Category Archives: Policies and Incentives

How Employers Can Better Manage the Recovery-Time Dimension of Healthcare

How Employers Can Better Manage the Recovery-Time Dimension of Healthcare


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A hidden dimension to healthcare costs lies in a workplace perk that most people take for granted: Paid time off to recover from an illness or injury. And most employers can improve their approach and improve health while reducing lost time by focusing on the right people, based on research by HCMS Group.

Work time lost because of illness or disability represents a major indirect cost in addition to the direct expenses of healthcare and other employee benefits. Sick days, disability, and workers’ compensation time off run into the millions of dollars every year for large employers and into the hundreds of billions for the U.S. economy, studies have shown.

The average worker with a disability claim uses about 11 days of recovery time a year, costing employers $5,577 annually (see figure 1 below). That is based on 10 million lost-time episodes from HCMS Group’s Research Reference Database of almost 4 million people covered by more than 300 employers.

But those averages mask the true nature of the issue. People in the 5% of the population that accounts for more than 50% of healthcare costs consume much more recovery time. For them, disability and sick time adds up to almost 92 days a year and costs almost $42,000. By comparison, members of the lowest-cost 50% use fewer than 2 sick days a year at a cost of less than $1,300. Clearly, the high-cost 5% group offers a great opportunity for helping people return more quickly to health and work, saving money on recovery time.

This is where most employers could improve their management approach. Almost every disability-management program in use today focuses on a patient’s primary medical problem. There’s a whole industry built around “disease management.” Do a Google search on that term, and you get more than 41 million entries.

What’s wrong with that? Well, a person’s primary disease is often only a relatively small part of the picture, based on more than a decade of research on the high-cost 5% group by HCMS. These are people with complex health needs who typically have 11 medical diagnoses and 10 healthcare providers, and are taking 10 prescription medications, HCMS researchers have found.

The additional conditions, known as comorbidities, account for anywhere from 50% to more than 90% of total healthcare costs for people in the 5% group, according to HCMS data (see figure 2 below). For example, among people with cardio-metabolic syndrome–one of the highest-cost diseases–the primary heart condition amounts to just 9% of total medical costs. For those with a musculoskeletal condition, the cost of treating the basic injury to the body’s structure of bones, joints and muscles comes to just 24% of the total.

Consequently, disease management that focuses on a single dimension of a person’s set of conditions will fail to address most of what else is keeping that employee away from work. The main takeaway from these research findings is the need for a whole person-centered approach to helping people return to health and to work.

— Bob Simison, HCMS communications, on behalf of HCMS Data Analytics

Figure  1: Average disability cost by population group, from the lowest-cost 50% to the highest-cost 5%.

Disability Claimant PRA

(Click image to enlarge)

Figure 2: Cost of primary condition and comorbidities, by category of primary disease.

Disability Claimant Comorbidity Analysis

(Click image to enlarge)


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Healthcare Reform Webinar Series Video 5: Centers of Excellence and Finding the Best Care


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In the fifth webinar in our healthcare reform series, Dr. Hank Gardner, Dr. Tim Ryan, Rene Sims, MSN, RN, and Justin Schaneman, MS discussed centers of excellence and how clinical prevention plays a role. Watch the video recording to hear how centers of excellence are commonly evaluated and learn a new way of evaluation that measures how efficiently healthcare networks/providers manage patient risk.

For HD viewing, please click on the video and then click on “HD” in the bottom right of the pop-up window. The HD button will be blue when it is turned on.

Have any questions or comments? Leave a comment and we’ll be sure to get back to you.

To see the other videos in this series, please click here.


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Which Comes First — Better Health or Better Job Performance?


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Better Health or Better Job PerformanceThere’s a strong link between better health and better job performance, according to a study by HCMS Group.

People who rated in the top 20% on year-end performance reviews also had the lowest medical costs and the lowest health risk scores, HCMS researchers found. The analysis covered several thousand professional workers in the HCMS database over 12 months. The performance evaluation system classified the group in three performance bands—the lower 20%, middle 60%, and upper 20%.

There are two ways of looking at the findings. One is that high job performance correlates with a high sense of responsibility, so the better workers try harder to maintain good health. The other is that healthier people are simply better able to perform at a high level in the workplace, while for others illness may cause productivity to suffer.

There’s been relatively little research on the connection between work performance and health. One study by Brigham Young University’s department of health science found that employee engagement, health behavior, and physical health were significantly associated with job performance and absenteeism. The research was based on 20,000 employees of three U.S. companies who completed surveys between 2008 and 2010.

For each of the three performance groups in the HCMS study, researchers calculated the average annual medical costs and the average risk score, using the Human Capital Risk Index® (HUI, patent pending). The HUI score takes into account about 300 variables for each individual, including medical diagnoses, health plan costs, compensation policies, and use of disability and workers’ compensation benefits. The average risk is 1.0.

Risk Score Health Plan Cost by Performance Group

Medical costs for the entire group averaged $5,455 for the year. Those in the top-performing 20% had average health expenses of $4,100, more than a third lower than the middle group’s $5,600. People in the lowest performance band had healthcare costs 41% higher than those in the middle band.

Similarly, the HUI risk scores average 1.0 for the top-performing group, or 17% lower than for those in the middle group. The lower-rated band had average risk scores 17% higher than those in the middle. The research also found that those in the middle and lower performance groups were two to three times as likely to have a disability claim. Workers’ compensation filings were twice as high for the bottom group as for the upper two categories.

 

— Robert L. Simison, HCMS Communications

On behalf of HCMS Data Analytics

 


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Higher Education, Lower Risk to Health


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Human Capital Risk Index EducationA college education doesn’t just raise your earnings potential. It may also lower your risk of poor health.

Health risks for people with a bachelor’s degree are 20% lower than for those with a high school education, and more than 27% lower than for people who didn’t finish high school, according to research by HCMS Group LLC. Holders of doctorates have risk scores 10% lower than for people with a bachelor’s degree.

The findings are based on the HCMS Group research reference database. Health risk reflects the company’s Human Capital Risk Index® (HUI, patent pending). The index weights more than 300 characteristics on each individual, including clinical diagnostics, medical and pharmacy benefit use, workers’ compensation claims, and disability time used. A score of 1.0 represents average risk across the entire database of 3.7 million people. The analysis of education level was based on a database subset for which the average risk score was higher than 1.0.

 

HUI Risk Scores by Education Level

For people who didn’t complete high school, HUI risk scores were 1.82, almost double the overall mean. The lowest score for any group was 1.19, for those with Ph.D.’s.

Other researchers have documented the link between higher education and better health. This month, the National Bureau of Economic Research published a working paper, “Education and Health: Evaluating Theories and Evidence.” The authors calculated that the health returns on education increase education’s total value by 15% to 55%. Earlier research sponsored by the Robert Wood Johnson Foundation examined the role in this phenomenon of health knowledge and behaviors, employment and income, and social and psychological factors.

The conventional wisdom is that a higher degree of formal education correlates with a higher degree of health knowledge. Our research also suggests a significant compensation impact. Employees with a higher level of education are more likely to have higher-paying jobs with more compensation at risk through incentive compensation structures. These workers have a stronger incentive to protect their health to ensure continuing success.

The HUI score, based on more than a decade of research by HCMS Group, is the most accurate person-centered risk score available. It is central to the company’s 5|50 Solution™ which is designed to address the 5% of any population that accounts for 50% of employer’s benefit costs.

— Robert L. Simison, HCMS Group Communications

On behalf of HCMS Group Data Analytics.

 


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Can a Backache Be Contagious?


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Contagious BackacheIf you have a backache, a knee sprain, or some other injury to the body’s structure of bones, joints, and muscles, the risk that someone else in your family has such an injury rises by more than a third.

That’s what researchers at HCMS Group LLC discovered in analyzing healthcare data on more than 3.7 million people whose medical benefits were provided by more than 200 employers. They found that when a covered employee has medical costs for treating a musculoskeletal condition, there’s a 27% likelihood that a dependent will, too. That compares with a 20% risk for dependents when the employed family member doesn’t have such an injury.

Among dependents, the risk is higher for adults than for children, but the findings are consistent across all groups. (See figure 1 below.)

Likelihood of Dependent Musculoskeletal Cost

For more than a century, economists and psychologists have observed a contagion effect in social networks and workplaces. One 1996 study found that health symptoms often spread through groups of workers without any physical cause. In 2000, researchers, led by Dr. Hank Gardner,  the CEO and principal owner of HCMS Group, analyzed data on claims for workers’ compensation and family leave. They found evidence that workers learning from each other about the benefits fueled a contagion effect in filing of claims.

With respect to musculoskeletal conditions, multiple cases within a family can have significant cost ramifications. Average annual expenses for treatment of these conditions range from $500 to $55,087, according to HCMS Group research. The low end of the scale is for the healthiest 50% of the population. At the high end are those in the 5% of the population who account for 50% of healthcare costs. People in this group have an average of 10 other conditions, with several medications and specialists involved in their treatment. (See previous blog post. For information on HCMS Group’s 5|50 Solution™ designed to address this problem, click here.)

 

— Robert L. Simison, HCMS Group Communications

On behalf of HCMS Group Data Analytics

 

This is the final installment in the series on musculoskeletal discoveries. Please visit the links below to read the other posts in this series:

1. Musculoskeletal: Top Contributor to Total Claim Costs

2. Musculoskeletal Costs Nearly Twice that of Condition-Specific Costs

3. The $55, 087 Backache

 


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Healthcare Reform Webinar Series Video 4: The Importance of Primary Care


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The fourth video in our healthcare reform webinar series focuses on the importance of primary care. Watch this live webinar recording of Dr. Hank Gardner, Dr. Nim Patel, Shawn Petrini, MSN, RN, and Justin Schaneman, MS as they discuss a market solution for healthcare reform, primary care and clinical prevention analyses, key issues with primary care usage, and clinical prevention’s synergy with primary care.

For HD viewing, please click on the video and then click on “HD” in the bottom right of the pop-up window. The HD button will be blue when it is turned on.

Have any questions or comments? Leave a comment and we’ll be sure to get back to you.

To see the other videos in this series, please click here.


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Healthcare Reform Webinar Series: Video 3


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The third video in our healthcare reform webinar series, The Pathway to Implementing a Single “Aligned Incentives” Health Plan, reviews why having this single health plan delivers the best results.

Watch this live webinar recording as Dr. Hank Gardner, Justin Schaneman, and Neil Sullivan discuss, analyze, and evaluate population risk, actuarial versus econometric modeling, the health insurance exchanges, and health risk assessments.

For HD viewing, please click on the video and then click on “HD” in the bottom right of the pop-up window. The HD button will be blue when it is turned on.

Have any questions or comments? Leave a comment and we’ll be sure to get back to you.

To see the other videos in this series, please click here.


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Optimal Number of Primary Care Visits?


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Optimal Number of Primary Care VisitsIntroduction

With the increasing interest in learning how to improve the use of primary care, we have modeled the optimal number of annual primary care visits related to health plan costs as shown in the graph below. Increasing primary care is a key element in the HCMS Aligned Incentives Health Plan as described in our webinar series (please click on these links to view the first and second webinar recordings in our healthcare reform series). Continue Reading


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Healthcare Reform Webinar Series: Video 2


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In the second webinar in our healthcare reform series, HCMS Group CEO Dr. Hank Gardner and VP of Data Analytics Justin Schaneman discuss the Data Analytics used in the successful implementation of effective healthcare reform.

Watch this live webinar recording and listen to a detailed analytic discussion on health plan selection bias, primary care, econometric modeling, population risk analysis, and more.

For HD viewing, click on the video and then click on “HD” in the bottom right of the video. The HD button will be blue when it is turned on.

To see the other videos in this series, please click here.


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