While health care costs of U.S. companies are expected to rise at a slower rate this year, employers will still pay an average of more than $8,400 per worker. Shifting more of the costs to employees has produced limited results. Additionally, employers worry about going too far in passing these costs along.
"Take Care of Yourself: Employers Embrace Consumerism to Control Healthcare Costs," a Pricewaterhouse Coopers study, found that 62 percent of the 150 executives surveyed felt that increasing deductibles might only cause their employees to defer care, risking their own health and potentially leading to higher health care costs later.
Employers need to take a closer look at what's fueling cost increases and take action to control these factors. A key culprit that surfaces in virtually every analysis is chronic illness.
The treatment of chronic disease in the United States is one of the country's most compelling and difficult health challenges. According to the Centers for Disease Control, more than 100 million Americans suffer from a chronic condition. Within six years, this number is expected to jump to 141 million, and 171 million by 2030 - roughly 50 percent of the population.
The CDC also reports that chronic diseases not only affect Americans' health and quality of life, they are the most expensive medical conditions to treat. While individuals with chronic conditions represent only 5 percent of the population, they account for 75 percent of the nation's total annual health care costs.
Making it worse
Another factor that must enter the discussion of health care cost containment is depression. Research is finally validating the co-morbid links between depression and chronic illness: a chronic illness can trigger depression, just as untreated depression can contribute to the development of a chronic illness.
According to a just-released Johns Hopkins study, workplace depression is an enormous expense to employers in terms of health care costs and productivity. One study of more than 46,000 employees found each one with depression generated $3,189 in annual health care costs compared with $1,679 for non-mental health illnesses. If depressed employees also suffered high stress, the cost skyrocketed: 147 percent more was spent on health care. The study adds that major depression will be the second leading cause of workplace disability within 15 years.
The University of Michigan Health System goes on to report that at any given time, one in 10 employees experiences depression, costing companies $52 billion in absenteeism and reduced productivity. Among employees surveyed, depression had a wide-ranging impact on their ability to function, including lack of motivation (83 percent), difficulty concentrating (82 percent), and chronic physical pain (24 percent) that made it uncomfortable for them to work. In addition, half reported missing one to three days of work a month as a result of their illness.
By itself, depression clearly takes its toll on U.S. businesses. Consider its impact in light of its newly validated link with chronic illnesses. According to estimates, depression as a co-morbid health issue affects 40 percent to 65 percent of cardiac patients, up to 27 percent of stroke patients and 25 percent of cancer patients. Depression is also estimated to occur in 25 percent of individuals with diabetes, which is one of the most prevalent chronic, complex conditions in the workplace.
A critical issue at play here, however, is that depression as a co-morbidity often goes underdiagnosed. In fact, experts say that as many as 50 percent of people who suffer from depression go undiagnosed - many times because the physical symptoms of depression are the same as those of medical illness.
In addition to not getting the help they need, individuals with undiagnosed depression are driving healthcare costs. According to the Agency for Healthcare Research and Quality, patients with undiagnosed depression average more than six visits per year with their primary care providers.
Integrated programs
Since the major chronic conditions that account for so much of the morbidity and mortality in the United States, and the enormous direct and indirect costs associated with them, in large part are preventable, we need to re-evaluate the way we spend our health care dollars. According to Tommy Thompson, former U.S. Secretary of Health and Human Services, roughly 95 percent of the $1.7 trillion spent annually on health care goes to direct medical services, with only 5 percent allocated to preventing disease and promoting health. To contain health care costs, our efforts need to be directed at modifying behaviors and influencing choices that cause and exacerbate these conditions, such as obesity, lack of physical activity, healthy eating and smoking.
This means that improving one's health - which is defined as a state of complete physical and mental well being, not merely the absence of disease - requires a holistic solution that is person-centric, rather than benefit-centric. While employers must assess the health and employee benefits they offer, these benefits need to be viewed and integrated in order to provide a holistic solution.
Unfortunately, it is not customary for employers to integrate behavioral health care benefits with employee assistance or health promotion programs. And, this lack of synchronization often results in employer-sponsored behavioral health services that are fragmented and uncoordinated.
However, a program that seamlessly integrates employee assistance, wellness and disease management has been shown to be an effective way to address co-morbid chronic illnesses. In this type of solution, health professionals help people make modifications in their lifestyles through wellness measures, treat chronic diseases through a long-term disease management approach that aims to prevent worsening of chronic medical conditions, and evaluate and treat people for psychiatric issues through integrated health and behavioral health programs.
An integrated model also enhances the preventive aspect of these employee services, potentially limiting costs that might have arisen if not for the early detection of problems made possible when all service users are funneled through one highly trained and skilled consultant serving as case manager.
As an individual experiences the various symptoms associated with intertwined chronic conditions, he must be able to ebb and flow among the three prongs of treatment - tapping into what he needs, when he needs it. This way, for example, if an assessment offered through a wellness program uncovers that an individual is at risk for cardiovascular disease, every aspect of that diagnosis can be seamlessly handled through one program. He can continue to monitor his condition through the wellness program, can get information on lifestyle changes through the disease management program, and can tap into the EAP to help manage the emotional health side of the issue.
Or, perhaps a disease management counselor who is working with an employee to get her diabetes in control determines she is stressed and depressed. The counselor immediately brings an EAP counselor on board to focus on the employee's behavioral health, and taps into the wellness experts to help the employee initiate a diet and exercise program.
Disability inclusion
As the relationship between chronic disease, depression and disability continues to unfold it is also important to link disability into the web of interconnected services. Missing work because of illness or injury can trigger depression because so much of a person's identity and self-esteem are linked with employment and being productive.
EAP counselors who intervene early on can address the behavioral health issues that often complicate recovery and return to work. In addition to the physical factors, there are a variety of psychological issues that affect a person's return to work, such as anxiety about returning to work and fear of being treated differently. If not diagnosed and treated, depression and anxiety can undermine the plan of care and treatment for the ill or injured employee and delay his or her return to work. Because depression immobilizes a person's energy and self-care ability, and could exacerbate the problem to the point that the employee is unable to come back to work at all, the behavioral aspects of chronic disease or illness cannot be ignored.
Depression as a comorbidity can be addressed only if care providers, case managers and other professionals take a holistic approach to treating an ill or injured employee. They need to treat chronic diseases through a long-term disease management approach that strives to prevent worsening chronic medical conditions, to help people make modifications in their lifestyles through wellness and prevention measures, and to evaluate and treat people for psychiatric issues through integrated health and behavioral health programs. Only this type of integrated health care solution gives individuals ready-access to a myriad of educational and preventive services to help manage the chronic condition before it even enters the health plan and promotes an overall healthier working environment.
