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Employers know an absent worker is not a productive worker and one who doesn't feel well probably isn't as productive as he could be. What most employers don't know is how much unproductive workers cost them each year.

UnitedHealth Group has information that may help employers identify these cost drivers--andhealth and wellness programs designed to help decrease costs, increase productivity and improve the bottom line.

IBI conducted two major studies to determine what employers know about their workforce health, productivity and impact to the bottom line. What would they do differently if they had the proper data to make informed decisions about their health care plans?

Chief financial officers surveyed had a broad understanding that poor health impacts productivity. Ninety percent understood ill health made it difficult for employees to focus on their jobs. Eighty-four percent said ill health--whether employees were absent (absenteeism) or present but not feeling well (presenteeism)--affected the bottom line. In addition, if they had quantitative lost-productivity information, here's how they would do things differently:

-- 73 percent said they would manage all health-related costs more closely;

-- 70 percent would examine the business benefits of their health plans;

-- 75 percent would welcome measures to reduce presenteeism.

Among the leading causes of presenteeism are chronic illnesses such as depression, obesity, arthritis, back and neck pain, anxiety, Gastroesophageal Reflux Disease (GERD) and allergies.

Ninety-eight percent said they are implementing at least one health-promotion practice. These include employee assistance, smoking cessation, nutrition education, fitness programs and participation incentives. More than half said they are implementing 12 of the 14 programs outlined.

Ninety-one percent are implementing at least one disease-management practice. Programs range from referrals to counselors, specialists, health-risk coaching, chronic-disease management and value-based benefits. Three out of five employers said at least half of their employees are engaged in at least one program.

Eighty-five percent are implementing at least one disability/return-to-work management practice. Programs include nurse case management, transition RTW, early disability reporting and/or RTW education and incentives. "Employers are starting to understand the importance of not managing conditions after they occur," said Dr. Parry.

Furthermore, he said, "Since the surveys were taken in the middle of the recent recession, you might expect employers to cut back on health benefits, the opposite was true. Seventy percent said they would increase resources for one or more practices."

"Health and productivity are genuine business issues. In lean times, when margins are small and downsizing is necessary, the employees left at work better be healthy and productive or you will have significant business problems," Dr. Parry said. "Waiting to try to manage a (disease or disability) after it occurs is too late."

Ironically, the surveys showed the most highly rated programs from a productivity standpoint--transitional return-to-work, early disability reporting and on-site clinics--were not the most widely used. While smoking cessation and Employee Assistance Plans (EAP) are prevalent, they are not high on the productivity scale. They may have positive impacts on employees' health and may reduce medical and pharmacy costs, but employers do not have productivity in mind when they adopt them.

"Without the proper data, employers are hard-pressed to move in a new direction," said Dr. Parry. "We believe there are avenues for employers to take the next step, but they need to know what the data says and what tools can help them."

Enter UnitedHealth Group. It recently rolled out several service models designed to lower health costs and help improve health outcomes, which may result in a more productive workforce.

Tom Beauregard, executive vice president, UnitedHealth Group Center for Reform & Modernization, said, "These programs were developed in response to the growing body of information on chronic illnesses that threaten the health and productivity of the American workforce. The increase in diabetes and associated costs and comorbidities could even eventually bankrupt the entire health care system if effective prevention and management steps are not taken."

"We need to focus on ways to decrease preventable chronic conditions. According to our book of business analysis 2008, three-quarters of today's health care expenditures are attributed to the 20 percent of people with chronic conditions," said Beauregard.

"The private sector--payers, employers and providers--need to focus on those with chronic conditions," he said. "If there is one area that needs the most focus, it is childhood obesity which can eventually lead to diabetes in adults." According to JAMA 2010, the number of individuals diagnosed with diabetes doubled in the last six years and the trend continues upward.

According to the CDC, 36 percent of U.S. adults are prediabetic or diabetic. Many diabetics are undiagnosed. Many of those who are diagnosed, do not comply with their medication and thus likely to develop even costlier complications. "A prediabetic doesn't need to become a diabetic, it's all about prevention and compliance," said Beauregard.

To that end, in 2008 UnitedHealth Group introduced a Diabetes Health Plan (DHP) that removes out-of-pocket expenses for certain care in exchange for meeting certain compliance requirements, based on American Diabetes Association (ADA) guidelines. They also recently introduced the Diabetes Prevention and Control Alliance (DPCA), a specialty, voluntary program for those identified as prediabetic or diabetic. The DPCA consists of two health service models, a Diabetes Prevention Program for prediabetics and a Diabetes Control Program for people with diabetes but noncompliant with medication.

The Diabetes Prevention program is an alliance with the YMCA. Its goal is to increase employee compliance, monitor medications, help control blood pressure and blood sugar?ideally avoid any debilitating and costly complications. It provides group sessions for nutrition training and prevention of bad habits that can lead to diabetes. The program is based on clinical trials conducted by the CDC and the National Institute of Health, which proves intervention for prediabetics can thwart progression to diabetes.

The Diabetes Control Program is a different model that uses pharmaceutical information to make sure diabetics stay compliant with ADA standards.

According to Beauregard, "Almost 90 percent of prediabetics do not know they are. We use the Ingenix (a UnitedHealth Group company) Disease Precursor Identification (DPI) database, the largest database of medical facts and demographics available to identify diabetes risk. We initiated a pilot program to identify employees likely to be prediabetic or diabetic, get them screened and then place them in either a clinical or control program."

"Our research shows that the intent to enroll, when paid for, is high," Beauregard said. Among suspected diabetics, more than 60 percent of those surveyed were likely to enroll. Among suspected prediabetics, about 70 percent were likely to enroll.

Another new and major UnitedHealth Group program is its Childhood Obesity Initiative, a pilot program to help prevent childhood obesity and associated medical impacts. "We are coordinating and investing in a collaborative, comprehensive solution that supports and empowers at-risk children and their families to achieve better health," Beauregard said.

Initially, the community-based child obesity intervention will target at-risk children and their families in and around Providence, R.I., starting in January 2011. The goal is to create healthier families, delay or prevent the onset of chronic disease, lower medical costs and reduce work/school absences. For children, the short-term expectation is a reduction in health expenses for inpatient/outpatient care and medication for other conditions such as asthma, diabetes and depression. For their parents, the expectation is for a reduction in lost productivity due to absenteeism and for overweight parents, a reduction in additional health expenses.

Longer term, the expectation is a reduction in eventual adult health expenses attributed to childhood obesity and in lost productivity. "All of these programs are simple to implement. Very little technical effort is needed," said Beauregard.

What it all boils down to, said IBI's Parry, is the need for data to understand the magnitude of the problem and the ability to use tools, such as those developed by UnitedHealth Group, to bring the pieces together and broaden the discussion about what it all means to employers, their employees and their businesses.

(The above piece is part of our continuing Perspectives series designed to highlight key products and services to our readers. This paid-for Perspectives was written and edited by Risk & Insurance® in conjunction with our marketing partner. Additional Perspectives can be found on our Web site at www.riskandinsurance.com/.)

November 1, 2010

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