Western Occupational and Environmental Medical Association Webinar – June 17, 2010

1. Western Occupational and Environmental Medical Association Webinar – June 17, 2010 To Work or Not to Work:The Costs of Presenteeism and AbsenteeismSpeaker: Constantine Gean, MD, MS, MBA, FACOEM Regional Medical Director, Liberty Mutual Group PLEASE STAND BY WEBINAR WILL BEGIN AT 12:00pm (PDT) For Audio: Call: 866-740-1260Access Code: 7644915# Faculty Disclosure: Constantine Gean, MD, MS, MBA, FACOEM has no conflict of interest to disclose.

2. To Work or Not To Work The Costs of Presenteeism and Absenteeism Constantine Gean, MD, MS, MBA, FACOEM Regional Medical Director, Liberty Mutual Group WOEMA Webinar - June 17, 2010

3. Learning Objectives • Understand absenteeism, presenteeism, and differences between the two • Describe why absenteeism and presenteeism are important concepts for occupational health practice • Obtain a general concept of the origins of presenteeism. • Appreciate absenteeism and presenteeism as they relate to the Workers Compensation and Group Health arenas. • Review the economic consequences of absenteeism and presenteeism. • Obtain an understanding of program approaches to monitoring and limiting costs from absenteeism and presenteeism.

4. The Big Picture The Solar System

5. “Ideas rather than materials or physical brawn have been by far the greatest contributors during the past half-century to our average annual increase of 3-1/4 percent in real gross domestic product.” Alan Greenspan, March 11, 2004 (Before the Committee on Education and the Workforce, U.S. House of Representatives)

6. WHAT IS PRODUCTIVITY? Levels of labor Productivity in 1990 US Dollars WORKING PAPER NO. 50 - European Central Bank, 2001http://www.ecb.int/pub/pdf/scpwps/ecbwp050.pdf

7. “Hang On! I just got another nibble!” The Perils of Fishing

8. Intel income statement - analysis of the value of human capital • Estimated cost of human capital • 36% of revenues • 24% of book value of Companies • Because of this high cost human capital warrants significant investment • On a par with fixed capital costs • Sending on human capital (some overlap): • Group health (47%) • Turnover (37%) • Unscheduled absences (8%) • Non-occ disability (5%) • Workers’ Comp.(3%) - Dr. Marc L. Berger VP of Merc Outcomes Research- Validated by R. Howell, Dean of Dartmouth’s Bus. School

9. Cost Drivers • Disability Costs Exceeded $340 million (Wall St. Journal) • Disability Costs 8-10%of payroll (Unum 2002 Study) • Disability Costs can exceed $2,500per employee (DOL/COREl)

10. What are they? How Measured? Examples? PRESENTEEISM AND ABSENTEEISM

11. Presenteeism Origins • Presenteeism is the opposite of absenteeism • Presenteeism discusses the problems faced when employees come to work in spite of illness, which can have similar negative repercussions on business performance • Issue has existed in some form or another for centuries • Name is relatively new • Factors and History • ‘40-’50’s EE-sponsored Health Care • GDP Growth + Managed care • Cornell Study, ACOEM, Dartmouth Cost of Human capital • Increased US Longevity • Downsized workforces (increases relative contribution from each EE) • Workforce Optimization

12. Presenteeism and Absenteeism – Unions’ and Employers’ Perspectives • Presenteeism often cited cause – • Fear of loss of income or employment on the part of the employee • Over59 millionAmerican workers (nearly half of the workforce) do not have access to paid sick days • Nearly80%of low-income workers do not have access to paid sick days • On average, workers need1.8 sick days/yearto care for themselves and4 days/yearto care for sick children • Trade Unions’ Perspective – • Presenteeism has developed as a result of a gradual relaxation of employment protection laws and reductions in benefits, most notably sickness benefits • Employers' Perspective – • Other factors are contribute to presenteeism, including an increase in health care costs, which has rendered employees more reluctant to seek medical attention when it is necessary Lovell, 2004 - IWPR publication B242

13. Most Relevant Conditions Impacting Productivity Change Based on POV(Top 10 Medical Conditions From Various Perspectives ) JOEM • Volume 49, Number 7, July 2007

14. Medications Can Compound Problems

15. Est. Annual Cost of Presenteeism(employed Population @ $23.15/hour) Arthritis Depression Hypertension Allergy Goetezel, et. Al., JOEM Volume 46, Issue 4, pp398-412 (April 2004)

16. Absenteeism • DEFINITION: A habitual pattern of absence from a duty or obligation • Traditionally viewed as poor individual performance • Seen as a management problem • Framed in economic or quasi-economic terms • More recently seen as an indicator of psychological, medical, or social adjustment to work • Short Term Disability • Generally 50% of absences are < 2 weeks, and 50% are > 2 weeks

17. Commonly used Days Away from Work (DAFW) Approach CONCLUSION: Find low hanging fruit just by adding up DAFW.

18. Spine Pain, Depression and Fatigue Top ListTop 10 Overall Most Costly Medical Conditions (Annual medical + drug + Absenteeism + Presenteeism costs per 1000 EE) JOEM • Volume 49, Number 7, July 2007

20. What to do to limit? How Managed? Examples? PRESENTEEISM AND ABSENTEEISM

21. Approaches to Absenteeism and Presenteeism Management Health & Productivity Management Disability management Value-based health care provision Productivity management Wellness & Health promotion Footnotes: a, b - 2001 Unscheduled Absence Survey. CCH Inc. c -2001 Health Value Initiative, Hewitt Associates

22. MANAGEMENT OF RESOURCES

23. ExpandedView Health & Productivity Management Disability management Value-based health care provision Issues • Per-EE abs cost = $755 in ’01a • Provider RTW role ignorance • Older workers (LTD incr 4x fr. 42 to 57 yo.)b • Multiple Health programs • Unreasonable utilization • Redundant benefits • Non Evidence-based Treatments • Multiple Health programs • Pharmacy spend & misuse Issues Approaches • Commonly used • Absence/DAFW mgt. pgms • Modified Duty pgms • Rapid medical assmt. & triage • Preventive Programs • Less commonly used • formal supervisor RTW training • setting RTW expectations • super’s & EE certainty: + training • keeping in touch with EE • ALOD Variation, analys & interven. • Plan approaches • Appropriate Benefit mix • Pharmaceutical restrictions • Defined Contribution Plans • Reduction/Attenuation of benefits • Clinical Management approaches • Pharmaceutical Management • Utilization analysis (Medstat) • Pre-Authorization ReviewsClinical • Concurrent Review • Case Management • Demand Management • Disease Management • Specialty Case Management • Population Health Management Approaches Productivity management Approaches • RTW and Stay at Work programs • Scope of Work Wellness & Health promotion • Health Promotion • Modifiable health risk/HRA pgms. Footnotes: a, b - 2001 Unscheduled Absence Survey. CCH Inc. c -2001 Health Value Initiative, Hewitt Associates Approaches

24. Backache and Depression Most Prevalent Conditions(Focus on the most common conditions)

25. OVERALL UTILIZATION TRENDS - Circulatory Case Types (ALOD = Average Length of Disability) Result: 12% ALOD decrease.

26. HIGH IMPACT UTILIZATION TRENDS- Psychiatric Case Types(ALOD = Average Length of Disability) 26

27. Manufacturer - Location Analysis- ALOD by Location and type (MedicalvsMH*)-4 Qtr Summary(Q3’ 00-Q2’01) Savings Potential: What’s up with San Jose and Orchard Park? *MH=Mental Health ICD-9’s

28. So What Does this Mean from the Clinician’s POV? “Oh, the Pain!”

29. Implications for the Practitioner(ID problems and be a good doctor) • Understand the continuumof Absenteeism and Presenteeism can help the care of the individual • Do aggressive treatmentof common conditions (depression, respiratory illness, hypertension) • Understand/find possible company resources(EAP’s, wellness programs, special benefits, etc.) • Encourage employers to use transitional workand focus on defining employee functional level

30. Chronic Pain (Biopsycosocial Model) Loeser J. Managing the Chronic Pain PatientD,, 1989

31. Implications for the PractitionerUnderstand basic disability prevention/management • Understand the Biopsychosocial Model(e.g., emotional reactions accompany temporary disability and should be managed to prevent it becoming permanent). • Understand that a diagnosisalone (without demonstrable functional impairment) may not justify work absence • ID and treat psychiatric issuesand teach patients about the interaction of psychiatric and physical problems. • Understand Functional Recovery Programsand use them in cases of delayed recovery

32. ? WRAP UP AND QUESTIONS

33. Presenteeism and Absenteeism Literature Preventing Needless Work Disability by Helping People Stay Employed – ACOEM Position Paper - J Occup Environ Med - 01-SEP-2006; 48(9): 972-87http://www.acoem.org/guidelines.aspx?id=566 Healthy Workforce/Healthy Economy: The Role of Health, Productivity, and Disability Management in Addressing the Nation's Health Care Crisis J Occup Environ Med - 01-JAN-2009; 51(1): 114-9 Health and Productivity as a Business Strategy J Occup Environ Med - 01-JUL-2007; 49(7): a712-21 Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers J Occup Environ Med - 01-APR-2004; 46(4): 398-412

34. Thank you for participating in today’s webinar. At the conclusion of this call you will receive an email with a link to a post-webinar questionnaire. You will need to complete this questionnaire in order to receive CME for this webinar. This webinar presentation can be downloaded at www.woema.org