EBenefits Press Releases

Program quantifies costs of chronic conditions Pittsburgh Business Times - by Kris B. Mamula

Friday, November 2, 2007

It's no secret that chronic medical problems, such as high blood pressure and low back pain, can mean time off the job. What's hard to quantify, is how much that absenteeism can cost a company. Until now.

A novel computer program recently developed by UPMC Health Plan reveals those hidden costs -- $1,056.12 for blood pressure and $1,920.94 for low back pain.

The value of the program, which is being patented by the insurer, is in helping employers carefully tailor wellness initiatives to control benefit costs and improve worker productivity, according to economist Pamela Peele, who is also vice president of health economics at the Uptown-based insurer.

"This is really about investing in human capital and keeping them at work," Peele said. "There are really cool, cool things going on."

Of course, big insurers nationwide have used predictive computer modeling to determine risk in underwriting health insurance plans for years. What's different at UPMC Health Plan is the detail of the forecasts about absenteeism and short- and long-term disability leave related to various problems.

"That's very progressive," said Andrea Cianfarini, director of the research division at Boston-based Urix Inc., a worldwide provider of predictive modeling software for the health care industry. "It's actually really exciting."

The program was developed with 2.5 years of claims and time-card data from more than 46,000 people who work for health plan affiliate University of Pittsburgh Medical Center.

UPMC had a gross payroll of $2 billion in fiscal 2007 with medical and vision costs of $213.2 million. Sick time costs totaled $14.5 million for the year and unscheduled time off cost another $4.3 million.

Employees who received short-term disability benefits for a respiratory condition, for example, were 85 percent more likely than others to have a repeat claim for the same condition within a year; the likelihood increased 44 percent if the leave was for digestive problems, according to the health plan's findings.

Low back pain led the overall increased absenteeism risk of 50 percent followed by diabetes at 37 percent and asthma at 36 percent compared to employees without those problems, according to the health plan's findings.

Lost productivity is the cost of absenteeism, which is made worse by chronic health problems: $1,920.94 for people with low back pain, $1,422.87 for diabetes, and $1,372.93 for asthma annually, not including things such things as medical or pharmacy expenses, according to health plan data.

Overall, experts say that 20 percent of the population accounts for 80 percent of health care costs and much of that expense is due to treatment for chronic conditions, such as diabetes.

Less well recognized is the relation of such health problems to absenteeism, which management consultant Rebecca Sohn, founder and CEO of Presto-based Sohn Mason LLC, said ranks with health care expenses. Business too often focuses on the cost of absenteeism without looking at the underlying reasons employees call off work, she said.

"All those things are symptoms," Sohn said. "They treat the symptoms, but unless they begin to treat what's behind it, they're never going to fix it."

Simply not hiring people with chronic health problems is not the answer, Peele and others say. For starters, refusing to hire or discharging an employee based on age or health status violates federal law. It's also not practical; the labor market is already tight, especially for nurses and other health care professionals.

"You can't just get rid of people because they're 50 years old," Peele said. "It's not somebody else's problem." Employee wellness is the latest push in efforts to hold down health care costs and improve productivity for business, and the value of UPMC Health Plan's tool is in the ability to individually tailor wellness programs to the workplace, said John Galley, vice president of compensation and benefits at UPMC.

Employees in low-risk groups can be counseled about exactly what they're doing that makes it unlikely they will have unscheduled absences, and health coaches and other interventions can help high-risk groups reduce the risk of absenteeism.

UPMC's experience shows that wellness initiatives such as screening for high blood pressure save money in the long run, Galley said. The predictive modeling program allows UPMC to further refine its wellness efforts.

"The model could help any workforce," Galley said. "It lets them be more targeted."

kmamula@bizjournals.com | (412) 208-3825

FOR IMMEDIATE RELEASE

Contact: Michael Taylor, Executive Director Marketing & Communications UPMC Health Plan 412-454-7534 HealthPlanMedia@upmc.edu

UPMC and UPMC Health Plan Recognized Nationally for Quality Leadership in Employee Health and Productivity

PITTSBURGH (October 24, 2007)

The Certification of Disability Management Specialists Commission (CDMSC) has chosen the University of Pittsburgh Medical Center (UPMC) as the recipient of its 2007 Quality Leadership Award, in recognition of the organization’s innovative programs to promote the health and productivity of its workforce.

The award was presented today at the National Business Group on Health’s 2007 Joint Forum on Health, Productivity, and Absence Management in Washington, D.C. The NBGH Forum is a key annual conference in the health and productivity industry, attracting employers as both attendees and presenters. Each year, the CDMSC – the only independent, nationally accredited organization that certifies disability management specialists – honors a company, organization, or individual for demonstrating leadership in disability management.

“UPMC provides a powerful example of how employers are discovering the importance of helping employees become healthier and stay healthier through a variety of programs, all of which promote productivity whether at work or at home,” commented Renee Mattaliano, Chair of the CDMSC.

The collaboration between UPMC and its health insurance division works to promote health and productivity among UPMC employees through several innovative initiatives, including:

Global Assessment for Triage and Engagement (GATE), which occurs on every staff member entering the disability benefits process, ensures that appropriate levels of case management and health advocacy resources are assigned at the onset of a case for optimal outcomes. The program includes a holistic clinical evaluation by a specially trained nurse case manager to assess health risks and identify cases that need early invention, including referrals to other programs. EAP – Work Transitions, specifically designed for staff members who are receiving disability benefits, brings together an array of psychosocial and work-life balance services and resources to support health, productivity, and return-to-work. This includes mental health screening, assessment, intervention, and referral; regular telephonic monitoring and support; psycho-educational skill building and training; resource identification and referral; formal work-life services referral; and counseling and coaching on adjusting to return-to-work. UPMC MyHealth “We’ve Got Your Back” program, providing information about safe lifting, injury prevention, and the importance of general and muscular fitness. Components include on-site physical assessment, tools for improving core stability and overall strength, and telephonic health coaching. “We recognize that our future success is dependent upon our people,” commented John Galley, Vice President – Compensation, Benefits, and HRIS of UPMC. “We are in an industry where the supply of labor has not kept pace with the need. Good, talented people are in demand, including nurses, pharmacists, and other clinical and non-clinical personnel. With the labor market tight and likely to be tighter in the future, we want to make investments in our people to make sure they are as healthy, satisfied, and productive as they can be.”

An important component in UPMC’s approach to health and productivity is an emphasis on wellness, especially identifying health risks before they become a chronic condition or disease.

UPMC Health Plan will present its “groundbreaking and innovative research” on workplace wellness during today’s Joint Forum. The Health Plan’s presentation, “How to Leverage Integrated Scorecards and Predictive Modeling to Promote a Culture of Health and Productivity,” was one of only 12 selected nationally from a variety of national and regional corporations involved with health care coverage and benefits.

"We are working to create a culture of health within a diverse workforce that has multiple needs and multiple risks," said Diane P. Holder, Executive Vice President of UPMC, and President of UPMC Insurance Services Division and UPMC Health Plan. "Helping employees learn more about what it takes to stay healthy, or providing resources to those with chronic conditions, will result in lasting benefits to both the individual and their employer."

The research features aggregate quantitative results from UPMC’s 46,000 employees. The presentation includes lost work time models designed to provide results that motivate employers to promote a culture of wellness in the workplace. The ultimate goal is to improve the health and welfare of employees.

For more information on the 2007 Joint Form on Health, please see the National Business Group on Health website at http://www.businessgrouphealth.org/.

creating a self service environment for employees.