiree health care costs (38 percent very concerned, 30 percent moderately concerned) and about faculty members working past traditional retirement age (25 and 37 percent, respectively). The health care costs issue was of equal concern across sectors; the delayed retirement of older faculty members was seen as a much bigger problem by CHROs at public doctoral institutions (85 percent very or moderately concerned) and private doctoral/master's institutions (78 percent).

The other three issues were closely lumped, with about half of human resources administrators expressing concern: a lack of sufficient retirement incentives for eligible faculty members (53 percent), filling positions of non-academic staff (49 percent), and pension costs for retirees (47 percent).

Paul Yakoboski, a senior economist at the TIAA-CREF Institute who studies retirement issues in higher education, saw a direct link between the top two answers to that question -- and a dilemma for HR administrators. "They are trying to walk a tightrope. They know they need to try to control retiree health costs just like all health costs, but doing that involves sharing the costs with employees, or transferring the costs," Yakoboski said. "And that creates unintended consequences for the people who you may want to retire: if the benefits are less generous, the co-pays or deductibles higher, whatever, that creates a big top of mind concern: I'm not sure, then, that I'm going to be able to afford to retire."

Another set of questions (and answers) offers additional insights into why faculty members may not be retiring. Campus HR administrators were evenly divided on whether their institutions provide sufficient phased retirement options for professors, with 39 percent answering positively and 37 percent negatively. (Nearly 60 percent said they did not believe their institution offers sufficient phased retirement options for staff members.)

And only a quarter of employees agreed or strongly agree that their employees have "sufficient knowledge and understanding about issues related to retirement, such as living arrangements, pensions and financial planning." Thirty-seven percent disagreed or strongly disagreed, with 39 percent undecided.

Yakoboski said the latter finding may be the key. "We know a huge driver for most of the faculty who are working past traditional retirement age -- even if they think the money's there -- is 'What would I do?' " he said. "There may not be anything wrong with an institution's phased retirement options. What may be wrong, as the HR directors suggest, is that [would-be retirees] need the knowledge and understanding about what comes next that HR says is lacking."

Why is it lacking? "At present, retirement is almost a taboo topic that is not discussed comfortably in public," Roger G. Baldwin, a professor of educational administration in the College of Education at Michigan State University, said via e-mail. "When most people are afraid to raise the retirement issue for fear of negative consequences, individuals have difficulty planning for a fulfilling conclusion to their careers and institutions have a difficult time with succession planning and maintaining a steady flow of talent through the faculty ranks."

He added: "For many faculty members, retirement is a mysterious black hole they are reluctant to step into. Until colleges and universities begin to address retirement issues holistically and strategically, HR directors and academic leaders will continue to have concerns about an aging faculty and all of the related issues that occur when retirement is viewed as something to avoid rather than an appealing and meaningful next phase of a well-lived academic life."

Benefits They Offer (and Should)

HR officers were asked to identify the benefits their institutions offered, and the five (of 12 total) listed by the most respondents were financial support for enrollment in higher education courses (93 percent), family-friendly work place policies (78 percent), wellness programs (81 percent), financial support for employees' children to pursue higher education (77 percent), and non-health-care benefits for opposite-sex domestic partners.

Respondents were also asked to say which of the same set of 12 benefits they thought their institution should offer. The table below shows the five benefits that showed the biggest gaps in the proportions of HR directors that said their institutions did and should offer the benefit:

Paying Attention to Performance

HR officers are focusing more than before on issues of employee performance. Asked whether they were paying more attention, less attention, or the same amount of attention than they have in recent years to 14 issues, two of the top five issues they identified as drawing more of their time were implementing performance evaluation measures (62 percent said "more attention") and evaluation of long-term employees with declining job performance (50 percent). Others in the top five were building employee engagement (63 percent), promoting wellness programs (55 percent) and succession planning for senior officials (49 percent).

Among the issues drawing the lowest proportions for "more attention" were evaluating factors in academic employee turnover (24 percent) and addressing salary gaps between faculty and staff members (34 percent). 

Among other findings of the survey:

• Given the recent spate of violent incidents on campuses, the survey asked several questions related to campus safety. Nearly three-quarters of HR administrators (72 percent) say their institutions had recently adopted new policies aimed at preventing violence, and 82 percent say staff members receive training to respond to violent incidences. But 40 percent say they do not believe staff members on campus received adequate training to respond to violent incidences on their campus.
• Chief HR officers seem more confident in their campuses' hiring policies for staff members than for professors. Nearly three-quarters (73 percent) agree that their institutions follow "best practice" in the recruitment and hiring of staff and administrators, while two-thirds (66 percent) say the same about their faculty hiring practices.
• Strong majorities of chief HR officers say their institutions have nondiscrimination policies regarding sexual orientation (88 percent) and gender identity (74 percent). But only 4 in 10 (41 percent) have such policies regarding domestic partner benefits.
• More than a third (37 percent) of chief HR officers say they report directly to the president or chancellor of their institution. Virtually all of the rest say they report to a senior official in the president's cabinet.