An Initiative of the John D. and Catherine T. MacArthur Foundation and Harvard Medical School

1. An Initiative of the John D. and Catherine T. MacArthur Foundation and Harvard Medical School

2. Adam Smith on the Relationship Between Illness and Productivity ��that men in general should work better when they are ill fed than when they are well fed, when they are disheartened than when they are in good spirits, when they are frequently sick than when they are generally in good health, seems not very probable. Years of dearth, it is to be observed, are generally among the common people years of sickness and mortality which cannot fail to diminish the produce of their industry.� - Adam Smith, Wealth of Nations, 1776

8. The World Health Organization Global Burden of Disease (GBD) Initiative Estimate productivity costs of disease to countries Rank order specific diseases in terms of DALY�s Rank order cost-effectiveness of available interventions

9. The GBD Message Treating illness costs money (direct costs) Not treating illness also costs money (indirect costs) When indirect > direct, treatment becomes an investment opportunity

10. Costs of Untreated Illnessto Employers Sickness absence Presenteeism Ripple effects Big losses Disability Other health care costs (offset)

16. Yes Flu shots Seasonal allergies Safety-sensitive jobs

17. What Are the Critical Questions? Are costs of untreated disorders high enough? Are treatments effective enough?

18. A Number of Major Disease Categories Are Corporate Investment Opportunities Commonly-occurring illnesses Associated with substantial work impairment Undertreated Effective treatments exist

19. Some Examples of Disease Categories and Needed Investments Low back pain ? Ergonomics Seasonal ? Increase use of allergies newer medications Depression ? Increase outreach

20. What Sorts of Investment Options Exist? Risk reduction to prevent onset Outreach to speed contact with the treatment system Improvement in treatment and disease management Improvement in disability management

21. Barriers to Investing in Worker Health Proving the case Overcoming the silo mentality Competing with alternative investment opportunities

22. Barriers to Proving the Case Indirect costs are difficult to document and quantify Standards of proof differ widely Generalizing from controlled studies to the real world is hazardous Helping internal sales efforts

23. Overcoming the Silo Mentality Who pays vs. who saves Short-term vs. long-term thinking Targeting the message at the right management level � (the VA at the cutting edge) end of bullet #2� (the VA at the cutting edge) end of bullet #2

24. Competing with Alternative Investment Opportunities Evaluating alternatives (R&D, training, performance incentives, etc.) Direct or implicit comparisons Does information hurt or help Missing 4th bullet Ron only: (Eli Lilly � How many people work for you? About half.)Missing 4th bullet Ron only: (Eli Lilly � How many people work for you? About half.)

25. Starting with the Easy Sells Disability management Safety sensitive jobs Winner take all and other key employee situations End of third slide for Ron only: (Exxon Valdez; GM) End of third slide for Ron only: (Exxon Valdez; GM)

26. What Next? And Where? High impact targeted conditions Key opinion-leader companies Outreach vs. best practices Case studies vs. capstone studies Ron only end of third slide: (HRA, blood pressure screening, PCP screen) Ron only end of third slide: (HRA, blood pressure screening, PCP screen)

27. Example: Restricting Benefits for Treatment of Mental Illness Percent 1993 1995 Change % of enrollees using 5.8% 5.2% -11% outpatient MH services % of enrollees using 63.5% 75.8% 19% other outpx services

28. Example: Restricting Benefits for Treatment of Mental Illness (cont.) Percent 1993 1995 Change Nonmental health $2325 $3175 37% costs of prior MH users Nonmental health 1297 1315 1% costs of MH nonusers

29. A strategy to monitor both costs of untreated illness and return on investment in health care

30. Harvard Program on Health and Work Productivity Claims data analysis The Health and Productivity Questionnaire (HPQ) Objective calibration Monetizing indirect costs The WHO WMH2000 Initiative

31. Harvard Program on Health and Work Productivity (cont.) Aggressive outreach effectiveness trials Best practices effectiveness trials Quality assurance

32. How common is the illness? How much performance decrement is associated with the illness? What is the monetary loss of the performance decrement?

33. How much does the decrement decrease after the intervention? What is the short-term return on investment in health care?