Presenteeism and Productivity

Three companies showcase different approaches to addressing reduced productivity in the workplace.

By Marybeth Stevens, MS, CDMS, CCM, CRC

Employee health is a bottom-line issue with a straight-line connection to a company's profitability. Companies have realized lower costs, reduced absences and improved morale through disability management and return-to-work programs that ease ill and injured workers back into their jobs as quickly as medically feasible. Efforts, however, have not stopped there.

Companies continue to focus on employee health and wellness with innovative strategies that help bolster productivity. These initiatives bring together various experts and services, from disability managers to occupational health nurses and Employee Assistance Program (EAP) professionals. Their efforts are aimed at absence management, seeking to reduce the number and duration of unplanned employee absences due to illness, injury, or a personal or family problem. The next step, which companies are beginning to take, is to tackle presenteeism — helping employees who are at work to be the most productive possible. That means addressing the health, psychological and personal issues that distract employees and reduce their productive work hours.

The strategies used are as varied as the problems themselves. Some companies offer wellness and prevention to help employees deal with chronic health problems such as diabetes, hypertension, obesity and asthma. Others offer limited counseling and access to experts through EAP services to address personal, family, financial or legal problems. Rather than targeting only one aspect of employee productivity, the programs tend to be integrated, providing solutions to complex productivity issues in the workplace.

This article will explore the efforts of three employers to address absence management and presenteeism:

• BankOne — The sixth largest bank in the U.S. with approximately 70,000 employees (prior to proposed acquisition by J.P. Morgan).

• The Hartford — The country's second largest group disability carrier with 28,000 employees.

• Polk County, Florida — Covering the Polk County Board of Commissioners and all of its offices (including sheriff's, clerk of the court, tax collector, supervisor of election and property) with 4,300 employees.

BankOne: Integrating resources

At Chicago-based BankOne, employee health and wellness programs have focused sharply on two major productivity issues: reducing disability and keeping employees productive at work. "Disability is the end game," explained Wayne Burton, MD, senior vice president and corporate medical director for BankOne. "What you want to do is develop programs and services to avoid employees becoming disabled, and to have programs in place to help them come back to work quickly and stay at work."

As part of this effort, BankOne has decided to manage internally its short-term disability and Family Medical Leave Act (FMLA) absences under the umbrella of its health management services/corporate medical director's office. This allows the company to devote diverse yet complementary resources — from EAP counselors to occupational nurses — toward the goals of avoiding disability and reducing absences. While the corporate medical department focuses on the health issues that cause absenteeism and reduced productivity at work, the EAP emphasizes the psychological and personal aspects, from childcare or eldercare concerns to the need for short-term psychological counseling.

"Normally short-term disability is handled by an external vendor. It's a silo, and there is very little interaction with the corporate medical department," Burton said.

By managing short-term disability internally, BankOne can offer assistance to employees to help them return to work, stay at work, and be the most productive as possible while at work.

In practice, for example, this means that an employee who has been on short-term disability because of diabetes will have assistance from an occupational health nurse to help educate him or her about wellness and blood sugar monitoring. Or, an employee who has been off work due to mental-health issues such as depression will have assistance from occupational health nurses and the clinical psychologists from the EAP program.

This integrated approach allows BankOne to amplify the benefits of its programs. By addressing health and personal issues that cause short-term disability, the company can also help prevent productivity losses due to presenteeism.

An important component of the programs is disease management, targeting issues such as hypertension, diabetes, asthma, obesity and even prenatal health and pregnancy issues. "It's more than just screening. It's calling employees back and assisting them, giving them the guidance they need to talk to their doctors about their health concerns," Burton added.

The results of its efforts are impressive. BankOne participated in a major benchmarking study in 2002/2003, comparing it with peer banks. "We turned out to be best in class when we looked at short-term disability costs, long-term disability costs, days out of work and so forth," Burton said. "I believe that is because of the integrated way we look at disability. The benefits weren't the issue; they were about the same among the banks. It was really about how the people are managed."

The Hartford: Evolution of a program

The Hartford has undergone an evolution in its thinking about employee disability, preventing absences and improving productivity, which is reflected in its internal programs (the company is self-insured) and the programs it offers its customers.

Carol Harnett, National Practice Leader of The Hartford's Group Disability and Life Practices, traces the changes back to 1993. In the wake of the passage of the Americans with Disabilities Act (ADA), The Hartford began embracing an "ability philosophy" that focuses on what people could do, not what they couldn't do because of a disability or other limitation.

Based in Connecticut, The Hartford in 1997 became one of the of the first companies to integrate worker's compensation and disability insurance, bringing together the reporting and managing of cases whether they were occupational or non-occupational. Job modifications and temporary assignments for workers' compensation cases were also made available to those who suffered an illness or injury away from work.

In 2001, The Hartford began to look more closely at the inter-relationship between medical and disability costs. The impetus was a national study that showed about 11 percent of employees at a typical company accounted for 53 percent of all medical costs. "That meant, if a company could get to the root causes, it could address about half of its medical costs," Harnett said.

Studying its workers' compensation and disability cases, The Hartford found that 24 percent were due to musculo-skeletal problems. That prompted the company to invest resources in ergonomics and onsite medical and fitness services. The scope broadened from those employees who had suffered injuries to a broader population with an eye toward prevention.

The wellness-prevention theme runs through The Hartford's programs as it tackles health issues such as diabetes, asthma and obesity. "We are not unlike the rest of the U.S. Our employees are gaining weight year after year, just like the rest of the U.S., in which about 65 percent of the American population meets the definition of being overweight or obese," Harnett explained.

To raise awareness about the problem and to promote fitness, The Hartford has launched internal initiatives and external programs such as becoming the first U.S. corporation to sponsor the U.S. Paralympics, a member of the U.S. Olympic Committee that provides opportunities and funding for athletes with physical disabilities to compete at the Olympic level. "The connection between health and fitness is important to us. There is a connection between how employees take care of themselves and what the company's medical/disability experience is," Harnett observed.

In 2002, The Hartford took what Harnett calls its "biggest step toward understanding why people are out of work," by integrating the reporting of FMLA absences with workers' compensation and disability. "Whether I'm off due to illness, injury or because my mother is sick, I can call a single 800-number. Even though the case is handled one of three ways, I only have to call one number — and the absences are all tracked together." In addition, when an employee calls in to report an FMLA absence, he or she can be reminded of EAP services available either onsite or telephonically, which can help get employees back to work and stay productive on the job.

Based on the company's experience, as well as the coverage it offers, Harnett offered a three-point guideline. The first step, she explained, is to look at plan design and how it has evolved. Second, understand the interrelationship between medical and disability experiences and costs. Third, look beyond limiting or eliminating coverage to cut costs to consider more proactive solutions.

"If a company can do those three things, it will address not only the absenteeism issue, but also presenteeism," Harnett said. "There's one thing that must be understood about presenteeism: it's a continuum."

Polk County: Onsite medical, pharmacy services

When Michael S. Kushner first went to work for Polk County, Florida, in 1994 as director of risk management, one of the first things he saw was a lack of integration in employee health issues. Physical exams for employment were done in one place. Workers' compensation cases were treated at another. And there was no connection between workers' compensation and disability.

Polk County brought together employee health and wellness under one roof — literally, through its Occupational Health and Wellness Center, which handles everything from pre-employment physicals and drug screenings to wellness initiatives for employees on topics such as smoking cessation and diabetes management.

"Our goal in opening the health and wellness center for county employees was not only to provide education about their personal health, but also to provide employees an integrated approach — whether the issue stems from a worker's compensation event or a disability claim or a health and wellness issue," Kushner added.

To complement the health and medical center, Polk County decided to add onsite pharmacy services to increase the efficacy of patient medications and reduce medical costs. One of the reasons, Kushner explained, was an increase in employee co-pay on prescriptions, which led some employees not to fill prescriptions or to take their medicines less frequently to reduce refills. When medicine is not taken as prescribed, however, employee health is compromised.

Starting in November 2002, a pharmacist has been onsite at Polk County offices three days a week, counseling employees and their families about their prescriptions and drug issues, including over-the-counter medications and herbal supplements that they might be taking. The pharmacist looks at possible drug-interactions or duplications, and may consult with physicians about more effective drugs.

"Through the onsite pharmacy, we've been able to address patient safety and realize better impact on the outcome of overall patient care, from the onset of a condition to drug therapy. That means better outcomes and lower hospitalization costs," Kushner explained.

An initial review of the onsite pharmacy showed favored results, including a 3-to-1 return on investment, he added.

The onsite medical and pharmacy centers address employee needs across the spectrum, from emergency care to chronic conditions and prevention. The onsite medical department also handles triage in workers' compensation cases, including securing a speedy referral to specialists or other care providers.

As ill or injured employees recover, they are eligible for the active transitional duty program that is open to all workers, whether the incident was job-related or non-occupational. "We've studied all the employee job descriptions and we have designed 75 legitimate transition duty jobs that employees can do no matter where they work. These are valid jobs that contribute something to the county, to help the productivity of the organization," Kushner added.

At the heart of it all is the onsite medical center, bolstered by the onsite pharmacy, which Kushner sees as a means for employees to "filter their health concerns, and all their privacy is protected." In addition, the center also allows the employer to offer prevention programs, including incentives to meet personal health goals.

"We're certainly able to justify a lot of the cost of the program through hard dollar savings," Kushner observed. "Beyond that, you really have to sell it as a leap of faith. You have this intuitive sense that something will work. You have to have people who will believe in this concept between health and wellness and prevention."

As these case studies illustrate, addressing the health, wellness and personal/family needs of employees will not only reduce absences, but also help workers be more productive on the job. By integrating the initiatives, maximum benefits can be derived with a focus on common, bottom-line goals: improving the health of employees and the productivity of the organization.

Marybeth Stevens, MS, CDMS, CCM, CRC, is the Chair of the Certification of Disability Management Specialists Commission (CDMSC), the only nationally accredited organization that certifies disability management specialists. For more information on the CDMSC and its certification, please see the website at http://www.cdms.org . Ms. Stevens is also the leader for delivery of Workplace Absence and Disability Management Programs for General Electric Co., managing the operations for GE's U.S. disability program.

More Business & Health Articles About This Topic:

Bringing Health to the Bottom Line (Jun. 15, 2003)

The Real Measure of Productivity (Nov. 1, 1999)

Resource Links:

Certification of Disability Management Specialists Commission (CDMSC)http://www.cdms.org

Marybeth Stevens. Presenteeism and Productivity.

Business and Health

May 20, 2004;22.