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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.

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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

Health & Productivity: A Research Agenda from the Private Employer Sector: What Works.. What Doesn’t

Health productivity management connections
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.

The health productivity realities
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

The real problem the full cost of employee illness
The Real Problem: The Full Cost of Employee Illness

Personal Health Costs

Medical Care



Behavioral Health

Medical & Pharmacy Costs

*$6,020 PEPY


Workers’ Comp

Medical Costs

Salary Continuation

*2003 PEPY Avg.

Productivity Costs


Health-related Productivity Costs

$12,000 PEPY




Temporary Staffing



Administrative Costs

Replacement Training

Off-Site Travel for Care


Total PEPY

= $18,020

Employee DissatisfactionCustomer Dissatisfaction

Variable Product Quality

Sources: Loeppke,, JOEM, 2003; 45:349-359

and Brady,, JOEM, 1997; 39:224-231

The context
The Context

Percent of GDP - Social Security, Medicare, and Medicaid Spending:



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.

Healthcare costs by age x risk
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

Pain costs compared to other conditions a case study
Pain Costs Compared to Other Conditions: A Case Study

Medical disability costs related to medical conditions
Medical & Disability Costs* Related to Medical Conditions

  • Includes direct disability costs, but does not include related absenteeism, presenteeism and productivity costs/losses



Dollars PEPY

(per employee per year)

Medical vs productivity costs of pain
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.

Medical conditions productivity connections
Medical Conditions & Productivity Connections

Prevalence =

% of ee’s





High Scores

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

Health Risk and Presenteeism




3-4 Risks

5+ Risks

0-2 Risks

Source: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005

Risk dynamics top std x industry age 40
Risk Dynamics – Top STD x Industry & Age > 40

* Based on UPC STD Database/2004

Source: UnumProvident Disability Database, 2002-2004.

Risk dynamics top long term impairments x age
Risk Dynamics – Top Long Term Impairments x Age

* Based on UPC Long Term Disability Database, 2000-2004

Continuing for our working lives
. . . 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

Short std and long ltd term disability
Short (STD) and Long (LTD) Term Disability

Distributionby age

Source: UnumProvident Disability Database, 2002-2004.

28% Decrease in STD Claim Duration

40% Decrease in

Per Claimant Medical Costs










STD Claim Duration to Claimant Medical Costs




Quarterly Medical Cost Trend per STD


STD Claim Average Days Duration Trend





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.















Calendar Days per Claim







Affective Disorders

Normal Pregnancy/Delivery

Other Mental Conditions

Intervertebral Disc Disorders




Variation in Claim Duration Impact across Conditions

53% reduction

23% reduction

15% reduction

36% reduction

Duration Comparison of the

Four Most Frequent STD Conditions

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










Quarterly Medical Cost per Claimant











Affective Disorders

Normal Pregnancy/Delivery

Other Mental Conditions

Intervertebral Disc Disorders




Medical Cost Comparison

of the Four Most Frequent STD Conditions

Bridging the gaps through research education
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.

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

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

A proposed h p employer research agenda
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