Bank One's worksite-based asthma disease management program.

Non-occupational asthma is a common disease affecting approximately 6% of the US population. Asthma accounts for an estimated 3 million workdays lost each year in the United States and for reduced employee job productivity. Although asthma disease management programs are relatively common in managed care organizations, they generally have not been offered at the workplace. A total of 168 employees with asthma were identified, and 76 participated in a worksite asthma disease management program. Of them, 41 (53.9%) completed an Asthma Therapy Assessment Questionnaire (ATAQ) at baseline, post-program (2 months), 4 months, and 12 months. The total ATAQ Index declined from 3.59 at baseline to 2.76 at 12 months (p < 0.01). After the program, significantly more employees reported using controller medications (the desired behavior) rather than reliever medications. A worksite-based disease management program for asthma should reduce medical care costs and absenteeism and improve worker productivity.

The impact of allergies and allergy treatment on worker productivity.

Allergic disorders are a chronic and highly prevalent condition in the general population and the workforce. Their effect on workers and corporate costs go beyond the direct cost of treatment, as the condition can lower a worker's productivity. Previous research includes estimates of the decrease in productivity associated with allergic disorders. None of these studies, however, offered an objective measure of how worker productivity is affected by allergic disorders. In the present study, the productivity of telephone customer service representatives suffering from allergic disorders is examined before, during, and after the ragweed pollen season. In addition, these workers were surveyed as to the type of medication they used in response to their condition. A significant correlation was observed between an increase in pollen counts and a decrease in productivity for workers with allergies. Compared with workers without allergies, employees with allergies who reported using no medication showed a 10% decrease in productivity. No differences were observed among workers with allergies using different types of medications, although the medication groups had significantly higher productivity than the no-medication group. The expected lowered productivity of those workers with allergies who used sedating antihistamines may have been offset by their relatively lower level of symptom severity and by the nature of the job and the productivity measures used.

Disability management: corporate medical department management of employee health and productivity.

This study describes a proactive in-house program for managing short-term disability (STD) in the workforce of a very large banking system. The goals of this program were to (1) minimize the personal and economic impacts of STD by early intervention, (2) validate the extent and duration of STD, and (3) coordinate medical services and provide guidance to managers that would facilitate an early return to work. This program was made possible by the installation of a comprehensive database, called Occupational Medicine and Nursing Information System. This database mainly includes employees' claims for inpatient and outpatient health services, disability and workers' compensation benefits, wellness program participation, medical examinations and laboratory tests, use of prescription drugs, and results of Health Risk Appraisals. As a result of these efforts, STD event duration declined after this STD management program was implemented in locations heretofore outside the system, and by providing full pay for part-time work after STD, within the system as well. Of note, the average number of STD days per employee showed substantial variation by health plan, including the fact that it was higher (3.9 STD days/employee) for health maintenance organization participants than for indemnity plan members (2.7 STD days/employee).

The role of health risk factors and disease on worker productivity.

The costs attributed to employee health problems are usually measured by employers in terms of direct health care costs, such as medical plan claims. Although it has been understood that employee health problems also produce indirect costs for employers, their measurement has been far less frequent. At best, studies have recorded one component of indirect health costs: the time lost to employee absenteeism and disability. The study presented here includes a measure of the actual decrease in the productivity of employees while they are on the job, in addition to measures of absenteeism and disability. These three measurements were combined to produce a Worker Productivity Index (WPI). The WPIs of 564 telephone customer-service agents were correlated with the employees' number and type of health risks, as measured by a Health Risk Appraisal. Additionally, the WPI was also examined across different disease states in the same population of employees. As the number of health risks increased, an employee's productivity decreased. The nature of the health risk may also differentially affect the pattern of the decrease. Finally, disease states were also associated with different patterns of productivity reduction.

The costs of body mass index levels in an employed population.

We studied 3,066 First Chicago NBD employees by using health risk appraisals and personnel data to determine the direct and indirect costs (in 1996 dollars) associated with varying levels of body mass index (BMI). The BMI is the most widely used measure of weight adjusted by height. We found that as BMI increases, so do the number of sick days, medical claims and health care costs and that the mean annual health care costs for the BMI "at risk" population (men with a BMI of > or = 27.8 kg/m2, women > or = 27.3 kg/m2) was $2,274 versus $1,499 for the "not at risk" group. Major differences in health care costs were observed for employees 45 years old and older, particularly among the women in this age group. Analysis was completed for those employees with and without a risk for BMI. A "J-shaped" curve between medical claims costs and BMI exists, with the low point occurring at about 25 to 27 kg/m2. We conclude that indirect and direct costs to an employer increase with increasing BMI. Employers may benefit from helping employees achieve a healthier weight. The initial target population should be those who are at highest risk of complications from obesity.

Cutting the costs of migraine: role of the employee health unit.

It is estimated that over 120 million Americans suffer from moderate to severe attacks of migraine characterized by headache and other debilitating symptoms, resulting in impaired functional capacity and diminished quality of life. And, it appears, its prevalence is increasing. Since the prevalence peaks during the ages of 25-55, the prime working years, migraine places a tremendous burden on employers, primarily in the form of lost productivity as well as increased health benefits costs. The fact that migraine is underdiagnosed and undertreated suggests the existence of opportunities for interventions that will reduce that toll. This article focuses on the contributions that employee health units may make to such interventions. In addition to first aid for migraine attacks occurring during working hours, these interventions may include educating occupational health staff, managers, and line supervisors about the management of migraine; identifying migraineurs in the workforce; educating them about their problem and ensuring that they are receiving optimal care; controlling exposures to factors in the workplace that may trigger migraine attacks; and managing disability to minimize loss of productivity. Perhaps most important is encouraging migraineurs to be more aggressive in confronting this problem and empowering them to seek out personal physicians who will guide them to effective treatment and preventive regimens.

The economic costs associated with body mass index in a workplace.

This study was undertaken to determine if a progressive correlation exists between body mass index (BMI), health care costs, and absenteeism and to identify an economically optimal BMI. We studied 3,066 First Chicago NBD employees by using health risk appraisals and personnel data. Analysis was completed for those employees with and without a risk for BMI. People at risk for BMI are more likely to have additional health risks, short-term disability and illness absence, and higher health care costs than those not at risk for BMI. A "J-shaped" curve between health care costs and BMI exists, with the low point occurring at about 25 to 27 kg/m2. We concluded that indirect and direct costs to an employer increase with increasing BMI. Employers may benefit from helping employees achieve a healthy weight. The initial target population should be those who are at highest risk of complications from obesity.

Evaluation of a worksite-based patient education intervention targeted at employees with diabetes mellitus.

Diabetes mellitus (DM) affect 5% to 10% of Americans and is estimated to account for $45 billion in direct and $47 billion in indirect costs. The average medical care cost in 1992 for a person with diabetes was $11,157, compared with $2,600 for a person without diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that good control of diabetes can delay the onset and slow the progression of many diabetic complications and thereby result in avoidance of costs related to such complications. First Chicago NBD evaluated a worksite-based patient education program for employees with DM. The goal of the program was to determine if such a program could result in improved DM control. A total of 53 employees participated in baseline laboratory testing and met monthly with a diabetic health educator. After 3 months, 45 (85%) employees participated in retesting. One of the 45 employees had an active infection and was not included in the analysis. Of the 44 remaining employees, 43% were on oral agents, 39% on insulin, 2% on combination therapy, and 16% controlled with diet alone. Prior to receiving any laboratory results, 48% of participants rated their level of control as "good" or "very good", while only 9% considered it "poor". After 3 months of educational programs, the subjects' mean fasting blood glucose levels fell from 197.8 mg% to 179.6 mg% (P = 0.12), mean glycohemoglobin declined from 11.5% to 10.1% (P < 0.001), and mean hemoglobin A1C declined from 9.0% to 8.3% (P < 0.001). A worksite-based diabetes disease education program has been shown to significantly improve control of the disease. This should result in lower direct and indirect health care costs and enhanced quality of life.

Blood pressure and diurnal variation in sodium, potassium, and water excretion.

The objective of this study was to examine associations of blood pressure (BP) with ratios of overnight to 24-h urinary excretion of sodium, potassium, and water. Each of 125 men 27-64 years of age, not taking diuretics, had BP measured during the day on a Monday. Beginning Monday evening, each participant provided three carefully timed 24-h urine collections, divided into daytime and overnight (bedtime to awakening) specimens. Proportion of total 24-h excretion of sodium, potassium, and water in the overnight specimen, standardised for creatinine excretion, was determined for each 24-h period. Associations of systolic and diastolic BP (SBP/DBP) with these proportions were examined with control for age, body mass index, alcohol intake, and heart rate. Mean BP was 116/71 mm Hg; 15 men were on non-diuretic anti-hypertensive therapy. Mean 24-h urinary excretion was 168 mmol for sodium, 68 mmol for potassium, and 16 mmol for creatinine. Mean overnight to 24-h proportions averaged over the 3 days were 30.7% for sodium, 22.0% for potassium, 32.1% for urinary volume, and 33.2% for creatinine. Partial correlations of SBP and DBP with the 3-day averages were 0.257 (P < 0.01) and 0.210 (P < 0.05) for sodium; 0.223 (P < 0.05) and 0.222 (P < 0.05) for potassium; 0.127 and 0.091 for urinary volume; and -0.033 and 0.014 for creatinine. Correlations for sodium proportions were larger for the first 24-h period, compared to the second or third 24-h period. These results indicate that higher BP was associated with a relatively greater proportion of sodium and potassium excretion at night. Further work is needed to clarify temporal sequence, ie, whether a relatively greater sodium and potassium excretion at night is a risk factor for higher BP (eg, via renal mechanisms), or whether higher BP results in relatively greater sodium and potassium excretion at night, or both.

Migraine: a problem for employers and managed care plans.

Headache is probably the most common symptom in the workforce and in the general population. Among the many types of headache, the one with perhaps the greatest impact on well-being and functional capacity is migraine. It disrupts work and leisure activities and engenders significant use of healthcare resources. Migraine cannot be cured, but it can usually be managed. Managed care organizations can facilitate the treatment of migraine through disease management programs. Unfortunately, however, many migraineurs receive substandard, ineffectual, and inappropriate care--or no care at all. This article reviews the diagnosis, epidemiology, and treatment of migraine, with an emphasis on the perspectives of employers and managed care plans, with the hope of encouraging them to become more proactive in dealing with individuals with migraine.

The cost of depression in the workplace.

Depressive disorders in employees and their dependents pose a major occupational health challenge, with implications for productivity, competitiveness, disability program utilization and medical care costs. The following article shows just how big an impact depression has had on the benefit programs of a major Midwestern employer--generating over half of all mental healthcare diagnoses and claims and even more days of disability and 12-month recidivism than chronic physical complaints such as heart disease, diabetes, high blood pressure and low back pain.

The economic impact of depression in a workplace.

Epidemiological studies hold that depressive disorders are among the most common forms of mental illness in the population and should produce a substantial economic impact upon corporate America. However, only a few studies have examined the economic impact of depression in the workplace. A study of the medical and disability costs of depressive disorders was conducted at the First Chicago Corporation. In this analysis, short-term disability data, medical plan costs and Employee Assistance Program referral data for depressive disorders were compared with selected common chronic medical conditions. The average length of disability and the disability relapse rate was greater for depressive disorders than for the comparison medical groups. Depressive disorders were also found to have the largest medical plan costs of all behavioral health diagnoses. Finally, depressive disorders proved to be the most common Axis-I-level diagnosis encountered in the Employee Assistance Program. These findings have important implications for medical benefit plan design, disability plan management, and occupational health professionals' training. The observed higher prevalence of these disorders in women force their recognition as a women's health issue.

A computer-assisted health care cost management system.

To our knowledge, First Chicago has developed and implemented the first operational integrated health data computer system that includes the traditional occupational medicine data base together with medical claims and health risk appraisal data. OMNIS has combined medical claims, personnel, disability, employee assistance program, wellness program participation, administrative functions, laboratory, periodic health evaluation data, and health risk appraisal data in a single system. OMNIS provides data that are being used to more accurately predict health care and disability costs and design intervention strategies. Clearly, the integrated health data computer system provides information to manage increasingly complex issues of health care quality and cost. For companies concerned about the quality as well as the cost of health care, an integrated health data computer system (OMNIS) may be a valuable tool to objectively assess quality of care. For example, a company could evaluate how effectively various providers (eg, health maintenance organizations, preferred provider organizations, indemnity plan) control medical conditions such as hypertension. Integrated health data management systems have the potential to assist in the selection of the highest quality and most cost-effective health care plans.

Women's health programs at the workplace.

Women-specific health issues are important to corporations because a large population of their work force are women. To address this issue, First Chicago provides the following innovative programs: prenatal education during work hours ("ABC's of Healthy Childbearing," "Early Pre-Natal Care," "Nutrition and Exercise in Pregnancy," "Pregnancy after Thirty"); gynecologic examinations and consultations at the work site (Pap smears and breast examinations for early cancer screenings); seminars teaching breast self-examinations and prevention of osteoporosis; mandatory second opinions to reduce unnecessary obstetric and gynecologic procedures. These programs provide cost-effective health care, and contribute to the good health of employees.

Value-managed mental health benefits.

The First National Bank of Chicago's comprehensive program for mental health services has been shown to be an effective response to the rising demand and cost of mental health care. By assertively managing a benefit plan rather than capriciously cutting it, employees are afforded quality care while the corporation is able to handle the costs of a worthwhile benefit. The plan represented a collaboration of the Benefits and Medical Units, which brought together philosophies of benefit plan management and research regarding primary prevention and early intervention. Employees are afforded education and early intervention while at the work site and appropriate referrals to cost-efficient providers outside the bank. Should they need time away from the work site for treatment, this along with their reentry is also managed to increase the probability of successful recovery. In this way continuity of care is assured so that recurrent disability (eg, rehospitalization, further STD) may be reduced. The 4-year follow-up investigation of the program reveals management of overall mental health care costs, reduction in inpatient psychiatric hospitalization costs, and reduction in the average length of psychiatric short-term disability episodes for employees.