Transcript RTW Pathways for Ambiguous Impairments

Health & Productivity:
A Research Agenda from the Private Employer
Sector: What Works.. What Doesn’t
Kenneth Mitchell, Ph.D..
Chattanooga, TN
Nuts and Bolts Research Methods Symposium
UT College of Medicine Chattanooga
September 29, 2006
Health & Productivity Management: Connections
All lost time is connected
Lost time and healthcare costs are connected
Impairment is objective… Disability is subjective ….
…and depends on…….
Understand that corporate policies and practices “disable”
more individuals than any injury or illness.
2
The Health & Productivity Realities
The following health and productivity issues are common issues for all employers in the
public and private sector.
1.
2.
3.
4.
5.
6.
Create affordable and accessible health care
Reduce the cost of lost productivity
Understand workforce health trends – Increased chronic disease & ambiguous
impairments
Prepare for aging workforce – Increased longevity & productive aging
Create solutions for ambiguous impairments (e.g. Depression, chronic pain) &
performance management
Recognize work/life predicaments that turn into “Disabilities” or Who will be the last
well person?
The H&P Points of Contact
that can be enhanced though
research & education
3
The Real Problem:
The Full Cost of Employee Illness
Personal Health Costs
33%
Medical &
Pharmacy Costs
*$6,020 PEPY
*2003 PEPY Avg.
Workers’ Comp
Medical Costs
Salary Continuation
Medical Care
Pharmacy
Hospitalization
Behavioral Health
Productivity Costs
$12,000 PEPY
Total PEPY
= $18,020
66%
Health-related
Productivity Costs
Absenteeism
STD
LTD
Overtime
Turnover
Temporary Staffing
Administrative Costs
Replacement Training
Off-Site Travel for Care
Presenteeism
Employee Dissatisfaction
Customer Dissatisfaction
Variable Product Quality
Sources: Loeppke, et.al., JOEM, 2003; 45:349-359
and Brady, et.al., JOEM, 1997; 39:224-231
4
The Context
30
Percent of GDP - Social Security, Medicare, and Medicaid Spending:
25
20
15
Medicare
10
Medicaid
5
Social Security
0
2000
2010
2020
2030
2040
2050
2060
2070
2080
Note: Social Security and Medicare projections based on the intermediate assumptions of the 2005 Trustees’ Reports.
Medicaid projections based on CBO’s January 2005 short-term Medicaid estimates and CBO’s December 2003 longterm Medicaid projections under mid-range assumptions.
Source: GAO analysis based on data from the Office of the Chief Actuary, Social Security Administration, Office of the
Actuary, Centers for Medicare and Medicaid Services, and the Congressional Budget Office.
5
Healthcare Costs by Age x Risk
Source: Musich, McDonald, Hirschland, Edington, Disease Managements & Health
Outcomes 2002; 10(4): 251-258; University of Michigan Health Management Research
Center.
Used with permission. Dee Edington, Ph.D. University of Michigan, Ann Arbor, Michigan
6
Pain Costs
Compared to Other Conditions: A Case Study
Prevalence
Disease
Rate
Cost
% of Grand
Total Cost
Coronary Artery
1.18
$5,329,189
1.16
Heart Failure
0.21
$18,487,808
4.03
Diabetes
3.19
$59,279,346
12.93
Asthma
2.68
$36,432,797
7.95
Depression
2.12
$44,181,502
9.64
Pain
8.36
$154,130,320
34.62
Subtotal
-----
$317,840,962
70.33
Grand Total
-----
$458,433,071
100.00
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Pain and Co-morbid Conditions
Condition
% Pain Patients w/
Condition
% Total Population
with Condition
Diabetes
8.34%
3.19%
Depression
7.91%
2.37%
Arthritis
9.14%
1.30%
Hypertension
18.06%
6.07%
Injuries
24.24%
7.19%
Anxiety
4.20%
1.27%
8
Source-of-Pain Categories
Source of Pain
# of
Patients
% of MSCP patients
Nerve compression
2,775
15.04%
Carpal tunnel syndrome (cts)
1,189
6.45%
Myalgia
12,390
67.17%
Nerve damage
3,929
21.30%
Migraine
2,134
11.57%
Joint
2,911
15.78%
Other drug dependency
2,946
15.97%
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Pain Related Events
Percent of Pain Patients Admitted to Hospital
77.91
80
% of Pain Patients
70
Percent of Pain Patients with Visits
for Health Care Utilization (all events)
40
50
40
30
15.54
20
4.41
10
30
0
0
25
20
2
0.91
3
4+
14.37
15
8.70
10
1
1.23
# of Admissions
17.49
5
6.40
4.53 3.63
2.78 2.26 1.96
1.79
4
9
0
0
1
2
3
5
6
7
8
10+
Percent of Pain Patients with Surgeries
# of Visits
% of Pain Patients
% of Pain Patients
35
36.08
60
100
90
80
70
60
50
40
30
20
10
0
93.42
5.47
0
1
0.86
2
0.17
3
0.01
4
0.01
5
0.01
6
0.01
7
0.00
8
0.02
9
0.03
10+
# of Surgeries
10
Pain Related Events
Percent of Pain Patients with Chiropractic Visits
80
% of Pain Patients
70
Percent of Pain Patients with MRIs
60
50
40
30
20
10
80 79.70
8.71
3.07 2.84 3.43 2.80 2.13 1.67 1.64 1.21 1.02
0
0
70
1
2
3
4
60
5
6
7
8
9
10+
# of Visits
50
40
30
17.17
20
10
Percent of Pain Patients with Physical Therapy Visits
2.50 0.45 0.12 0.03 0.02 0.01 0.00 0.00 0.01
0
0
1
2
3
4
5
6
7
8
9
10+
60
# of MRIs
59.02
50
% of Pain Patients
% of Pain Patients
71.47
40
30
20
12.98
10
0
5.77 4.33 4.01
0
1
2
3
3.35 2.79 2.40 2.04 1.69
4
5
6
7
8
1.63
9
10+
# of Visits
11
Medical & Disability Costs*
Related to Medical Conditions
‫٭‬Includes direct disability costs, but does not include related absenteeism,
presenteeism and productivity costs/losses
*Disability
Medical
$350
(per employee per year)
Dollars PEPY
$300
$250
$200
287
199
39
20
$150
$100
120
$50
$0
182
192
52
Musculoskel
Strains
Depression
Anxiety
Cancer
Ischemic Heart
Disease
12
Medical vs. Productivity Costs of Pain
Costs of Selected Pain Related Conditions
Condition
Annual Direct Medical
Costs
Annual Productivity
Costs
Repetitive Strain
Injuries, including
Carpal tunnel
syndrome
$1 billion
$26 billion
Lower back pain
$25 billion
$28 - $56 billion
Migraine
$1 billion
$13 - $17 billion
American Academy of Orthopedic Surgeons. www.aaos.org2.Hu, X.H., Markson, L.E., Lipton, R.B., Stewart, W.F.,
Berger, M.L. “Burden of migraine in the United States: disability and economic costs.” Arch Intern Med. 1999;
159:813-818.
3.Osterhaus, J.T., Gutterman, D.L., Plachetka, J.R. “Healthcare resource use and lost labor costs of migraine headache
in the United States.” Pharmacoeconomics 1992; 2:67-76.
4.Patterson, J.D., Simmons, B.P. “Outcomes assessments in carpal tunnel syndrome.”
Hand Clin 2002 May; 18(2):359-63, viii.
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Medical Conditions & Productivity Connections
Prevalence =
% of ee’s
reporting
condition
Ambiguous
Impairments
High Scores
14
Health Risk and Absenteeism
14
12
12.6 Days
10
8
6
9.3 Days
4
2
6.4 Days
0
1 Risks
3 Risks
4+ Risks
Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005
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Health Risk and Presenteeism
30.00%
25.00%
26.9%
20.00%
15.00%
20.9%
10.00%
5.00%
0.00%
14.7%
0-2 Risks
3-4 Risks
5+ Risks
Source: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005
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Risk Dynamics – Top STD x Industry & Age > 40
Other/Metabolic Diseases
Digestive
Cancer
Circulatory
Musculoskeletal/Injury
0%
Manufacturing
10%
20%
Transportation
30%
Education
40%
Banking
50%
Healthcare
* Based on UPC STD Database/2004
Source: UnumProvident Disability Database, 2002-2004.
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Risk Dynamics – Top Long Term Impairments x Age
Circulatory
3%
Cancer
8%
17%
7%
7%
Mental Nervous
< 40
10%
10%
Accident
12%
15%
13%
Back
Maternity
40 +
0%
0%
26%
10%
20%
30%
* Based on UPC Long Term Disability Database, 2000-2004
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. . . Continuing for Our Working Lives!
Percent Growth in U.S. Workforce by Age: 2000-2020
80%
73%
60%
54%
40%
20%
7%
8%
7%
3%
0%
-10%
-20%
under 14
15-24
25-34
35-44
45-55
55-64
65+
Age of Workers
Source: US Census Bureau International Data Base
19
Short (STD) and Long (LTD) Term Disability
Distribution by age
Source: UnumProvident Disability Database, 2002-2004.
20
STD Claim Duration to Claimant Medical Costs
$8,000
Quarterly Medical Cost Trend per STD
Claimant
$7,000
50
$6,000
$5,000
$4,000
$3,000
60
40
40% Decrease in
Per Claimant
Medical Costs
30
20
$2,000
$1,000
10
STD Claim Average Days Duration Trend
28% Decrease in STD
Claim Duration
$0
0
Month Claim Began
Quarterly Employee Claimant Costs
Average STD Claim Duration
Discussion: Comparing cost reduction per employee to the claim duration patterns suggests
a direct and positive relationship between the two outcomes.
21
Variation in Claim Duration Impact across Conditions
•
23% reduction
15% reduction
36% reduction
53% reduction
70
64.5
Calendar Days per Claim
62.6
60
53.7
50
49.0
48.2
49.5
52.2
48.1
42.2
37.5
40
34.4
30.1
30
20
10
0
Affective Disorders
Normal Pregnancy/Delivery
1999
2000
Other Mental Conditions
Intervertebral Disc Disorders
2001
Duration Comparison of the
Four Most Frequent STD Conditions
22
Variation in Medical Cost Reduction by Condition
(Costs are per claimant incurred during the 90 days immediately following the start of the disability.
Costs are adjusted for both claim runout and for inflation.)
Quarterly Medical Cost per Claimant
29% Reduction
4% reduction
$6,000
60% reduction
< 1% reduction
$5,708
$5,430
$5,295
$5,000
$4,057 $4,199 $4,026
$4,000
$3,000
$2,000
$2,590
$1,700 $1,837
$1,500
$1,164
$1,000
$610
$0
Affective Disorders
Normal Pregnancy/Delivery
1999
2000
Other Mental Conditions
Intervertebral Disc Disorders
2001
Medical Cost Comparison
of the Four Most Frequent STD Conditions
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Bridging the Gaps Through Research & Education
Employers and various health and disability partners connect and compete with services. There are
clear gaps on how the services are connected with the relative impact only guessed at. Research &
education programs can measure a clear sense of impact and accurately communicate innovative
combinations and connections.
Risk
Reduction
Disease/Condition
Management
Increase
fitness
of workers
Reduce onset
of chronic
disease
Reduce
impairment
Protect
work
capacity
Reduce sudden
death in
workforce
Reduce
medical/
pharmacy
costs
Create
H&P
culture
Reduce
work
related
injuries
Health
Promotion
Full Work
Productivity
Working but
Productivity
Impaired
Leave
Management
Disability
Management
Increase
compliance
with law
Reduce STD
incidence &
duration
Track &
monitor
absences
Reduce LTD
incidence &
duration
Reduce
Presenteeism
Reduce
admin
burden
Reduce WC
medical &
indemnity
costs
Intermittent &
Cyclic
Lost time
Lost Time
< 30 days
Lost Time
< 26 weeks
Employer Based Services
Partner Based Services
UPC Based Services
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Health & Productivity: What Works? What Doesn’t?
What Works
– Evidence Based Medicine
What Doesn’t
– Functional Work Capacities
– Market research designed to
support a target product
– Psychosocial & corporate
culture influences
– “Research” supporting
solutions of convenience
– Determining a Return on
Investment
– The politics of incapacity &
competing self interests
– Patient centered investigations
– Political correctness
– Public & corporate policy
analysis
– Lack of demonstration &
application of “model”
programs
25
A Proposed H & P Employer Research Agenda
• Develop & test models for accessible, affordable & effective healthcare
• Focus on lost productivity & treatment outcomes…
– Protecting work capacity in the aging work force
– Cancer survivors’ health, productivity and employability
– Depression as a comorbid condition
– Patient compliance – Patient motivation with metabolic Syndrome
• Demonstrating unique employer, healthcare, & insurance connections &
partnerships
• Understand and control Iatrogenic/Bureaugenic disability
– Avoid/mitigate treatment/physician/employer collisions
• Prepare Physicians to accurately determine functional work capacity
• Build work transitions into treatment recommendations – a WorkRx model
26