U.S. businesses spend more than $1 billion every week on serious, nonfatal workplace injuries, according to the 2017 Liberty Mutual Workplace Safety Index. That’s one of the reasons that employers deploy a host of tactics to maintain a safe and productive workplace and lower healthcare and workers’ compensation costs.
Yet a staggering $1 trillion is lost to unaddressed employee chronic disease each year, according to The Milken Institute. And most employers aren't taking the necessary steps to really help workers manage their conditions.
Too many workplace wellness programs just focus on health assessments and disease identification. Granted, that’s an important start. But a more proactive approach could lower both employee absence and employer healthcare costs. Specifically, initiatives should be designed that help employees effectively manage their chronic diseases.
There are two reasons this is a critical imperative for America’s business community:
First, chronic health conditions are epidemic. Heart disease, stroke, cancer, type 2 diabetes, obesity and arthritis are among the most common and preventable of all health problems. According to the Centers for Disease Control and Prevention, as of 2012, about half of all adults — 117 million people — had one or more chronic health conditions. One of four adults had two or more chronic health conditions. Seven of the top 10 causes of death in 2010 were chronic diseases. So it’s not a chance that employers will have one or more employees with a chronic condition, it’s a virtual certainty.
Second, the costs of these diseases disproportionately manifest in and impact the workplace. More than 150 million Americans get their health coverage through their employer, compared to the roughly 20 million people who buy their coverage on and off the Affordable Care Act's troubled insurance exchanges, according to the Kaiser Family Foundation.
In recent years, employers have tried to shift more healthcare costs onto their workers, such as through high-deductible health plans. But when the average annual premium for family coverage is more than $18,000, there is only so much cost shifting one can — or should want — to do to their employees.
Unlike episodic illness, which comes on suddenly and generally has a distinct end, chronic illness can last indefinitely and worsen over time. The CDC notes that treating chronic disease accounts for 86% of the nation’s healthcare costs, and the National Association of Chronic Disease Directors estimates that healthcare costs for people with a chronic condition are five times higher than those without a condition. In addition to increased insurance costs, there are uncalculated indirect costs including loss of productivity, absenteeism, increased workers’ compensation costs, and additional employee stress and anxiety.
With care management, many conditions such as diabetes, hypertension, raised cholesterol and heart disease risk can be controlled. But they require linkage to intervention.
One problem with current employer-sponsored wellness programs is that they may offer screening, such as biometric lab testing, to help the employee understand current health problems or future risks. Providing this insight is intrinsically valuable, and our experience, both as a provider of wellness services and a large employer that offers them to our employees, is that many people often learn they have conditions — and take steps to arrest them —after receiving this information. But for some people, insights from screening may not be enough. For some, a link needs to be made between these insights and access to guidance and care.
In our diabetes programs at Quest Diagnostics Health & Wellness, for example, we work with the employer to identify those within the workforce that are at risk for the disease and deliver prevention and access to management programs. Diabetes, which affects an estimated 29 million individuals in the U.S., is the leading cause of kidney failure, lower-limb amputations other than those caused by injury, and new cases of blindness among adults. But the CDC estimates that one-third of the American population, or 86 million individuals, are living with prediabetes, defined as having higher than normal blood glucose levels, but not high enough to warrant a type 2 diabetes diagnosis. For some people, prediabetes — which often has no symptoms and can only be detected with lab tests — can progress to type 2 diabetes. By then, both the employee and the employer are likely to incur healthcare costs, work loss and health-related work limitations.
But some intervention programs have proven to be effective at lowering the risk of progression from prediabetes to type 2 diabetes. For example, Quest digitally links individuals identified with prediabetes through our screenings to a 16-week, CDC-developed Diabetes Prevention Program (DPP), education, coaching and lifestyle modification services program provided through a third party behavioral health company. Through this connection, people who are struggling with being hyperglycemic or overweight can gain access to guidance, education and lifestyle modification services through their personal laptops, cell phones or desktop computers. These programs are associated with reductions, in new cases of diabetes.
Why is combatting chronic disease the responsibility of corporate America? For one, a healthier workforce will benefit them in the form of cost savings. But science also suggests that healthier people are happier people; similarly, happier people are healthier. Wellness programs can help engage people by showing them their employer cares enough about their health and well-being to do something about it. Ultimately, nurturing a culture of health through employee wellness programs is about creating more engaged and productive employees.
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