Presenteeism Featured

5:36am EDT May 19, 2006
Employers can never stop looking for new ways to control their business costs. Many focus very carefully on rising medical costs. But a wealth of emerging research indicates that a broadened view of the issue is in order. A large cost component of poor health isn’t directly associated with medical costs, but rather is associated with lost or impaired productivity while at work. This is commonly referred to as presenteeism.

Published studies in the Journal of Occupational and Environmental Medicine and the Journal of the American Medical Association (JAMA) indicate that common aliments can contribute to excess absenteeism (missed work days) and presenteeism. Last year, JAMA reported that depression cost U.S. employers $35 billion a year in reduced performance at work and that pain conditions such as arthritis, headaches and back problems cost nearly $47 billion.

“Most employers will agree that healthy employees are productive employees — but few will have resources needed to address the issue. You need contemporary approaches to measure the impact of health on productivity and pinpoint health issues of greatest importance to their organization,” says Bill Berenson, vice president of sales and service for Aetna’s North Central region.

Smart Business spoke with Berenson about presenteeism and how an integrated care management approach can improve the health status and productivity of an employer’s workforce.

What is presenteeism?
Presenteeism is a term used to describe impaired job performance and/or reduced productivity at work among employees who come to work with health problems that interfere with working. Common sources of presenteeism include migraine headaches, depression, hay fever, lower back pain and even heartburn.

How does presenteeism affect the quantity and quality of an individual’s work?
A health impairment can impact employee performance on the job in several ways; it can interfere with capability to manage time, pose physical limitations needed to get a job done, add stress to interpersonal relationships and reduce job output.

Here’s an illustration. Kathy, a 42-year-old office worker, suffers in silence. At any time, her lower back pain can suddenly or gradually appear. Sometimes the severe and debilitating pain causes her to miss work. But most of the time, she goes to the office and quietly lives with a dull ache or sharp, stabbing pain. Routinely, her job performance suffers. It’s hard for her to focus and she ends up just muddling through the day.

Kathy is not alone in her struggle. Studies show that most companies overlook what may be a $150 billion problem that not only impacts health care costs but also workforce productivity.

How does an integrated care approach improve employee health and productivity and reduce medical costs?
Traditionally, employers have offered individual programs to their employees to address these challenges. However, we believe that an integrated, total health management approach produces better outcomes. We have seen promising results from the integration of medical, pharmacy, disability and behavioral health benefits and programs. These programs have helped employers improve the health and productivity of their employees and reduce medical costs.

To illustrate the point, a 2005 study revealed that an integrated benefits package that includes medical, pharmacy and disease management services can yield significant improvements in certain health outcomes for members and substantial medical savings for the employers. According to the data, overall costs dropped by 20 percent for high-risk members with integrated benefits compared to similar members with just medical insurance benefits.

What actions can employees take to understand their own health status?
Employees can take action by completing an online health assessment, which identifies specific health needs and generates a personalized health action plan with wellness and disease prevention programs. They are encouraged to make health changes that fit their lifestyles and track progress toward improvement. Based on self-reported information, participants may receive feedback and recommendations for additional programs and resources. For example, an employee who completes the health risk assessment and indicates risk factors for heart disease may receive dietary and exercise suggestions in addition to a link to a Web site with cardiac-related health information and decision-support tools.

What can health plans do to help employers measure the link between health and productivity?
Health plans are in a great position to offer more information services to employers. There is a growing need to provide information driven services to enhance members’ health status, including productivity.

Indeed, this is an exciting time, and an important opportunity to help employers of all sizes get more value from their investments in employee health. Work with your broker to look for innovative ways to meet your needs that provide a strong connection to employee health, productivity and bottom-line results.

WILLIAM BERENSON is vice president of sales and service for Aetna’s North Central Region. Reach him at (312) 928-3323 or