Present and accounted for Featured

6:47am EDT June 30, 2005

You probably know the feeling -- you're physically present, but you're not all there. You may be distracted by something, you may be in pain, but you're simply unable to focus on what you're supposed to do.

If that happens once in a while at a party or during an after-dinner conversation, it's usually no big deal. But if it happens to frequently at work, it may be a very big deal.

"Even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality -- a concept known as 'presenteeism,'" writes Dr. Cheryl Koopman, lead author of a health-related productivity study conducted by a Stanford University research team.

Historically, presenteeism has been overlooked by employers who generally focus on absenteeism when evaluating health-related losses in productivity. One reason for that has been the difficulty in developing reliable data and/or measuring standards.

"Although productivity gains attributable to decreased presenteeism may be substantial, appropriate measurement tools are still in their infancy," Koopman's study reported.

According to Ron Goetzel, director of the Cornell Institute for Health and Productivity Studies (IHPS), losses related to presenteeism have "not been adequately considered by employers." In fact, these productivity losses could possibly exceed the costs of both absenteeism and medical and disability benefits.

An IHPS study indicates that employees who go to work when they are not feeling well and are less productive as a result may cost companies more in terms of lost productivity than what the companies actually pay in dollars for sick days and other medical and disability benefits.

The role of a company's health plan and the effectiveness of the health plan's health management programs are essential to limiting the production losses that result from presenteeism. Effective treatment of recurring minor ailments can keep employees healthy and reduce presenteeism.

Benefit plans including health management programs that monitor employees with chronic conditions and encourage them to seek appropriate care and take the appropriate medications can result in savings for an employer both in terms of long-term health care costs and improved productivity.

"If a company's health plan is poor, for example, disorders may not be well-managed," says Goetzel. "Workers will continue to work and not be as productive. Employers need to weigh the cost of good medical care against the potential for on-the-job productivity losses, which we see are substantial in many areas."

Employers who are sensitive to bottom-line concerns may notice increased utilization costs that often accompany effective health management programs. But companies should not overlook the resulting improvement in their employees' overall health and the increased productivity that results from health management programs.

Indirect costs triggered by presenteeism can be as costly as any other business expense -- the IHPS study estimated that presenteeism costs businesses an average of $255 per employee per year.

Controlling the financial impact of presenteeism means putting an emphasis on specific ailments, many of which are not normally considered expensive to treat. A major industry study found five top causes of presenteeism.

* Headache

* Cold/flu

* Fatigue/depression

* Digestive problems

* Arthritis

Clearly, one way to decrease absenteeism and presenteeism is through a comprehensive employer-focused health management system that integrates all aspects of health care, including traditional health care management services for chronic conditions and catastrophic illnesses, disability services, employee assistance programs and corporate health promotion programs. Finding a health insurance carrier that brings together these components into an integrated model means that employers have a one-stop shop that can deliver the key components that help keep employees at work and focused on their tasks.

Debra Horn is vice president of clinical and network services for UPMC Health Plan. The Health Plan, with 440,000 members, is part of the University of Pittsburgh Medical Center's integrated medical delivery system and is the only provider-led health plan in Western Pennsylvania. Reach Horn at (412) 454-5210.