From a benefits site:

Employers Start to See Link Between Health Productivity

Researchers say that employers will take action when they are offered
easy-to-use, verifiable methods of determining how employee illness affects
profits.
by Kate Mulligan

Employers are beginning to take a serious look at how the health of their
employees affects the bottom line, according to information presented at the
Washington Business Group on Health (WBGH) meeting in March (Psychiatric News,
April 19).

Walter Stewart, Ph.D., M.P.H, director of the AdvancePCS Center for Work and
Health and an adjunct professor at Johns Hopkins University, spoke on "Getting
a Handle on the True Costs of Illness to Improve Productivity" and later
expanded on his comments in an interview with Psychiatric News.

AdvancePCS provides pharmacy benefits management (PBM) and other
health-related services.

Stewart said that a key element in persuading employers to act on the link
between health and productivity is providing them with quantitative data on
actual costs and an easy-to-understand metric that translates into a direct
dollar value and applies broadly across all occupations and work settings.

"Most employers know there’s a link between health and productivity, but
because the link has been difficult to quantify, they have chosen not to act,"
he told Psychiatric News.

In part, quantification has been difficult, according to Stewart, because
research has focused on productivity (how much an employee produces) as
opposed to productive time (number of effective hours worked) and because
easy-to-use measurement tools are not available.

Business factors such as the work environment can affect productivity,
weakening a causal relationship between the health of an employee and what he
or she accomplishes at work.

American Productivity Audit

Stewart and his colleagues began the American Productivity Audit last July
with telephone interviews of a random sample of U.S. workers each day. The
first full year of the survey will be completed June 30, with a total of
25,000 interviews.

The five- to 15-minute survey interview covers items such as occupation
description, health assessment, missed days of work due to health conditions
(self and others), reduced performance at work because of health conditions,
and demographic factors such as age and sex.

Before beginning the audit, the research team tested six different
questionnaires and two time periods of recall. Two weeks was the longest
period for which recall was deemed reliable, according to Stewart.

After validation of the interview questions, the research team began
conducting 2,000 telephone interviews of workers in randomly selected
households each month. The database now includes results of more than 17,000
interviews.

Stewart analyzed the prevalence of 11 common ailments during a two-week period
of recall among subjects in the database. For purposes of his analysis, he
separated "fatigue" and "sad/blue," although he recognizes an overlap.
Sad/blue is not synonymous with a diagnosis of depression. Stewart plans
follow-up studies to determine what percentage of workers reporting feeling
sad/blue meet diagnostic criteria for depression and the implications of that
diagnosis on an employer’s costs.

Headache and other pain conditions were reported most frequently. Fatigue was
second, with 42 percent reporting at least one episode during the preceding
two weeks. About 29 percent of the respondents reported feeling sad/blue.

The annual cost of employees’ lost productive hours due to the conditions
above is more than $180 billion.

Using the interview results, Stewart developed data on hours of lost
productive time (while an employee was at work or absent from work) among
those with one of the ailments specified (see chart). Fatigue and sad/blue
were outranked by cold/flu, headache/pain, digestive problems, and arthritis
in terms of number of lost productive hours.

Stewart also tested his methods of calculating lost productive hours with the
staff of the AdvancePCS call center. He had access to records showing
productivity of employees in terms of calls answered and time on line and
compared those records with self-reports.

Extrapolating from the database, Stewart estimated the total cost each year of
the top five episodic health conditions in the U.S. workforce by gender. He
combined the categories of fatigue and sad/blue because he is still developing
a method of separating the costs.

The combined category of fatigue and sad/blue ranks third, with estimated
annual costs of $17.8 billion for men and $14.2 billion for women. These costs
include lost work time due to missed days and hours and reduced performance
translated into lost hours.

Next Steps

Stewart envisions a five-stage implementation plan with employers. As the
first stage, he will offer an employer a free estimate of the costs of
work-related illnesses at that company or organization.

Stewart can tailor his database to fit the demographics of individual
companies. "For example," he said, "the average age of employees at AdvancePCS
is about five years lower than the national average." The age and sex
distribution of a workforce, as well as other demographics, have implications
for the prevalence of various ailments, as well as for the amount of time lost
because of the illnesses of family members.

The second stage would be to conduct an employer-specific audit. Research,
such as pilot studies and focus groups, is being conducted now to determine
how best to communicate with employees and to understand how receptive they
are to this work. Stewart would then work with the employer to prioritize
illnesses in terms of their impact on costs and the likelihood that they can
be successfully addressed with low-cost interventions.

He said, "For any one condition, 70 percent to 80 percent of the lost
productive time is concentrated in 20 percent to 35 percent of the employees."


The fourth stage would be to develop tools and services to address the
conditions, and the fifth stage would be to evaluate the benefits of the
interventions by conducting follow-up surveys where the costs of lost
productive time are compared with estimates obtained in previous surveys.

AdvancePCS is conducting pilot studies with five companies on this
implementation approach. Stewart said, "One of those companies (which cannot
be named) has a workforce of about 23,000 individuals. We’re estimating that
the company loses $60 million each year due to all illnesses. Five conditions
account for 65 percent of the loss." The figure includes lost productive time
(due to missed days or missed hours and reduced performance at work)
translated into lost hours.

Lloyd Sederer, M.D., director of APA’s Division of Clinical Services, said,
"At the heart of our business initiative program is the belief that treatment
for depression and other mental illnesses is important for the individual and
is also good business. That is the message that we take consistently to
employers."

The program is an APA effort that started two years ago to educate the
business community that providing good mental health services can positively
impact their bottom line (Psychiatric News, July 20, 2001).

Sederer, along with Ron Z. Goetzel, Ronald J. Ozminkowski, and Tami L. Mark of
the MEDSTAT Group, published an article, "The Business Case for Quality Mental
Health Services: Why Employers Should Care About the Mental Health and
Well-Being of their Employees" in the April issue of Journal of Occupational
and Environmental Medicine. The MEDSTAT Group is a health information company.


The authors reported available information on employee depression and its
impact on business, including the results of a recent analysis that found that
depressed workers cost their employers 70 percent more in annual health costs
when compared with nondepressed colleagues.

They also suggested promising research opportunities in light of their
relevance, time feasibility, data availability, and affordability.


OK, if you've read this far, let me say this worries me.  What if they don't
stop at depression or flu or colds?  What if they expand the concept of
illness to disabilities?  Very scary.

Kat