Kenneth Mitchell, Ph.D.. Chattanooga, TN

1. Kenneth Mitchell, Ph.D..Chattanooga, TN Nuts and Bolts Research Methods SymposiumUT College of Medicine Chattanooga September 29, 2006 Health & Productivity: A Research Agenda from the Private Employer Sector: What Works.. What Doesn’t

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. • 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

4. The Real Problem: The Full Cost of Employee Illness Personal Health Costs Medical Care Pharmacy Hospitalization Behavioral Health Medical & Pharmacy Costs *$6,020 PEPY 33% Workers’ Comp Medical Costs Salary Continuation *2003 PEPY Avg. Productivity Costs Overtime Health-related Productivity Costs $12,000 PEPY Turnover 66% Absenteeism Temporary Staffing STD LTD Administrative Costs Replacement Training Off-Site Travel for Care Presenteeism Total PEPY = $18,020 Employee DissatisfactionCustomer Dissatisfaction Variable Product Quality Sources: Loeppke, et.al., JOEM, 2003; 45:349-359 and Brady, et.al., JOEM, 1997; 39:224-231

5. The Context Percent of GDP - Social Security, Medicare, and Medicaid Spending: Medicare Medicaid Social Security 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

8. Pain and Co-morbid Conditions

9. Source-of-Pain Categories

10. Pain Related Events

11. Pain Related Events

12. Medical & Disability Costs* Related to Medical Conditions • Includes direct disability costs, but does not include related absenteeism, presenteeism and productivity costs/losses *Disability Medical Dollars PEPY (per employee per year)

13. Medical vs. Productivity Costs of Pain 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 Prevalence = % of ee’s reporting condition Ambiguous Impairments High Scores

15. Health Risk and Absenteeism 12.6 Days 9.3 Days 6.4 Days 1 Risks 3 Risks 4+ Risks Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005

16. Health Risk and Presenteeism 26.9% 20.9% 14.7% 3-4 Risks 5+ Risks 0-2 Risks 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 Source: UnumProvident Disability Database, 2002-2004.

18. Risk Dynamics – Top Long Term Impairments x Age * Based on UPC Long Term Disability Database, 2000-2004

19. . . . Continuing for Our Working Lives! Percent Growth in U.S. Workforce by Age: 2000-2020 Age of Workers Source: US Census Bureau International Data Base

20. Short (STD) and Long (LTD) Term Disability Distributionby age Source: UnumProvident Disability Database, 2002-2004.

21. 28% Decrease in STD Claim Duration 40% Decrease in Per Claimant Medical Costs $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 STD Claim Duration to Claimant Medical Costs 60 50 40 Quarterly Medical Cost Trend per STD Claimant STD Claim Average Days Duration Trend 30 20 10 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.

22. 70 64.5 62.6 60 53.7 52.2 49.5 49.0 48.2 48.1 50 42.2 37.5 40 Calendar Days per Claim 34.4 30.1 30 20 10 0 Affective Disorders Normal Pregnancy/Delivery Other Mental Conditions Intervertebral Disc Disorders 1999 2000 2001 Variation in Claim Duration Impact across Conditions 53% reduction 23% reduction 15% reduction 36% reduction Duration Comparison of the Four Most Frequent STD Conditions

23. 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 forboth claim runout and for inflation.) 29% Reduction 4% reduction 60% reduction < 1% reduction $6,000 $5,708 $5,430 $5,295 $5,000 $4,199 $4,057 $4,026 $4,000 Quarterly Medical Cost per Claimant $3,000 $2,590 $1,837 $2,000 $1,700 $1,500 $1,164 $1,000 $610 $0 Affective Disorders Normal Pregnancy/Delivery Other Mental Conditions Intervertebral Disc Disorders 1999 2000 2001 Medical Cost Comparison of the Four Most Frequent STD Conditions

24. 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.

25. 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 Health & Productivity: What Works? What Doesn’t?

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