Reducing total health burden from 2001 to 2009: an employer counter-trend success story and its implications for health care reform.

OBJECTIVES: To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs. METHODS: Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001-2002 to 2008-2009. RESULTS: Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred. CONCLUSIONS: Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.

Impact of a musculoskeletal disability management program on medical costs and productivity in a large manufacturing company.

OBJECTIVE: To evaluate a program to reduce musculoskeletal disability-related absenteeism at a North American manufacturing facility. STUDY DESIGN: Staged communication and educational interventions targeting physicians to improve care of musculoskeletal conditions and reduce related absenteeism. METHODS: The program was implemented in three 1-year stages. The first stage required physicians to complete assessment forms for employees claiming disability because of musculoskeletal injuries. The second stage added physician education programs focusing on current clinical guidelines. The third stage incorporated local physician education about the facility's onsite physical therapy program. Annual number of work-related injuries, days lost per injury and per scheduled full-time-equivalent (FTE) employee, light-duty days per injury, average annual indemnity per FTE, indemnity per injury, medical costs per FTE, and medical costs per injury were examined to determine the program's effectiveness. RESULTS: Overall productivity improved by a mean of 12.5 days per injured employee. Mean days lost per work-related injury decreased from 35.1 to 27.6. Number of light-duty days increased from 6.1 to 11.1 per work-related injury. Mean annual indemnity per work-related injury decreased from $9327 to $4493; mean annual medical costs per work-related injury decreased from $4848 to $2679. The annual incidence of musculoskeletal injuries declined by up to 50%. CONCLUSIONS: This intervention was associated with reduced musculoskeletal disability-related absenteeism and increased productivity. The program reduced medical costs per work-related injury and improved the company's communications and relationship with local physicians.

The burden of allergies--and the capacity of medications to reduce this burden-in a heavy manufacturing environment.

This article addresses the observational findings of the first systematic study undertaken by a manufacturer to address the impact of allergies and use of allergy medications on health, safety, and productivity. It provides background for 3 other papers from the same project, including an evaluation of an intervention to promote appropriate medication use among affected employees, which appear in this issue. The observational data are developed on 10,714 employees from: 1) 2 employee surveys; 2) administrative databases monitoring employee absenteeism, workers compensation, short-term disability, and group health. The results show that health, productivity, absenteeism, workplace injury, and workers compensation measures register consistent declines as allergy severity levels increase. This pattern is present but less pronounced for the short-term disability and group health measures. In addition, among the 16 measures registering a significant allergy burden, 6 posted significant advantages for the use of nonsedating antihistamines relative to other medication regimens that included sedative antihistamines. These results document the burden of allergies and the capacity of medications to reduce this burden. Effective intervention programs that target this condition can achieve improved health, productivity, and related outcomes.

An intervention to promote appropriate management of allergies in a heavy manufacturing workforce: evaluating health and productivity outcomes.

This work presents the evaluation of a first-of-its-kind intervention to improve the management of allergies among workers in a largely blue-collar industrial setting. This intervention implemented eight educational strategies focusing on appropriate medication use in the context of a controlled, nonrandomized, pre-post quasi-experimental study design. Program implementation occurred during summer 2001, with change assessed by means of measures of health and productivity, developed from employee surveys timed to occur at the height of the spring and fall allergy seasons, and measures of contemporaneous adverse events developed from administrative databases. Evidence of improvement was found at one experimental site but not at the other experimental sites or the control site. Tests using exploratory and confirmatory analyses were conducted of two hypotheses linking the gains of this site's allergy group to 1) intervention process changes and 2) changes in allergy severity caused by seasonality. Neither hypothesis is found to fully account for the explained variation between sites. Similar pre-post productivity gains for other disease groups at this site relative to the other sites suggest that the inclusion of other unmeasured variables would improve explanation; e.g., the responses of employees with chronic disease to notably challenging labor negotiations at this site. The implications for promoting behavioral change in the management of the impact of disease on productivity are explored.