Disease Management

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These executive summaries were compiled from EMPLOYEE BENEFITS INFOSOURCE database, a source for information on employee benefits and human resources.

Drug Program Targets Costs.
Wojcik, Joanne; Business Insurance; v46 no11 p 6 Mar 12, 2012; journal article

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Abstract : An innovative drug insurance product is attracting self-funded midsized employers. EBC Rx LLC is offering Rx 'n Go, a mail order program under which employers pay for 90-day prescriptions for generic drugs. Employers note the lower cost and easy refills improves compliance with chronic condition treatment plans, potentially cutting long-term health care costs. Billing statements for the program provide drug utilization data to the employer, third-party administrator and/or pharmacy benefits manager (PBM) at no extra cost. Obstacles come from the fact that most PBM contracts prohibit employers from such outside arrangements, and there is no integration between data for drug utilization and other medical services or metrics.
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Medical Cost Savings for Participants and Nonparticipants in Health Risk Assessments, Lifestyle Management, Disease Management, Depression Management, and Nurseline in a Large Financial Services Corporation.
Serxner, Seth; Alberti, Angela; Weinberger, Sarah; American Journal of Health Promotion; v26 no4 pp 245-252 Mar-Apr 2012; journal article

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Abstract : Nearly 50,000 employees enrolled in group health plans through a single corporation were followed over three years to assess health cost differences between those involved in a comprehensive health and productivity management program and nonparticipants. Participation was based on competing a health risk assessment or involvement with programs geared to lifestyle management for weight, nutrition, smoking, and general health promotion; disease management; or depression management; or interaction with a nurse through a telephonic health information line. Medical claims for all participants increased less than for nonparticipants. The return on investment in the second year was 3.33:1 and 2.45:1 for the three-year program. The study demonstrated the value of a multiprong approach supported by a strong corporation-wide campaign to promote health awareness.
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Meta-Evaluation of Worksite Health Promotion Economic Return Studies: 2012 Update.
Chapman, Larry; American Journal of Health Promotion; v26 no4 pp TAHP1-TAHP10 suppl. Mar-Apr 2012; journal article

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Abstract : Researchers performed a meta analysis of 62 studies on worksite health promotion. The studies met rigorous selection criteria and focused on smoking prevention and cessation, physical fitness, nutrition, stress management, medical self care, hypertension control, weight management, prevention of back pain and injury, seat belt use and prenatal care. Evaluation of the studies shows works published after the median 1996 to be stronger with better methodologies and newer prevention technologies. Over half of the studies measured results based on health care utilization or cost, and almost 42 percent measured sick leave absenteeism, but few tracked costs associated with workers compensation and disability management. Seven in ten looked at only one outcome measure, probably understating the economic impact of their interventions. A more recent meta analysis of 22 studies showed $3.27 in medical cost savings per dollar spent on worksite health promotion programs, and 22 studies focusing on sick leave absenteeism yielded $2.73 in savings per dollar spent.
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Misdiagnosis: The Clinical Integration Solution.
Falchuk, Evan; Employee Benefit Plan Review; v67 no3 pp 15-16 Mar 2012; journal article

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Abstract : Research estimates the rate of misdiagnosis at 20 percent or higher. This is the result of lack of integrated clinical data, time pressure, inattention to detail and provider stress, and contributes to soaring health costs, and patient confusion and suffering. The solution is clinical integration, starting with a health plan sponsor's expectation that all vendors will coordinate efforts to support employees' disease management. Covering disability, specialty pharmacy, care providers, wellness programs and disease management, clinical integration aims to make the most efficient use of existing benefit offerings. It starts with the right diagnosis, which should be checked by a second opinion or more, considering personal and family medical history. Employers should insist that employees take active part in clinical integration, being educated about the true costs of care and being responsible health care recipients.
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Managing the Modern Disease: Is Cancer the Next Frontier for Employers?
Kendall, Demian; Benefits Quarterly; v28 no1 pp 22-25 1st Qtr 2012; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Advances in treatment have made cancer become a chronic disease demanding ongoing management for afflicted employees. Workplace issues include productivity, absence, mental health, scheduling and ergonomic modifications for those directly affected, while caregivers are indirectly but significantly affected. The National Business Group on Health and National Comprehensive Cancer Network are collaborating on An Employer's Guide to Cancer Treatment and Prevention, with two of five planned components ready as of early 2012. The guide spells out the cost effects and the need for employers to address prevention, screening, treatment, and recovery, relapse and/or hospice. The Quick Reference Guide summarizes evidence-based benefits, while the Employer Benefit Design and Assessment helps employers evaluate how well their benefits meet the needs of cancer patients and caregivers.
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Link To Full Article
Shedding Weight of Workplace Health Risks.
Brown, Sue; Canadian HR Reporter; v24 no22 pp 15, 18 Dec 19, 2011; journal article

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Abstract : Statistics Canada reports that 62 percent of Canadian workers are overweight or obese, making employee health a serious risk management issue for employers. These workers are disproportionately likely to be absent, generate disability and medical costs and be less engaged and productive at work. Employers can offer a variety of programs and tools to help employees manage their weight in a healthy way, including group and personal challenges which can boost morale and team spirit. Employee assistance programs and plan vendors may provide educational sessions and personal coaching. Technology can help through online progress tracking systems and simple pedometers, and workplace meetings can provide support. The Canada Standards Association and Bureau de Normalisation du Quebec established the Healthy Enterprise standard to focus on promoting employee health in the workplace.
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Chiropractic Care Comes With Savings for Employers.
Clum, Gerard W.; Employee Benefit Plan Review; v66 no6 pp 27-30 Dec 2011; journal article

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Abstract : Evidence of the effectiveness of chiropractic care is strong and mounting, from anecdotal reports to numerous scientific studies. One hospital-based study demonstrated successful treatment outcomes for lower back pain with an average 5.2 visits, $302 per patient, 70 percent pain reduction and 95 percent patient satisfaction rate. Chiropractic has been shown to be especially effective for lower back and neck pain and sciatica, yielding better results than treatment by a physical therapist or physician, with lower drug use and fewer surgeries. Its clinical effectiveness, cost efficiency and patient satisfaction are helping chiropractic achieve a strong position in value-based health care design.
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Coca-Cola, Others Pop Open Consumer-Driven Plans.
Beyer, Lisa; Workforce Management; v90 no12 p 6 Dec 2011; journal article

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Abstract : Since the Coca-Cola bottler in North Carolina replaced its array of health plans with three consumer driven plans in 1995, the company has held annual medical cost increases to just over four percent. This contrasts with a nine percent increase nationally over six years. The company is also focusing on chronic disease management and has established free onsite health clinics. By turning to high-deductible and consumer driven plans, large employers will limit cost increases to between 5.4 percent and 7.2 percent, according to surveys by Mercer and the National Business Group on Health. Employers are no longer able to sustain the health benefits of the past without cuts, cost sharing and innovation. Wellness programs are showing evidence of effectiveness, as seen in Baptist Health of Alabama, where widespread wellness program participation has helped cut tobacco use, lower cholesterol and blood pressure and boost drug treatment compliance.
[0161341]
Raising A-Wear-Ness.
Gillespie, Lisa V.; Braun, Darren; Employee Benefit News; v25 no15 pp 29-31 Dec 2011; journal article

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Abstract : Levi Strauss and Co. is a leader among employers in support for employees with HIV/AIDS as part of its employee assistance program. With strides in medical advances and education, the disease, though still challenging, is treated as a chronic condition that does not impede an employee's contributions or career development. Support services, such as through Levi Strauss' HIV Connect, help employees and educate coworkers and managers to deal with HIV issues in the workplace. Employees with the disease are likely to be healthy and productive, needing little special consideration other than time for medical appointments. Enabling them to stay in active employment has numerous beneficial ramifications.
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'Missed Opportunities' in Wellness Arena: Survey.
Dobson, Sarah; Canadian HR Reporter; v24 no20 pp 3, 17 Nov 21, 2011; journal article

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Abstract : A Sun Life survey of 677 Canadian employers suggests a disconnect between employees' health risks and the wellness initiatives employers offer. Most of the top ten health concerns are linked with chronic diseases. Few wellness efforts address them directly, though employee assistance programs provide a range of health-oriented services, and employee recognition and flexible hours support wellness. A small but slowing growing number of employers track wellness effort results or their return on investment. That requires baseline and ongoing data collection, a challenge for many. Employers are making progress, starting with services that are easy to provide.
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Group Health Plan Costs Rising More Slowly.
Geisel, Jerry; Business Insurance; v45 no45 pp 3, 20 Nov 21, 2011; journal article

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Abstract : A Mercer LLC survey found group health plans faced a 6.1 percent cost increase in 2011 with the cost per employee at $10,146. This compares with $9,562 per worker in 2010 and plan cost increases of 6.9 percent in 2010, 5.5 percent in 2009, 6.3 percent in 2008 and 6.1 percent from 2005 through 2007. Large employers are more focused on and successful at holding costs down. Their use of lower cost, account-based consumer driven health plans jumped to 32 percent in 2011, and they are more likely to attach incentive and penalties to the use of wellness and disease management programs. Larger plans held cost increases down to 3.6 percent, in contrast to 9.9 percent for small employers.
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Medical Stop-Loss Insurers Warming Up to Wellness.
Wojcik, Joanne; Business Insurance; v45 no45 pp 6, 16 Nov 21, 2011; journal article

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Abstract : Chartis Inc. took the lead among stop-loss insurers by formally endorsing the cost containment system of MedEncentive L.L.C. Other underwriters are showing greater interest in and support of wellness and disease management programs, including U.S.-based Sun Life Financial and Sun Life Assurance Co. of Canada, but Chartis is the first to offer premium discounts and lower aggregate attachment points for employers adopting a specific program. MedEncentive's online program rewards patients for healthy behaviors and physicians for providing evidence-based care. It is expected to contain future actual costs and liabilities and is available for self-insured employers with 100 or more employees.
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Wellness Project Seeks to Serve and Protect.
Ceniceros, Roberto; Business Insurance; v45 no45 pp 3, 20 Nov 21, 2011; journal article

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Abstract : Researchers at Oregon Health & Science University created a health promotion and intervention program to understand and improve the unique health risks of law enforcement personnel. The program aims to replicate improvements made through a similar program for Portland, Oregon, firefighters. Data shows law enforcement officers' work lifestyles lead to different types of compensable injury and disability claims and that they tend to die or show chronic diseases within five years after retirement. The program will help the Marion County sheriff's department officers, working in teams, identify and overcome habits interfering with their health over the long term.
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Bottom Line: Business Increasingly Pointing Smoking Gun at Chronic Obstructive Pulmonary Disease.
Walsh, John W.; Employee Benefit Plan Review; v66 no5 pp 11-13 Nov 2011; journal article

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Abstract : Every smoking employee increases business costs by $3,391, according to the Centers for Disease Control and Prevention, amounting to 18 percent higher costs than for a nonsmoking employee, from direct care, absenteeism, disability and lower productivity. Smoking is the leading cause of chronic obstructive pulmonary disease (COPD), which is the third leading cause of death in the U.S., afflicting 24 million Americans, 70 percent of whom are employed. Four of five COPD patients are current or former smokers. A few companies refuse to employ smokers, but more are taking a gentler approach through insurance surcharges or incentives to quit.
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Engaging the Invincibles.
Shebel, Brenna; Dan, Dannel; Employee Benefit News; v25 no14 pp 22-23 Nov 2011; journal article

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Abstract : As the employee group under age 30 advances toward demographic majority, their poor health is alarming employers. Younger workers may consider themselves invincible, but, as a group, they are more overweight and obese and have more chronic health conditions than their predecessors. They rely on family and friends for health information, rarely turning to credible sources. They expect government to explain what health approaches work best, make decisions on the basis of cost and take a passive approach to their own care. Employers can counteract these habits by spreading useful information through their workforce by social media, linking to trustworthy health information sites, passing on information on cost effective care, providing online cost and quality calculators and suggesting questions workers should ask their doctors to take control over their own health management.
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Integrating Wellness Into Hospital Systems.
O'Donnell, Michael P.; Bensky, Jeffrey M.; American Journal of Health Promotion; v26 no2 pp TAHP1-TAHP13 suppl. Nov-Dec 2011; journal article

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Abstract : Hospitals are major employers and representatives of the health care industry, yet most have failed to significantly influence the well-being of their communities. Key areas in which hospitals can get involved in health promotion are employee wellness programs, patient care, community outreach, business ventures, and research and education. Employee programs not only improve worker health, lower medical costs and support a talented workforce, but also boost a hospital's credibility in the community. A simple way to demonstrate a wellness philosophy is by establishing a smoke-free workplace and not hiring smokers. Patient care should focus on preventing and reversing chronic conditions. Community outreach, business partnerships and ongoing research programs can reinforce wellness goals. Case studies illustrate points made.
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Kids in Crisis.
Gillespie, Lisa V.; Employee Benefit News; v25 no14 pp 27-28, 30 Nov 2011; journal article

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Abstract : The Centers for Disease Control and Prevention report that 15 percent of children and adolescents are overweight and 16 percent are obese, nearly triple the obesity rate of the 1980s. These figures translate to soaring health benefit costs for employers, but wellness efforts rarely include employees' children. Programs are available to intervene, some directly targeting children such as the puppet characters of Eat, Move, Play, America! Others take a more traditional approach geared primarily toward parents, such as WellNet Interactive, Alere Health's Healthy Kids and Families Step Up at Baptist Health South Florida. All involve initial health screenings for kids and parent guidance to reinforce healthy eating and physical activity. The Alere program has demonstrated significant increases in activity, lower screen time and higher intake of fruits and vegetables.
[0161259]
Take Your Meds, Please!
Shelly, Jared; Human Resource Executive; v25 no11 pp 28, 30-31 Oct 16, 2011; journal article

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Abstract : When a patient fails to fill a prescription or adhere to a drug therapy plan, the small initial cost saving can backfire, leading to more frequent emergency room visits, longer hospitalizations and medical complications, as well as higher absenteeism and lower productivity at work. The New England Healthcare Institute reports over $290 billion is spent yearly in avoidable medical expenses, and the American Pharmacists Association reports over 1.5 million preventable adverse events annually from not adhering to treatment plans. Those with diabetes, high blood pressure and high cholesterol are most likely to be noncompliant. Proven strategies include proactive refill reminders, automated refills and value-based insurance design providing free drugs or low copayments for chronic disease patients who participate in a disease management program. Express Scripts is piloting predictive modeling programs to identify common factors in treatment plan adherence.
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The Skinny on Fat in the Workplace.
Liedman, Julie; Risk & Insurance; v22 no9 pp 34, 36 Oct 1, 2011; journal article

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Abstract : Nearly three out of four American adults is overweight or obese, and the rise in obesity accounts for 12 percent of the increase in health care expenditures. Obese individuals spend 40 percent more for health care than normal weight people and face a high risk of metabolic syndrome, diabetes, cardiovascular disease and other conditions. Encouraging healthy eating and exercise is a positive move but often insufficient for the morbidly obese. Studies have shown bariatric surgery to be safe and effective for most candidates, with lower risks than living with morbid obesity. Bariatric surgery averages $11,500 to $26,000, and insurance coverage is highly variable. With greater understanding of the value of surgery for extreme overweight, informed employers will seek insurance that provides the benefit for employees.
[0161070]
Come Together Right Now.
Davis, Andrea; Employee Benefit News; v25 no11 pp 23-24 Sep 1, 2011; journal article

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Abstract : Disease management programs have demonstrated effectiveness, but many employers are not seeing cost savings. Challenges include the opt-in nature of traditional programs and the increasing cost of the individual components of treatment. For some, hiring a professional case manager to organize and coordinate care is an effective approach. A growing solution is vendor summits, which bring together health vendors to discuss workforce health, share data and brainstorm solutions. Employers are culling vendors who refuse to share data, replacing them with those who will.
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Moving Forward.
Hryniuk, William; Waechter, Mike; Benefits Canada; v35 no9 pp 39-41 Sep 2011; journal article

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Abstract : The incidence of cancer is growing, with one in 2.2 men and one in 2.5 women developing the disease. Effects are reflected in the workplace with lower productivity and higher absence rates. While disability and other income protection benefits help, a cancer support benefit can go a long way to provide extra protection, emotional support and coordination of care and to smoothe recovery and return to work. Canada's public health system has started offering complementary services, though the approach and availability vary widely from place to place. A patient advocate working with group health benefits plans can help navigate through care options, make sure best medical practices are being followed and ultimately help lower the risk of complications. The advocate is typically an oncology nurse working with medical and surgical specialists.
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The Growth in Cost Per Case Explains Far More of US Health Spending Increases Than Rising Disease Prevalence.
Roehrig, Charles S.; Rousseau, David M.; Health Affairs; v30 no9 pp 1657-1663 Sep 2011; journal article

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Abstract : Researchers looking at the increase in health care spending found it due in part to the fact that more people are being treated for disease, rather than to a growing prevalence of disease. Health expenditures were examined from 1996 through 2005, analyzing by population group and medical condition. It was found that, while the rates of disease for seven conditions analyzed, whether treated or not, varied between -0.4 percent and 2.9 percent over the time studied, the proportion of treated disease rose dramatically. While the prevalence of those with a disease being treated accounted for one-fourth of the health care spending increase, three-fourths of the increase reflected the growth of cost per case. The results have policy implications indicating the need to lower the rate of cost growth per case.
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The Doctor Is In.
Galentine, Elizabeth; Employee Benefit News; v25 no10 pp 27-29 Aug 2011; journal article

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Abstract : Convinced of the value of establishing employee clinics at workplaces, the principals of insurance brokerage Benefit Controls routinely recommend the strategy to their clients. A textile firm with 1,000 workers is typical, finding sponsoring an onsite health care clinic leads to better employee time management, compliance and engagement in health care, cost control and employee trust and support. Greater emphasis on primary care, required by the Patient Protection and Affordable Care Act, and closer monitoring of employees with chronic conditions can be more effective than many wellness programs. Both self-insured and fully-insured employers can save money with onsite clinics, whether operated by a third party or through a partnership with local physicians.
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Function First: Medical Benefits to Manage Chronic Disease or Aid Recovery.
Welcher, Paul A.; U.S. Department of Labor: Bureau of Labor Statistics: News; 7 pp Jul 20, 2011; journal article

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Abstract : The National Compensation Survey reveals statistical details on a variety of employee benefits as of 2009. The data shows 45 percent of plan participants had organ and tissue transplantation benefits, while other plan documents do not mention the benefit. Only 31 percent of HMO participants are covered, compared with 48 percent of participants in fee-for-service plans or PPOs. Fee-for-service plan participants are more than twice as likely as HMO participants to face some plan-wide limits, typically cost sharing. Seventy percent of plan members are covered for physical therapy, nearly all with plan and individual limits. About two in three members have coverage for durable medical equipment, twice as often with plan limits than individual limits. About half of plan members are covered for prosthetics, more likely through HMOs than PPOs. Diabetes care management and kidney dialysis data are sketchy, mentioned in documents for only 30 percent of PPO members and 17 percent of HMO members.
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Employees Not Focused on Improving Health Right Now, Survey Finds.
Managing Benefits Plans; no13-7 pp 1-5 Jul 2011; journal article

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Abstract : A Towers Watson survey of over 9,000 employees finds wellness has fallen as a priority for workers worried about finances and retirement income. Those whose health is fair or worse are even less likely to stay focused on managing their health than the total employee population, 44 percent to 59 percent. Fewer individuals are taking action to significantly improve their health or using lifestyle management programs offered by their employers. The 23 percent in very good health are twice as likely to use lifestyle management programs as the 13 percent in poor health, who are less likely to be aware of company efforts to promote employee health. Employees are open to incentives and penalties tied to health and wellness efforts but do not want to see their benefits put at risk.
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