What Public Employee Health Plans Can Do To Improve Health Care Quality: Examples From The States

Source: Aaron McKethan, Terry Savela, and Wesley Joines, The Lewin Group, January 2008

In recent years, health system stakeholders have experimented with a wide range of efforts to stimulate quality improvement, often combined with efforts to contain costs. In this report, the authors explore strategies that public and private purchasers are using to improve care quality, focusing specifically on the role that states play as employers providing health benefits for public employees and retirees. Examples of innovations used by state public employee health plans include: promoting provider adherence to clinical guidelines and best practices, publicly disseminating provider performance information, implementing performance-based incentives, developing coordinated care interventions, and taking part in multi-payer quality collaborations. This report can be used by public employee health plans and other large purchasers making strategic decisions about how to develop or coordinate quality improvement initiatives.

Donning and Doffing: The New Wave of FLSA Litigation

Source: Brian Walter and Cepideh Roufougar, IPMA-HR News, December, 2007
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Throughout the state of California and the United States, police officers are demanding compensation for time spent putting on and taking off their police uniforms. This rash of “donning and doffing” cases is based on a decision by the U.S. Supreme Court involving employees working in a meat processing plant. Courts all over the country are now facing the question: “What do police officers have in common with meat processing plant workers?” Public employers are anxiously awaiting an answer to this question, as the answer could cost employers and the public tens of millions of dollars.

The Union Authorization Card Majority Debate

Source: Henry H. Drummonds, Labor Law Journal, Vol. 58 no. 4, Winter, 2007

This article sketches developments in the card majority debate and several related issues reflected in developing case law concerning the use of “salts,” “neutrality” agreements, and accretion clauses in union attempts to expand representation rights. It also briefly mentions other significant recent decisions that make it more difficult for unions to win, and keep, representation rights. … A major public policy issue faces the Congress, state legislatures, and federal and state labor boards. How is the ideal of employee free choice best actualized? The law is changing. From the union side one sees legislative attempts to win card majority recognition/certification rights and to avoid elections in which employers are free to campaign against unionization at all costs. And from the perspective of the NLRB’s General Counsel and the NLRB’s current majority, concerns for employee free choice create persistent questioning of long-assumed principles of card check recognition. For the private sector unions, especially, this issue may decide their ultimate fate as the percentage of represented employees shrinks toward the vanishing point.

Moving from Interest-Based to Results-Focused Bargaining

Source: John R. Stepp and Gary I. Bergel, Perspectives on Work, Vol. 11 no. 2, Winter, 2008
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More than two decades ago Roger Fisher and William Ury published Getting to Yes, ground-breaking research on how to conduct negotiations to yield superior outcomes for all parties. … Known by a variety of names (including Mutual Gains Bargaining and Win-Win Bargaining), Fisher and Ury’s methodology, which they refer to as Interest-Based Negotiations (IBN), has been promoted as a more effective alternative to the typically adversarial methods used in traditional labor negotiations. In the zeal to tone down the adversarial and dysfunctional aspects of traditional bargaining, however, some IBN devotees have removed components of traditional bargaining that we believe to be legitimate and productive, while they have added or emphasized features that seemingly elevate form over function, leaving labor and management bargainers frequently frustrated and disappointed. …we are convinced that a synthesis of traditional contract negotiations and IBN is much more effective than either approach by itself. This synthesis, which we refer to as Results-Focused Bargaining (RFB), uses the interest-based methodology as the foundation and borrows selectively from more traditional methods of negotiating. This article examines IBN’s shortcomings and the RFB alternative, with a focus on transformational negotiations.

Navigating Pennsylvania’s Dynamic Workforce: Succession Planning in a Complex Environment

Source: Kimberly A. Helton and Robert D. Jackson, Public Personnel Management, Vol. 36 no. 4, Winter, 2007
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Through its workforce and succession planning efforts, Pennsylvania is committed to proactively indentifying, preparing for and maintaining pools of well-trained and motivated state government employees to assume critical positions of leadership. But the concept of leadership extends beyond senior-level positions within agencies. The goal in Pennsylvania is to improve leadership capabilities in every work unit and to encourage all employees to use their skills to build stronger teams. Leadership at all levels means equipping employees with the tools, skills and expectations to communicate effectively and foster leadership at every organizational level. Leadership at all levels ensures that no lack of business continuity results from staff departures such as retirements, resignations, promotions or reassignments or other situations in which an individual is unable to or unwilling to continue his or her role within an organization.

Beyond Discrimination: Understanding African American Inequality in the Twenty-First Century

Source: Michael B. Katz and Mark J. Stern, Dissent, Winter, 2008

In November 2007, two reports by distinguished research centers turned African American inequality into national news. Their startling and discomfiting data highlighted both the fragility of African American success and the widening fault lines that divide African Americans from each other. Impressive and authoritative as the reports are, they nonetheless remain incomplete because they do not explain how and why African American inequality has changed during the last several decades or the place of gender and publicly supported work in the new black inequality. … Public and state-related employment, thus, have proved the most powerful vehicles for African American economic mobility and the most effective antipoverty legacy of the Great Society. This dependence on publicly funded work also left African Americans vulnerable. Reductions in public employment and spending strike them with special ferocity and undermine their often fragile achievements.

Private Equity and Public Good

Source: Stephen F. Diamond, Dissent, Winter, 2008

The collapse of the credit markets over the last year has hit more than just the homebuilding and mortgage sectors of the economy. As interest rates increased, private equity, or “PE,” an important new form of financial capital, was also rocked on its heels. … Trade unions have an ambivalent attitude toward the rise of private equity. On the one hand, many American labor unions have representatives on the boards of the same pension funds that are largely responsible for the steady flow of capital into PE funds, and, of course, that means some union members have benefited handsomely from the funds’ above-average returns. On the other hand, over the last decade, organized labor has developed a relatively sophisticated program of investor activism through the Office of Investment at the AFL-CIO, the Capital Strategies Group of Change to Win, and similar groups at key affiliates. This effort relies on labor’s pension-fund investments in public companies to raise concerns about corporate social responsibility, excessive CEO pay, workers’ rights, and internal corporate governance. But labor does not seem to have made up its mind whether or not PE funds raise or lower corporate standards of behavior.
See also:
The Modern Corporation and Private Property
Adolph Berle and Gardiner Means

Private Equity’s Broken Pension Promises: Private Equity Companies’ Links
To Insolvent Pension Funds

GMB, a Central Executive Council Special Report, 2007

A Workers’ Guide to Private Equity
International Union of Food, Agricultural, Hotel, Restaurant, Catering, Tobacco and Allied Workers Associations

Technological Change and the Growth of Health Care Spending

Source: Congressional Budget Office, Publication number 2764, January 2008

Health care costs in the United States have grown substantially for decades and are expected to continue to grow in the future. For the federal government, rising health care costs constitute the principal challenge of fiscal policy-no other single factor will exert more influence over the long-term balance of the federal budget. The effects of rising health care costs are not limited to public programs, however. Private payers have experienced similar growth in costs.

This Congressional Budget Office (CBO) paper-written at the request of the Chairman of the Senate Committee on the Budget-describes the historical growth in spending on health care in the United States. It examines the factors that determine health care spending and how they have contributed to spending growth over time. Special emphasis is given to the largest single factor driving spending growth-the greatly expanded capabilities of medicine brought about by technological advances in medical science over the past several decades. Finally, the paper discusses the implications of continued technological change for future growth of health care spending.
Charts
Testimony on Growth in Health Care Costs