kenneth mitchell, ph.d.. chattanooga, tn
DESCRIPTION
Kenneth Mitchell, Ph.D.. Chattanooga, TN Nuts and Bolts Research Methods Symposium UT College of Medicine Chattanooga September 29, 2006. Health & Productivity: A Research Agenda from the Private Employer Sector: What Works.. What Doesn’t. Health & Productivity Management: Connections. - PowerPoint PPT PresentationTRANSCRIPT
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 SymposiumUT College of Medicine Chattanooga
September 29, 2006
2
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.
3
The Health & Productivity Realities
The following health and productivity issues are common issues for all employers in the public and private sector.
1. Create affordable and accessible health care2. Reduce the cost of lost productivity 3. Understand workforce health trends – Increased chronic disease & ambiguous
impairments4. Prepare for aging workforce – Increased longevity & productive aging5. Create solutions for ambiguous impairments (e.g. Depression, chronic pain) &
performance management6. 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
4
The Real Problem: The Full Cost of Employee Illness
Medical & Pharmacy Costs
*$6,020 PEPY
Health-related Productivity Costs
$12,000 PEPY
33%
66%
Workers’ CompMedical CostsSalary Continuation
Personal Health CostsMedical CarePharmacyHospitalizationBehavioral Health
Productivity Costs
Presenteeism
Turnover
Replacement Training
Temporary Staffing
Administrative Costs
Variable Product Quality
Employee Dissatisfaction Customer Dissatisfaction
Overtime
Off-Site Travel for Care
STDLTD
Sources: Loeppke, et.al., JOEM, 2003; 45:349-359 and Brady, et.al., JOEM, 1997; 39:224-231
Total PEPY= $18,020
*2003 PEPY Avg.
Absenteeism
5
The Context
0
5
10
15
20
25
30
2000 2010 2020 2030 2040 2050 2060 2070 2080
Percent of GDP - Social Security, Medicare, and Medicaid Spending:
Social Security
Medicaid
Medicare
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 long-term 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.
6
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
7
Pain Costs Compared to Other Conditions: A Case Study
Disease
Prevalence
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
8
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%
9
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%
10
Pain Related Events
77.91
15.54
4.41 1.23 0.910
10
20
30
40
50
60
70
80
% o
f Pai
n Pat
ient
s
0 1 2 3 4+
# of Admissions
Percent of Pain Patients Admitted to Hospital
36.08
17.49
8.706.40 4.53 3.63 2.78 2.26 1.96 1.79
14.37
0
5
10
15
20
25
30
35
40
% o
f Pai
n Pat
ient
s
0 1 2 3 4 5 6 7 8 9 10+
# of Visits
Percent of Pain Patients with Visits for Health Care Utilization (all events)
93.42
5.47 0.86 0.17 0.01 0.01 0.01 0.01 0.00 0.02 0.030102030405060708090100
% o
f Pai
n Pat
ient
s
0 1 2 3 4 5 6 7 8 9 10+
# of Surgeries
Percent of Pain Patients with Surgeries
11
Pain Related Events
79.70
17.17
2.50 0.45 0.12 0.03 0.02 0.01 0.00 0.00 0.010
10
20
30
40
50
60
70
80
% o
f Pai
n Pat
ient
s
0 1 2 3 4 5 6 7 8 9 10+
# of MRIs
Percent of Pain Patients with MRIs
71.47
3.07 2.84 3.43 2.80 2.13 1.67 1.64 1.21 1.028.71
0
10
20
30
40
50
60
70
80
% o
f Pai
n Pa
tient
s
0 1 2 3 4 5 6 7 8 9 10+
# of Visits
Percent of Pain Patients with Chiropractic Visits
59.02
5.77 4.33 4.01 3.35 2.79 2.40 2.04 1.69 1.63
12.98
0
10
20
30
40
50
60
% o
f Pai
n Pat
ient
s
0 1 2 3 4 5 6 7 8 9 10+
# of Visits
Percent of Pain Patients with Physical Therapy Visits
12
Medical & Disability Costs* Related to Medical Conditions
52
287
120
199
182
39
192
20
$0
$50
$100
$150
$200
$250
$300
$350
MusculoskelStrains
DepressionAnxiety
Cancer Ischemic HeartDisease
D
oll
ars
PE
PY
(p
er
em
plo
yee p
er
year)
Medical*Disability
,Includes direct disability costs, but does not include related absenteeism٭presenteeism and productivity costs/losses
13
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.
14
Medical Conditions & Productivity Connections
AmbiguousImpairmentsAmbiguousImpairments
High ScoresHigh Scores
Prevalence =% of ee’sreporting condition
Prevalence =% of ee’sreporting condition
15
Health Risk and Absenteeism
0
2
4
6
8
10
12
14
1 Risks 3 Risks 4+ Risks
6.4 Days
9.3 Days
12.6 Days
Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005
16
Health Risk and Presenteeism
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
0-2 Risks 3-4 Risks 5+ Risks
14.7%
20.9%
26.9%
Source: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005
17
Risk Dynamics – Top STD x Industry & Age > 40
* Based on UPC STD Database/2004
0% 10% 20% 30% 40% 50%
Musculoskeletal/Injury
Circulatory
Cancer
Digestive
Other/Metabolic Diseases
Manufacturing Transportation Education Banking Healthcare
Source: UnumProvident Disability Database, 2002-2004.
18
Risk Dynamics – Top Long Term Impairments x Age
* Based on UPC Long Term Disability Database, 2000-2004
13%
12%
10%
7%
3%
15%
10%
7%
17%
8%
26%0%
0% 10% 20% 30%
Maternity
Back
Accident
Mental Nervous
Cancer
Circulatory
< 40 40 +
19
. . . Continuing for Our Working Lives!
Age of Workers
Percent Growth in U.S. Workforce by Age: 2000-2020
7% 8% 7%
-10%
3%
73%
54%
-20%
0%
20%
40%
60%
80%
under 14 15-24 25-34 35-44 45-55 55-64 65+
Source: US Census Bureau International Data Base
20
Short (STD) and Long (LTD) Term Disability
Source: UnumProvident Disability Database, 2002-2004.
Distribution by age
21
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
Month Claim Began
Qu
arte
rly
Med
ical
Co
st T
ren
d p
er S
TD
C
laim
ant
0
10
20
30
40
50
60
ST
D C
laim
Ave
rag
e D
ays
Du
rati
on
Tre
nd
Quarterly Employee Claimant Costs Average STD Claim Duration
40% Decrease in Per Claimant
Medical Costs
28% Decrease in STD Claim Duration
STD Claim Duration to Claimant Medical Costs
Discussion: Comparing cost reduction per employee to the claim duration patterns suggests a direct and positive relationship between the two outcomes.
22
62.6
49.5
53.7
64.5
49.0 48.1
37.5
52.2
48.2
42.2
34.4
30.1
0
10
20
30
40
50
60
70
Affective Disorders Normal Pregnancy/Delivery Other Mental Conditions Intervertebral Disc Disorders
Ca
len
da
r D
ay
s p
er
Cla
im
1999 2000 2001
• 23% reduction 15% reduction 36% reduction 53% reduction
Duration Comparison of the Four Most Frequent STD Conditions
Variation in Claim Duration Impact across Conditions
23
(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.)
$2,590
$5,430
$1,500
$4,057
$1,700
$5,708
$1,164
$4,199
$1,837
$5,295
$610
$4,026
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
Affective Disorders Normal Pregnancy/Delivery Other Mental Conditions Intervertebral Disc Disorders
Qu
art
erl
y M
ed
ica
l C
os
t p
er
Cla
ima
nt
1999 2000 2001
Variation in Medical Cost Reduction by Condition
29% Reduction 4% reduction 60% reduction < 1% reduction
Medical Cost Comparisonof the Four Most Frequent STD Conditions
24
Bridging the Gaps Through Research & Education
Increase fitness
of workers
Protect work
capacity
Create H&P
culture
Full Work Productivity
Working but Productivity
Impaired
Intermittent & Cyclic
Lost time
Lost Time < 30 days
Lost Time< 26 weeks
Health Promotion
Risk Reduction
Disease/Condition Management
DisabilityManagement
LeaveManagement
Increase compliance
with law
Track & monitor
absences
Reduce adminburden
Reduce onset of chronic
disease
Reduce suddendeath in
workforce
Reducework
related injuries
Reduce impairment
Reduce medical/
pharmacy costs
Reduce Presenteeism
Reduce STD incidence &
duration
Reduce LTD incidence &
duration
Reduce WC medical & indemnity
costs
Employer Based Services Partner Based Services UPC Based Services
Increase fitness
of workers
Protect work
capacity
Create H&P
culture
Full Work Productivity
Working but Productivity
Impaired
Intermittent & Cyclic
Lost time
Lost Time < 30 days
Lost Time< 26 weeks
Health Promotion
Risk Reduction
Disease/Condition Management
DisabilityManagement
LeaveManagement
Increase compliance
with law
Track & monitor
absences
Reduce adminburden
Reduce onset of chronic
disease
Reduce suddendeath in
workforce
Reducework
related injuries
Reduce impairment
Reduce medical/
pharmacy costs
Reduce Presenteeism
Reduce STD incidence &
duration
Reduce LTD incidence &
duration
Reduce WC medical & indemnity
costs
Employer Based Services Partner Based Services UPC Based Services
Increase fitness
of workers
Protect work
capacity
Create H&P
culture
Full Work Productivity
Working but Productivity
Impaired
Intermittent & Cyclic
Lost time
Lost Time < 30 days
Lost Time< 26 weeks
Health Promotion
Risk Reduction
Disease/Condition Management
DisabilityManagement
LeaveManagement
Increase compliance
with law
Track & monitor
absences
Reduce adminburden
Reduce onset of chronic
disease
Reduce suddendeath in
workforce
Reducework
related injuries
Reduce impairment
Reduce medical/
pharmacy costs
Reduce Presenteeism
Reduce STD incidence &
duration
Reduce LTD incidence &
duration
Reduce WC medical & indemnity
costs
Employer Based Services Partner Based Services UPC Based Services
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.
25
Health & Productivity: What Works? What Doesn’t?
What Works
– Evidence Based Medicine
– Functional Work Capacities
– Psychosocial & corporate culture influences
– Determining a Return on Investment
– Patient centered investigations
– Public & corporate policy analysis
What Doesn’t
– Market research designed to support a target product
– “Research” supporting solutions of convenience
– The politics of incapacity & competing self interests
– Political correctness
– Lack of demonstration & application of “model” programs
26
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