Chronic health conditions are a fact of life for an estimated
99 million Americans. Research shows that more than 45 percent
of adults have some type of chronic condition _ back pain,
heart disease, arthritis, respiratory diseases, mental disorders
and diabetes among the most common.
Employers are painfully aware of the toll chronic illness
takes in lost workdays. Now, as they fight alarming increases
in health care costs, many want to know how these conditions
affect so-called presenteeism, or the reduced performance
of employees when they're on the job.
"We're not just worried about absenteeism. We're worried
about if, when they are at work, are they fully with us,
are they engaged and are they excited about doing their
work and working at full potential," said David McKenas,
medical director at American Airlines Inc.
In a report published in the March issue of the Journal
of Occupational and Environmental Medicine, Dr. Ronald C.
Kessler, a researcher at Harvard Medical School, said presenteeism
nationwide totals 2.5 billion days each year.
Another report, by the Boston-based Institute for Healthcare
Improvement, places the cost of treating chronic conditions
at $470 billion a year _ and climbing _ and the cost of
lost productivity from chronic illnesses at $230 billion
"Increasingly, an important actor in the health care
debate in America is employers, because they're paying for
the large health care contracts," Kessler said. "So
now employers are very interested in productivity and how
health care can help improve the day-to-day efficiency of
Kessler based his figures on a survey of 3,032 adults conducted
by the MacArthur Foundation Midlife Development in the United
States. The participants submitted self-reports on their
symptoms and productivity levels. Over a 30-day period,
20.2 percent of respondents said they worked less or left
early at least one day, compared with 17.5 percent who called
in sick at least one day.
"Presenteeism _ when they show up to work but do less
_ is more important than absenteeism because for certain
illnesses, it's the larger share of productivity loss,"
But measuring productivity is a difficult task. It's much
easier to note that a worker is sitting at her desk than
to say that she's there but only working at 90 percent of
capacity, he said.
Work impairments also have a trickle-down effect, he said.
"When I'm at work but only producing at 50 percent
and I work in a group, I might be messing up the work performance
of five people or 10 people," he said.
Kessler recognizes that his results, based on self-reports,
could introduce error. He's working with several major corporations
to develop figures in a more controlled setting. Results
will be available next year.
Focus groups include Fort Worth, Texas-based reservations
agents at American Airlines, where administrators already
measure productivity levels.
"Reservation centers are able to track not only activity,
such as how much time they're on the phone, how promptly
they answer the phone, but they can also track the results
of their effort and how much revenue is booked in an eight-hour
shift," said John Saylor, manager of American Airlines'
employers assistance program. "It's a good opportunity
to do research they couldn't do anywhere else."
Kessler said the purpose of his study is not to point fingers
at workers with chronic conditions but rather help improve
their quality of life.
"Quite a few companies are starting to look at health
care as an investment opportunity, as a way to pick plans
that will offer a return on the investment," he said.
Health care providers have started to offer numerous disease-specific
or disease management programs that feature outreach to
employees, newer medications with fewer side effects, education
on the benefits of diet and exercise, and training to employers.
Their efforts come on the heels of much criticism of the
health care system.
A private organization chartered by Congress to advise
the government on scientific matters said in early March
that the American health care system is failing to improve
the care of patients. The Institute of Medicine specifically
recommended that health care providers develop and promote
detailed strategies to treat 15 chronic conditions, such
as asthma, heart disease and diabetes.
Gerard F. Anderson, executive director of the nonprofit
Partnership for Solutions, which works to improve the lives
of people with chronic conditions, said it has become easier
for employers to design appropriate health benefit packages
for those people.
"What they should do is look at what some of the more
enlightened companies offer. But one thing we've found in
talking with corporate managers is that a lot of people
don't ask the right questions about chronic illness benefits
because they don't think they can get it," said Anderson,
also a professor at Johns Hopkins University.
Aetna Inc., for instance, runs a Healthy Outlook Program
for management of asthma, heart failure, diabetes and low
back pain. Each program includes individualized instruction
and material. Diabetes patients receive videos and workbooks
on blood-sugar control, glucose self-monitoring equipment
and access to specialized professionals.
"We've found that patients who have information about
a disease and manage it have a positive impact on their
quality of life. They work better, and employers see that
as a good thing," said Andrea Maluso, Aetna's certified
case manager in Dallas-Forth Worth.
Aetna's Healthy Outlook Program is free to subscribers.
Of the 300,000 subscribers in the area, 9,600 are enrolled
Cigna Health Care offers a similar Well Aware Program for
Better Health. It, too, embraces only a small percentage
_ 3.5 percent nationally _ of all potential patients with
"Not everyone is taking advantage of it. Employers
may not be telling their workers that they're eligible,"
said Dr. Richard M. Burton, Cigna's senior medical director.
Alton Anderson, an Arlington, Texas, insurance agent, discovered
Cigna's Well Aware program two years ago. He'd been fighting
diabetes for 13 years with limited specialized care.
"I'd check my blood-sugar level and get glucose if
I needed it, but I never felt like I had a health problem
or that I was sick," he said.
A foot blister, however, led to the amputation of his left
leg. Now he's more careful than ever to monitor his condition.
Anderson, 62, said Cigna's Well Aware program makes a huge
difference "I feel like I've really been able to control
my diabetes with the information that they send me and the
services that I receive," he said.
While health organizations push for more comprehensive
treatment plans, employers are finding ways to enhance their
J.C. Penney Co., for example, offers two health seminars
a month on topics such as diabetes, hypertension, depression
and stress for its 9,000 employees in Dallas-Fort Worth.
Cigna Behavioral Health and Texas Health Resources Programs
run the seminars. Its corporate headquarters in Plano, Texas,
features a fitness club, child-care center and medical facility.
"J.C. Penney has always been concerned with the welfare
of our associates. If we didn't have the associates running
the day-to-day business, running the stores, managing the
operation, where would we be?" asked Stephanie Brown,
senior public relations coordinator.
AMR Corp., the parent company of American Airlines, operates
a 10-room medical facility called Dallas Hope at Dallas/Fort
Worth International Airport. A staff of 120 medical professionals
caters to the needs of the 31,700 employees in the area.
McKenas said the presence of the clinic has helped reduce
lost time. A diabetic who may feel shaky can receive a blood
check and glucose, if needed, and assume their normal responsibilities.
Workers injured on the job return to work within five days,
compared with 21 days when they're treated elsewhere, McKenas
"The whole goal is to return the workers to work as
soon as possible, ideally before the mindset of disability
comes to fore," he said.
Dallas Hope, operated with a $90,000 monthly budget, also
offers workers flu vaccinations, fatigue countermeasures,
cholesterol screening and a mobile mammography program.
Texas Instruments provides comprehensive services through
an on-site Baylor Health Care Systems clinic. But the company's
philosophy is to promote self-responsibility by giving people
the tools and heading them in the right direction, said
Janet Solomon, TI's Health Benefits and Wellness Director.
"Chronic conditions can still benefit from preventive
measures. If you have asthma, you want to prevent an attack.
People out many days are people who don't control their
asthma," she said.
Kessler said he expects more employers to seek improved
care for chronic conditions once they study the bottom line.
"There are things that corporate America is appreciating
more. For example, last flu season was the worst we've seen
in long time. All of a sudden this flu season, everyone
wanted to give their employees the flu shot because they
realize the cost of a little flu shot is so much cheaper
than having your employees disappear for a week. The same
thing is happening with allergies," he said.
Innovative companies have started to link their human resources
programs with staff that analyze returns on investment.
American Airlines will soon hire an epidemiologist to look
at what's causing workers to slow down.
"We have to better study the problem to have the lever
to make changes we need to make," McKenas said.
In the meantime, American Airlines continues its research
on presenteeism with Harvard Medical School.
"Dr. Kessler is fighting a battle that we long ago
accomplished here," said American's Saylor, "and
that is to get a company to say if we help our employees
become a little more healthy, then maybe our company will
be more successful."
(c) 2001, The Dallas Morning News. Reprinted with permission
of The Dallas Morning News.