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Sponsor Spotlight BY Christopher O'Keeffe | February 18, 2025

Rising Health-Plan Costs and the Role of Centers of Excellence

Cancer treatments now account for the majority of employer healthcare costs, says Dana Baker, senior director at Mayo Clinic’s Complex Care Program. With the rise in high-cost claims and the growing prevalence of cancer treatments, Baker discussed how Mayo Clinic’s Centers of Excellence can help alleviate costs. Beyond rising drug costs, Baker highlighted the impact of high-cost claimants during a thought leadership spotlight at From Day One's Chicago benefits conference. “Employers are experiencing a 50% increase in this, so when we talk about high-cost claimants,” or individuals whose healthcare costs reach over a million dollars annually. More companies are turning toward structured healthcare solutions. Each year, Business Group on Health conducts a major survey covering about 17 million insured lives. Based on the findings, these are the top three solutions for controlling health plan costs, says Baker. Baker notes, “50% of the employers shared that they would have a cancer solution by the end of this year, then another 26% are sharing that they’re implementing in 2026 and 2027.”The Three R’s: Right Diagnosis, Right Treatment, Done RightDana Baker of Mayo Clinic led the session Mayo Clinic’s Centers of Excellence (COEs) follow a strategic model to improve healthcare outcomes. “So when you look at what COEs do, we call them the three R's: right diagnosis, right treatment and done right."Here’s how it breaks down, says Baker. Simplifying access to high-quality care, even if that means literally moving the patient: Baker acknowledges that some may see covering travel as a significant expense. “When you look at the overall expense of covering travel for a patient, when they go through a program like this, they;re only there for three to five days,” Baker said. “It’s under $2,000 for a patient to travel, have a flight there, and have a hotel. So it's actually not as expensive as you think it would be”It’s important to focus on the right employees. “That’s really when you look to your partners on how they are identifying these individuals. Are they doing active outreach to patients that are having complex issues?”Lastly, Baker emphasizes the importance of simplifying the experience. “At Mayo, we’re all under one roof. And what makes that unique is, if anyone’s experienced care there, when you walk in, your labs, your imaging, your pathology, is all done on one campus.”A Real-World Case Study: Molly’s StoryTo illustrate the impact of COEs, Baker shared the case of a patient named Molly. “She was having persistent coughs. This is a case last year, and her local oncologist that treated her before diagnosing her was starting her on aggressive chemotherapy and radiation treatments. However, her employer did offer a Centers of Excellence benefit with Mayo Clinic.”Mayo Clinic reevaluated Molly’s diagnosis and determined she didn’t have cancer—after she had already begun aggressive treatment. By ensuring diagnostic accuracy, COEs help employers avoid costly and unnecessary treatments. One key factor is having the frozen lab on the same floor as the surgical suites, allowing patients to remain under anesthesia while confirming clean margins. This approach reduces the risk of repeat surgeries or incomplete diagnoses, says Baker. “So Molly had an easy fix, antibiotics and a trip home, and she didn’t have cancer.”What Employers Should Look for in a COE ProgramBaker advised employers to carefully evaluate healthcare solutions. “As you look at the marketplace that's out there, it’s saturated with vendors.” Mayo differentiates itself by ensuring equal access to high-quality care.Mayo has been providing care for 160 years, compared to some centers that have only emerged in the past few years. Unlike others, Mayo also delivers the actual care. Cancer remains a top driver of employer healthcare costs. “It’s going to be the number one thing for a while. It used to rotate between cardiovascular health and cancer on the top ones, but now it’s truly riding up there as a top expense.”She emphasized the importance of data-backed healthcare solutions. “The proof is in the data on what the outcomes look like.”Editor’s note: From Day One thanks our partner, Mayo Clinic, for sponsoring this thought leadership spotlight. Chris O’Keeffe is a freelance writer with experience across industries. As the founder and creative director of OK Creative: The Language Agency, he has led strategy and storytelling for organizations like MIT, Amazon, and Cirque du Soleil, bringing their stories to life through established and emerging media.

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News BY the Editors | February 11, 2025

The Demonization of DEI: 10 Questions About What Went Wrong and What Happens Next

When disaster strikes, the traditional way for leaders to respond is to mourn the victims, praise the first responders, and call for patience while experts figure out the cause. But in America’s culture wars, such forbearance is gone. One common suspect is targeted in calamity after calamity: the pursuit of diversity, equity and inclusion, or DEI, the relatively recent approach to addressing inequities and structural racism going back centuries in the U.S.The accusations have become reflexive. Anti-DEI activists and politicians have blamed DEI for the tragic airborne collision in Washington, D.C., the California wildfires, a toxic train derailment, a major bridge collapse, the Silicon Valley Bank failure, and more. No evidence has emerged to support those theories, yet the rising chorus of accusations have turned DEI into a radioactive term. The assault reached a crescendo last month when President Trump veered from somber, prepared remarks about the DC tragedy into a half-hour attack on “woke” elements and diversity as the underlying cause. How could he prove the connection? “It just could have been,” he said. “Because I have common sense. OK? And unfortunately, a lot of people don’t.” His supporters have been more explicit, making the case that competent white males have been overlooked in favor of incompetent DEI hires, an alleged pattern of reverse discrimination.While the backlash against DEI has been building for more than two years, the momentum picked up steam when the president launched his second term with a sweeping attack on DEI in the federal government, academia, the scientific community, corporate America, and beyond. Calling DEI “nonsense,” Trump told financial leaders at Davos last month that “America will once again become a merit-based country.”Wielding his executive power over the federal workforce, which employs more than 3 million people, Trump ordered all DEI-focused offices to shut down, put their workers on leave, and ordered them to report any coworkers trying to “disguise these programs by using coded or imprecise language.” Failure to do so “may result in adverse consequences,” the administration told workers, which created a prospective new persona: the DEI snitch. Workers were told to scrub personal-pronoun preferences from their email signatures, and the Pentagon announced that the military would no longer “use official resources” to celebrate commemorations like Black History Month.How did the cause of DEI become vulnerable to such vehement and often misleading attacks that even many of its advocates are losing the will to fight? Why are some major corporations backing away from their wholehearted embrace of DEI, while others are sticking to their commitments? Can advocates of DEI learn from its excesses and pursue their principles by other terms or other means? Should the term DEI simply be dropped?These questions need to be energetically explored, since the war on DEI has created a perilous landscape for HR leaders and corporate America in general. Companies will have to balance stakeholder interests, employee expectations, legal vulnerabilities, and their public reputation. They need to consider the impact of their DEI-policy decisions on recruiting and employee engagement, especially among younger and more diverse workforces who may view such retreats as a step backward. As we head into four years of a new administration that’s bent on escalating the backlash, how should HR leaders continue to build inclusive organizations? From Day One asked experts and sampled the latest surge in reporting on the DEI wars. Among the issues:Which employers are backing away from their DEI commitments, and why?In the racial-justice movement that arose after George Floyd’s death in May 2020, corporate America rushed to build programs and put money behind the cause of DEI. Yet within three years, the zeal flagged in the face of a U.S. Supreme Court decision striking down affirmative action in higher education, attacks and lawsuits by anti-DEI activists, and financial constraints. Many DEI advocates questioned whether corporations were ever really committed, but the headwinds became undeniable.And the threats keep growing. Many types of DEI programs could draw new lawsuits accusing them of “illegal D.E.I.,” a term that has caused widespread confusion and has lawyers scrambling to interpret what it might mean. “We’re in a brave new world. People are freaked out,” Jon Solorzano, a lawyer who counsels corporations on DEI, told the New York Times.The trigger effect: Among President Trump’s barrage of executive orders was one that struck down a 1965 executive order by LBJ banning discrimination by federal contractors, which had inspired them over the decades to set up programs favoring marginalized workers and subcontractors. Trump’s executive order tells each federal agency to identify “up to nine potential civil compliance investigations” for companies pursuing such practices, like giving jobs or promotions to specific groups based on their race. No company wants to be among the nine called out.Even before this new legal threat, a parade of household-name companies had publicly dialed back their DEI efforts. Walmart, Ford Motor, Lowe’s, Harley-Davidson, John Deere, Amazon, Google, Target, and others have all announced cutbacks. Among the programs: DEI spending, labeling, diversity goals, and participation with partners who monitor DEI progress. While not long ago companies were often accused of “rainbow-washing,” or being performative about their commitments to DEI, now they’re “rainbow-hushing” by cutting or reframing their DEI programs.Walmart, which employs 1.6 million workers in the U.S., said it won’t renew a racial-equity center that was established through a five-year, $100 million philanthropic commitment from the company. Ford told employees it will no longer participate in an annual survey from an LGBTQ advocacy group, the Human Rights Campaign. After showing little reluctance to support DEI causes in recent years, many corporate leaders now tend to acknowledge that they’re feeling the heat. “We are mindful that our employees and customers hold a wide range of beliefs,” Ford CEO Jim Farley told employees in an email. “The external and legal environment related to political and social issues continues to evolve.”Which companies are sticking with their commitments­—and why?Costco, which ranks No. 11 on the Fortune 500 and has more than 300,000 workers, has made headlines by bucking the trend. Its board of directors unanimously urged its shareholders to vote against a proposal by a conservative think tank that would require Costco to issue a report on the financial risks of maintaining its DEI program. The group criticized Costco “for possible ‘illegal discrimination’ against employees who are  ‘white, Asian, male, or straight,’” as CNN reported.Costco’s response, in a statement to investors, echoed what many corporations has given as the purpose behind their DEI support: “Among other things, a diverse group of employees helps bring originality and creativity to our merchandise offerings, promoting the ‘treasure hunt’ that our customers value. We believe (and member feedback shows) that many of our members like to see themselves reflected in the people in our warehouses with whom they interact.”Apple, too, pushed back against a similar proposal. DEI hasn’t been a passing fancy for the company. Apple has had a supplier-diversity program since 1993, hired its first VP of DEI in 2017, and among its employees now has 67 “diversity network associations.” Apple said the proposal “inappropriately attempts to restrict” and “micromanage” the company.Speaking at Davos, Jamie Dimon, CEO of JPMorgan Chase, said, “We are going to continue to reach out to the Black community and Hispanic community, LGBT community, and the veteran community. ... Now if you point to something we’re doing that’s wrong, I’d change it. But we’re very proud of what we’ve done, and what we’ve done is lift up cities, schools, states, hospitals, countries, companies, and we’re gonna do more of the same.”Yet it was the National Football League that delivered the most well-timed defense of its DEI programs: on the eve of the Super Bowl. While the NFL had struggled to navigate the politics of Black Lives Matter and earlier social-justice waves, it more solidly committed after the murder of George Floyd. “We got into diversity efforts because we felt it was the right thing for the National Football League, and we're going to continue those efforts because we've proven to ourselves that it does make the NFL better,” the league’s commissioner Roger Goodell told reporters. “We're not in this because it's a trend to get into it or a trend to get out of it.” In terms of hiring decisions, he added, “There are no quotas in our system. This is about opening that funnel and bringing the best talent into the NFL.”Did DEI advocates overreach—and how?While standing up for their basic values, many DEI advocates admit that the cause committed some self-sabotage. “Undoubtedly, there has been ham-fisted DEI programming that is intrusive or even alienating, making workers feel that they are being told what to think or how to feel. But, for the most part, it is a relatively benign practice meant to increase diversity, while also sending a message that workplaces should be fair and open to everyone,” writes Keeanga-Yamahtta Taylor, a professor of African-American Studies at Princeton, in the New Yorker.Indeed, many experts in the field of corporate training say that part of the DEI backlash was triggered by poorly designed programs and overly righteous practitioners, not core values. “You cannot be inclusive by being exclusive and the way DEI has been operationalized over the last few years gives the appearance of being exclusive, rather than common-sense principles that uplift everyone,” Janine Yancey, CEO and founder of Emtrain, told From Day One.The current DEI movement gained momentum after the murder of George Floyd in May 2020. A memorial to police-shooting victims sprang up near the site of his death in Minneapolis (Photo by Stephen Koepp/From Day One)“The current model of diversity needs a shift,” said Stefanie Christmas, global head of DEI for Inizio, a Dublin-based, life-sciences company. “We’ve defined it too narrowly, associating it only with ‘minorities’ instead of embracing the full spectrum of human differences. This leaves many—especially straight, cisgender men—feeling they have nothing to contribute.”“Decades of research shows clear problems with status-quo DEI,” writes inclusion strategist Lily Zheng in Harvard Business Review. “Despite their widespread prescription, DEI trainings often fail to change bias or reduce prejudice. Popular strategies for communicating the value of DEI can paradoxically both hurt marginalized communities and decrease leadership support for DEI. Common initiatives intended to create better workplaces for all might instead activate backlash, increase burnout, and fail to improve outcomes for underserved groups. DEI needs a reset,” wrote Zheng, who offers a prescription for responding to the backlash.What is the continued rationale for keeping up the fight for DEI programs?Backing up their DEI initiatives, organizations typically have made both a moral case (it’s socially just) and an economic case (it’s good for business), in various measure and emphasis, but always with a sense of inevitability about it. “Saying diversity is dead is like saying gravity is ending. Ridiculous,” said a diversity professional who didn’t want to be quoted by name given the crossfire of the moment. “Ask yourself, ‘Are you building the types of teams that are better for business?’ Managers are underprepared to get the best work out of diverse employees, whether we’re talking about neurodiversity, gender, LGBTQ+, accessibility. Most employers know they need to do and say the right things to keep and attract those new generations. It’s a math problem, a business issue, a growth issue.”Surveys of the workforce indicate steadfast support for DEI issues, despite the blitz coming from Washington. “Continuity of DEI as a value driver in the workplace doesn’t make the news. Pushback is part of the news cycle, but the commitment to DEI endures,” said Ripa Rashid, managing director of Seramount, which advises companies on building more inclusive workplaces. According to Seramount’s nationally representative 2024 survey of more than 3,000 U.S. white-collar and frontline employees across dimensions of diversity, geography, and political affiliation, 76% of employees agreed with the statement: “I am committed to helping my company fight racism and injustice within the organization” and 78% indicated that it is “very important” for their company to be an inclusive organization.The pronounced whiplash in corporate support for the LGBTQ+ community strikes some experts as financially self-defeating. “Inclusion is a driver of the business. Those businesses backing away from their support of the LGBTQ+ community will fall behind their competition who continue to show up for the community, Mita Mallick, author of Reimagine Inclusion: Debunking 13 Myths To Transform Your Workplace, told From Day One. “According to LGBT Capital, the estimated purchasing power of the global LGBTQ+ community is $4.7 trillion. Belief-driven buying consumers are on the rise, and they will continue to vote with their wallet and walk away from brands and companies they feel no longer match their values.”Did DEI programs make any measurable progress toward their own stated goals?Not all that much, at least in numerical terms, according to a Wall Street Journal analysis of 13 million workers at S&P 500 companies. In the four years since George Floyd’s murder launched the wave of DEI programs, “the workforces of the biggest public companies have become slightly less white, and Asian and Hispanic employees have made modest games,” reported the Journal. “The picture is more lopsided in the upper ranks of these companies. White men have lost a little ground but still occupy half of all senior manager roles. White women—a bigger focus of corporate diversity efforts before 2020—have experienced the least change since then. The share of senior managers who aren’t white, meanwhile, rose to 26% from 22%.”Amazon, which said in a memo to employees in December, that it’s halting some of its DEI efforts, has one of the most diverse workforces, the Journal noted. With hundreds of thousands of workers in warehouses and other operations, “about 69% of its roughly 1 million workers were people of color in 2023, compared with nearly 67% in 2020,” the Journal said. Though its senior management remains largely white, “Amazon embarked on a pandemic hiring spree and made a push to hire more Black executives into high-level roles. Over four years, the share of nonwhite senior managers nearly doubled, with those of Asian descent rising the most.”And at the top of the C-suite, the number of women CEOs running Fortune 500 companies was at 52 last year, more than double the number of six years ago—and a 2,500% increase from 1998, when only two Fortune 500 companies were led by women. One of the current women CEOs, Citigroup’s Jane Foster, is making a case for sticking with inclusive policies that benefit everybody, such as flexible work schedules and parent-friendly policies.Can DEI programs avoid the flak and focus their mission by changing their terminology?Many companies have shifted from standard DEI terminology to focus more on terms like just inclusivity and belonging, with the implication that no employee is left behind. This is reflected in job titles as well. For example, top leader Mark Brown of Starbucks, who has a background in both talent acquisition and DEI, since 2023 has carried the title of SVP of global talent and inclusion. “We want to represent the communities that we serve, and we want to innovate for all our different audiences,” he told a From Day One audience last year. “And if we don’t have more voices in the conversation and more backgrounds in the conversation, we can’t continue to create a sense of belonging and warmth in our stores, which is core to what we do.”Of course, anti-DEI advocates are wary of organizations doing a rebranding of such efforts without a more wholesale capitulation to dumping DEI, hence the warning from the Trump administration to anyone who might “disguise these programs by using coded or imprecise language.”Despite the high-profile statements from famous companies, however, surveys of U.S. corporations taken in recent months indicate that “these programs aren’t dying; they’re morphing,” according to DEI legal experts Kenji Yoshino and David Glasgow, writing in the Los Angeles Times. “The ‘DEI in the dustbin’ narrative is utterly unsupported by the data. The companies that have formally backed away from their diversity programs represent a tiny minority of corporate America. The conservative Heritage Foundation recently conceded that 486 out of the Fortune 500 still have inclusion statements or commitments on their websites,” they write. “This data jibes with our experience as scholars who study DEI. A vast majority of the hundreds of major organizations with which we have interacted over the last year or two are still deeply committed to these values. They are just doing the work more quietly and carefully than before, to avoid unwanted scrutiny and lawsuits.”What can DEI advocates do better, by whatever name they go by?Many DEI advocates assert that workforces and other communities need to dig even deeper into emthathy and brave conversations, rather than retreating into opposite camps based on identity or political affiliation. “If DEI reframes to focus on everyone's consciousness and intentionality—thinking about what each person needs to feel respected and a sense of belonging so they can deliver their best work—that gets the behaviors needed to foster DEI,” said Emtrain’s Yancey.“To create change, we need to highlight—through personal stories and self-reflection— privilege’s sliding scale and the impact of exclusion,” said Inizio’s Christmas. “Once people can understand what it feels like to lack privilege or be excluded, they’re more likely to empathize with other marginalized communities and drive real change.”Are liberals and progressives all on the same page in advocating DEI programs?No, a thoughtful cohort of thinkers and leaders on the left are skeptical of DEI programs, saying they’re a distraction from attacking economic inequality—and sometimes even get in the way. People in this camp “prefer activism that focuses on class rather than racial or gender and sexual identity. They tend to see labor unions and worker-led organizing as a more effective solution to inequality,” writes labor journalist Noam Scheiber in the New York Times.Faiz Shakir, a Democratic activist and former manager of Senator Bernie Sanders’s presidential campaign, told Scheiber that DEI programs often serve to divide the working class and “soften the actual confrontation with corporate power we need in society.” Workplace DEI policies essentially buy off workers on the cheap, he said, adding: “You get a penny for your efforts. A little trinket here or there, that should mollify you.” In that view, DEI is essentially a tool of management, rather than one that empowers employees.What are the stakes in terms of who else is hurt when DEI programs are dropped?The case has been made that the fallout will affect people ranging from women and minority contractors to rural poor communities. In late January, Target announced that it was concluding its three-year DEI goals and its Supplier Diversity team would be renamed Supplier Engagement. Pernell. “The announcement from Target, just a week before the start of Black History Month, hit Black entrepreneurs particularly hard. The company had created an infrastructure that helped Black-owned start-ups even before the 2020 protests, [coffee entrepreneur Pernell] Cezar said, and then set a goal of featuring about 500 Black-owned brands in its stores by the end of this year,” the New York Times reported. Since the entrepreneurs behind such startups tend to have less startup capital and fewer connections than their competitors, “It’s definitely the wild, wild West of the haves and have-nots if you don’t have institutional knowledge,” Cezar said.One of Trump’s executive orders also took aim at “environmental justice,” eliminating positions and assessing spending on projects, including those aimed at poor, rural communities, CNN reported. The order cancelled many financial grants designed to help small communities,  including everything from wastewater-treatment plants to tornado shelters for schools in poor communities. The thinking behind such grants is that the effects of climate change fall disproportionately on poor communities. “Environmental justice is not affirmative action. It’s not DEI [to have] the right to breathe clean air, drink clean water and the right to have environmental laws to be enforced equally across the board,” said Robert Bullard, an environmental-justice pioneer.Employers, too, could face legal trouble from abandoning DEI principles by exposing themselves to more discrimination lawsuits by workers, experts said. While reverse-discrimination lawsuits do occur, they’re vastly outnumbered by those filed by members of marginalized communities. “Many common corporate policies that fall under the DEI umbrella, such as auditing pay practices, requiring diverse pools of job candidates, and ensuring that promotions are awarded fairly, are crucial tools for employers to ensure compliance with state and federal laws banning workplace discrimination,” lawyers and other experts told Reuters.Will corporate American start to deny diversity, either as a fact or value?Even the statements by leaders whose companies announced pullbacks in DEI programs seemed to be hedging their bets, from leaders of Tractor Supply Co. to Meta, the parent of Facebook. In a companywide meeting after Meta ended its DEI and fact-checking programs, CEO Mark Zuckerberg sought to reassure his workforce that the company’s values hadn’t changed, despite the new regulatory regime in Washington. “I mean, it’s a little crazy that we need to say this,” Zuckerberg said. “We continue to believe that diversity is a strength.”Reported by Jenny Sucov, independent journalist, and Stephen Koepp, editor-in-chief of From Day OneFor further reading, here's a selection of more than 200 stories on DEI by From Day One.(Featured photo by FG Trade/iStock by Getty Images)

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