Study suggests significant cost saving through holistic medical management

Employers trying to reduce their medical and pharmacy costs may want to take a close look at the overall health of their employees. A new study suggests companies may be able to control some of the hidden costs of absenteeism and presenteeism.

The study, Medication Adherence, Comorbidities, and Health Risk Impacts on Workforce Absence and Job Performance, was conducted by the California-based Integrated Benefits Institute in partnership with Alere Health and American College of Occupational and Environmental Medicine and published in the Journal of Occupational and Environmental Medicine. The study was funded by the National Pharmaceutical Council.

It shows a strong association between increased absences and comorbidities, and lower job performance and health risks. The authors say employers can take steps to prevent and manage many of these cost drivers.

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"Integrated clinical preventive medicine strategies should be part of the foundational underpinnings of the solution to the cost conundrum of this economic burden of chronic illness and its associated consequences of morbidity and mortality," the study said.

Absenteeism and presenteeism. Absenteeism is absence from work while presenteeism equates to decreased job performance. The costs of both can be staggering.

"An earlier study showed the health related workforce absence and job performance costs are significantly greater than medical and pharmacy costs alone, on average 2.3 to 1," the study says. "Chronic conditions such as depression/anxiety, obesity, arthritis and back/neck pain were identified as especially important causes of productivity loss."

The researchers were initially looking into how medication adherence might impact absence and lost job performance among employees with chronic conditions. What they found was something unexpected.

"We knew comorbidities would be important and health risks would be important," said Kim Jinnet, IBI research director. "But we found among a highly medication-adherent population with chronic conditions that those two measures kind of jumped out at us in terms of having a fairly consistent effect on job performance or absence."

The study. The researchers examined information from employees at five different companies who had at least one of four chronic health conditions -- coronary artery disease, hypertension, Type 2 diabetes, and depression -- and divided them into nine different condition-related medication groups. They examined the employees' medical and pharmacy administrative claims data as well as self-reported health risk appraisal information collected during the period Jan. 1, 2007, through May 31, 2009.

A comorbidity index was developed using a simple count of the number of chronic health conditions an employee had among a list of 31. Employees were further identified in terms of how many of the 12 modifiable medical and lifestyle risk indicators they had based on the following at-risk thresholds:

Body weight: BMI greater than or equal to 25.0 or less than 18.5.
Blood pressure greater than or equal to 120/80 mm Hg.
Cholesterol greater than or equal to 200.
Triglycerides greater than or equal to 150 mg/dL.
Blood glucose greater than or equal to 100 mg/dL or greater than or equal to 130 (with diagnosis of diabetes).
Tobacco use: any form.
Alcohol use greater than or equal to eight drinks per week (females) or greater than or equal to 15 drinks per week (males).
Physical activity: estimated physical activity calories less than 999 per week.
Dietary fat: takes steps to reduce fat intake some of the time/rarely/never.
Fruits and vegetable consumption: less than five servings per day.
Stress/coping: completely overwhelmed with pressure or stress -- a moderate amount or more of the time.
Seat belt use: sometimes/rarely/never.

Low health risk status was defined as zero to two risks, moderate was three to four risks, and those identified as high health risk status had five or more risks.

Findings. "The number of health condition comorbidities was found to be a significant predictor of absenteeism in five of the nine medication subsamples," the report found. There was not a significant association seen between the number of health condition comorbidities and lower job performance. The reverse was true for those with higher numbers of health risk factors. The researchers were somewhat surprised by the finding, although in retrospect they said it makes sense.

"In conclusion we thought . . . the more chronic conditions [a person has], the more likely they'll need to take time off work because they're so ill it's difficult to show up," Jinnett said, "or they may have to go to multiple providers and see different physicians for the care. So, we see the effect of comorbidities on absence or not showing up to work."

"There are still a lot of preventive pieces for someone who may have a chronic illness and be on medical management. Instead of sending them off to a pharmacy benefit manager, which they need as well, they also need ongoing screening to see what their health risks are and see what other comorbidities they have," Jinnett said.

Read more at the WorkersComp Forum homepage.

September 19, 2011

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