Category Archives: Health

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Handling the Pain: Getting People Back to Work

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Photo ©Donscarpo

Employers nationwide are always concerned about absenteeism. When a worker doesn’t show up, the loss of productivity and profits can be staggering, making the worker’s problems a serious issue for the employer.

If the employee doesn’t stay home, the result doesn’t fall under ‘absenteeism’ but it still creates a negative impact.

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Productivity loss due to poorly performing employees who try to “work through” recurrent pain places employers in a difficult situation. Lost productivity—like time itself—is a non-renewable resource. No one wins when employees are unable to work.

The reverberations are felt on many levels. The worker may continue to feel pain. The employer must deal with the issue. Colleagues and associates often need to pick up the slack. Customers may be affected.

Who else? The employee benefits managers and the company’s workers compensation claims statistics. The higher the number and value of claims, the greater the drag on the company’s fiscal performance.

Pain emanating from chronic or lingering injuries needs professional involvement. The good news is that by treating the pain comprehensively or applying interventional pain techniques, nagging injuries or pain can be remedied or reduced sufficiently to increase the productivity of suffering employees.

On the Job

For many sufferers, relief through medication, physical therapy or other ‘traditional’ remedies is temporary, but pain and lost productivity continue.

Interventional pain care and management is a specialty where the physician diagnoses and treats pain at the source. According to the American Society of Interventional Pain Physicians (ASIPP), “Interventional pain management is defined as the discipline of medicine devoted to the diagnosis and treatment of pain-related disorders, principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.” Employers should encourage workers to learn more on how interventional pain management can reduce the duration and severity of pain, help them return to work faster and enjoy an overall improved quality of life.

Interventional pain physicians employ a number of techniques and procedures. Among the many successful solutions are epidural steroid, trigger point and botox injections; sympathetic plexus blocks; spinal cord stimulation; radiofrequency ablation, percutaneous intradiscal procedures, and implantable intrathecal drug delivery systems.

Pain reduction or eradication is the desired outcome, but diagnosis plots the path to potential recovery. Procedures like fluoroscopically-guided injections using local anesthetic can provide both relief and diagnostic value. Fluoroscopy is an imaging technique that incorporates X-rays to produce real time images of the internal anatomy. This diagnostic tool provides more accurate delivery of medication and important information to the physician on the origination of the pain, and thus the doctor can offer more effective treatment. In a healthcare climate that seeks to reduce unnecessary expenditures, like tests or procedures, such interventional techniques can reduce or eliminate ineffective, unnecessary or even more invasive options, up to and including surgery.

Injuries, chronic pain and absenteeism, plus the urgency to get employees back to work affect more than the bottom line. From on-the-job injuries, like lifting, strains and slip-and-fall injuries, to the resulting drain on human capital and performance, organizations are in need of solutions.

The Call of the Benefits Manager

The appropriate first call made by a human resources director or employee benefits manager is to the general practitioner or claims adjuster to document the mishap. Yet, if pain persists and lengthens an employee’s out-of-work status, quite possibly exacerbating a deteriorating psychological status, resolution may be difficult to achieve.

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The advice and services of an interventional pain management specialist are beneficial and can often be even more effective when combined with physical therapy or other home programs. A patient treated early often begins to experience expedient and lasting relief. The employee is not only more comfortable, but also returns to work sooner. This increases organizational productivity and, equally as important, reduces the time of a workers compensation claim.

Interventional pain care and management is growing in favor and its beneficiaries run the demographic gamut. Depending on the injury or source of lingering pain, employees from millennials to baby boomers approaching retirement are ideal candidates for many procedures.

This is especially important as many workers are putting off retirement into their late 60s and 70s. As those older patients more frequently suffer degenerative problems that may create or complicate injuries, interventional treatments deliver an ideal remedy, especially when performed in concert with physical or occupational therapy.

Using an Interventional Pain Specialist

The engagement of an interventional pain specialist presents a unique scenario. Benefit managers, human resource professionals and case workers have become more aware of interventional pain care over time.

Who should get the referral? The American Board of Anesthesiology has a certification process for interventionalists, as well as an additional sub-specialty certification in pain management. The American Board of Pain Medicine (ABPM) also certifies qualifying members. A Fellow of Interventional Pain Practice (FIPP) has earned certification by the World Institute of Pain, and the American Board of Interventional Pain Physicians (ABIPP) has a certification process as well.

The American economy loses upward of billion annually, due to lost productivity stemming from health issues and missed work, according to a 2013 report from Gallup-Healthways.

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Issues include chronic health problems such as pain, obesity, high cholesterol, blood pressure, cancer, asthma and depression. Even issues like poorly designed ergonomics in the workplace can result in significant pain and absenteeism. About one in three (34%) of all work missed stems from ergonomic-related issues, according to the U.S. Bureau of Labor Statistics.

For employee benefits managers who know how to help employees tackle pain and return to work, absenteeism and lost productivity can be reduced and billions of dollars can be saved all year long.

Health Care Reform and Workers Compensation

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Since its passage in 2010, the Affordable Care Act (ACA), commonly referred to as health care reform, has been the subject of intense political debate and a source of anxiety for many employers. Although most employers have focused on the law’s health benefit requirements, the ACA is also expected to impact how they manage their workers compensation costs in the following ways:

Workers’ Health

Proponents of the ACA say that it will lead to a healthier society. Advocates say that because more people will have access to health care, there will be a reduction in comorbidities. There is, however, no significant evidence to support this contention. For example, data from the Centers for Disease Control and Prevention indicate that heart disease remains the leading cause of death in the United States and that the percentage of Americans with a high body mass index has steadily climbed over the last 50 years—two trends that are not confined to the uninsured population.

Cost Shifting

Employers have long been concerned that injuries from non-work-related causes will be shifted to workers compensation. Doing so is tempting because of workers compensation’s combination of higher reimbursement rates for medical providers and lack of deductibles and co-payments for employees.  Some have speculated that the greater access to health insurance promised by the ACA will reduce this shift to workers comp.

It has become clear, however, that the law will not result in all Americans having health insurance coverage. With the ACA requiring that employers offer coverage to all employees working 30 or more hours per week starting in 2015, one-in-10 large companies are planning to cut back on hours for at least a portion of their workforce, according to “Mercer’s National Survey of Employer-Sponsored Health Plans” 2013.

Access to Care

Probably the most predictable outcome of the ACA is that it will increase the number of individuals in the U.S. with health insurance coverage. Despite the potential benefits, this could put additional stress on a health care system that is already short on doctors.

This is particularly troubling as it relates to specialists and the potential for delays in obtaining diagnostic tests and scheduling elective surgeries and other procedures. Longer periods of disability and complications as a result of such delays would ultimately drive workers’ compensation costs up.

With this added pressure on a limited number of medical providers, it becomes more important than ever for employers to develop medical networks that focus on quality of care and outcomes—even if it means paying more on a fee-for-service basis.

Standards of Care

Traditionally, the health care industry’s focus has been on volume; more patient admissions, tests, and procedures translated to higher revenues. Post-reform, however, the industry has shifted its focus to improving standards of care and achieving better patient outcomes.

If this transition results in less emphasis on costly procedures, which often produce questionable results, workers’ compensation costs could be reduced.

Although it remains to be seen whether the standards of care developed under the ACA for group health care would be enforced under workers compensation, this is a promising development for employers.

CVS Announces Plan to Stop Selling Cigarettes

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CVS to Stop Selling Cigarettes

On Feb. 5, CVS Caremark Chief Executive Larry Merlo said, “We’ve come to the decision that cigarettes have no place in an environment where healthcare is being delivered.” The company, he announced, will remove all cigarette and tobacco products from its 7,600 pharmacies nationwide by Oct. 1. The move is expensive, with up to billion in projected lost sales.

But CVS is betting on the long-run gains from doubling down on brand reputation and helping customers to live—and shop—far longer.

President Barack Obama personally took the time out to praise CVS, saying in a statement that the move will help wider efforts to “reduce tobacco-related deaths, cancer, and heart disease, as well as bring down healthcare costs.”

“CVS is now one of a small group of companies that have realized that their reputation is the most valuable asset they have and that building a stronger reputation by avoiding risks to that reputation can create a significant competitive advantage,” said Paul Argenti, professor of corporate communications at Dartmouth’s Tuck School of Business, in a column for the Harvard Business Review. “From the White House to the American Lung Association, CVS has received kudos for what seems to be a focus on shared value with society rather than the reckless pursuit of revenue at any cost.”

While CVS stock initially dropped the day of the announcement, shares have since risen 2.3%, success further bolstered when the country’s largest drugstore chain reported 2013 revenue of $126.8 billion—up 3% on healthy growth for drug plans and in-store pharmacies offset by weak growth in front-of-store sales.

“Its profit comes increasingly from health plans, which aren’t keen on carcinogens,” Jack Hough wrote in Barron’s. “Consider: CVS’ tobacco decision is expected to subtract six to nine cents from its yearly earnings per share. But a prescription deal with the Federal Employee Health Program, which expires at year’s end, is worth 16 cents to 21 cents a share, estimates investment bank Mizuho Securities. For CVS, a good chance at renewal just became better, and there’s plenty more business to be won.”

In Forbes’ CMO Shift blog, brand consultant Scott Davis wrote:

The $2 billion decision to boldly dump tobacco sends CVS’ boldest signal of commitment to the brand and to where it sees its future growth; it’s an unprecedented move and one that is wickedly smart. CVS is putting its money where its brand is, betting that this first mover advantage will pay off. I say “first mover” because no one truly owns health and wellness. Sixteen thousand health and wellness apps were downloaded last year.

Over $1.4 billion was spent by people trying to learn more about the topic. The overall category is heading to $1 trillion in the next 3-5 years and the timing is right for someone to step in and lead the dialog and become the Amazon of health and wellness. Why not CVS?

Indeed, CVS has spent considerable time and money extending the legacy of pharmacists as community health experts by adding over 800 MinuteClinic walk-in facilities. In doing so, the company has become the largest U.S. pharmacy healthcare provider.

The chain’s competitors are also branching into anti-smoking efforts as they expand their role in the wellness market. Walgreens recently unveiled a partnership with GlaxoSmithKline Consumer Healthcare to launch a free, Internet-based smoking cessation program called Sponsorship to Quit.

Overall U.S. cigarette sales fell 31.3% from 2003 to 2013, according to Euromonitor International. Many health officials hope that the move will help continue to decrease the number of smokers and smoking-related deaths in the U.S. “I think CVS recognized that it was just paradoxical to be both a seller of deadly products and a healthcare provider,” U.S. Centers for Disease Control and Prevention Director Thomas Frieden told Reuters.

Working to build and maintain a strong reputation also boosts the bottom line. Studies from Argenti and a range of other researchers suggest that companies with a strong reputation enjoy price advantages, being able to negotiate lower prices with suppliers and higher charges to customers. They can also recruit better employees, have more stable revenues and, “when something bad happens, they are given the benefit of the doubt by their stakeholders.” Further, “highly reputed companies are more stable, which means they have higher market valuation and stock price over the long term and greater loyalty of their investors, which leads to less volatility,” according to Argenti.

Convenience stores account for 75% of cigarette sales nationwide, so the tobacco industry has yet to express concern about prospective losses from drugstore sales. But Dr. Richard Wender of the American Cancer Society said CVS’s move would have an effect. “Every time we make it more difficult to purchase a pack of cigarettes, someone quits,” he told Reuters. So far, CVS is betting on that for patients’ health, and its own.

The 10 Most and Least Expensive Health Insurance Markets in the U.S.

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Health Insurance

Under Obamacare’s new insurance marketplaces, people in Minnesota, northwestern Pennsylvania, and Tucson, Ariz., are getting the best bargains for health care coverage. Premiums in these areas are half the price of policies in the most expensive regions, based on the lowest cost of a “silver” plan – the mid-range plan most consumers are choosing.

“The cheapest cost regions tend to have robust competition between hospitals and doctors, allowing insurers to wrangle lower rates,” according to a report from Kaiser Health News and NPR. “Many doctors work on salary in these regions rather than being paid by procedure, weakening the financial incentive to perform more procedures.”

The 10 regions with the lowest premiums are:

$154: Minneapolis-St. Paul – Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne and Washington counties.

$164: Pittsburgh and Northwestern Pennsylvania – Allegheny, Armstrong, Beaver, Butler, Crawford, Erie, Fayette, Greene, Indiana, Lawrence, McKean, Mercer, Warren, Washington and Westmoreland counties.

$166: Middle Minnesota – Benton, Stearns and Wright counties.

$167: Tucson, Ariz. – Pima County.

$171: Northwestern Minnesota – Clearwater, Kittson, Mahnomen, Marshall, Norman, Pennington, Polk and Red Lake counties.

$173: Salt Lake City – Davis and Salt Lake counties.

$176: Hawaii

$180: Knoxville, Tenn. – Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier & Union.

$180: Western and North Central Minnesota – Aitkin, Becker, Beltrami, Big Stone, Cass, Chippewa, Clay, Crow Wing, Douglas, Grant, Hubbard, Isanti, Kanabec, Kandiyohi, Lac qui Parle, Lyon, McLeod, Meeker, Mille Lacs, Morrison, Otter Tail, Pine, Pope, Renville, Roseau, Sibley, Stevens, Swift, Todd, Traverse, Wadena Wilkin and Yellow Medicine counties. In Chisago County, the lowest premium is $162.

$181: Chattanooga, Tenn. – Bledsoe, Bradley, Franklin, Grundy, Hamilton, Marion, McMinn, Meigs, Polk, Rhea and Sequatchie counties.

 

The 10 most expensive regions are:

$483: Colorado Mountain Resort Region – Eagle, Garfield and Pitkin counties, home of Aspen and Vail ski resorts. Summit County premiums are $462.

$461: Southwest Georgia – Baker, Calhoun, Clay, Crisp, Dougherty, Lee, Mitchell, Randolph, Schley, Sumter, Terrell and Worth counties.

$456: Rural Nevada – Esmeralda, Eureka, Humboldt, Lander, Lincoln, Elko, Mineral, Pershing, White Pine and Churchill counties.

$445: Far western Wisconsin – Pierce, Polk and St. Croix counties, across the border from St. Paul, Minn.

$423: Southern Georgia – A swath of counties adjacent to the even more expensive region. Ben Hill, Berrien, Brooks, Clinch, Colquitt, Cook, Decatur, Early, Echols, Grady, Irwin, Lanier, Lowndes, Miller, Seminole, Thomas, Tift and Turner counties.

$405: Most of Wyoming – All counties except Natrona and Laramie.

$399: Southeast Mississippi – George, Harrison, Jackson & Stone counties. In Hancock County, the lowest price plan is $447.

$395: Vermont*

$383: Fairfield, Conn. – The southwestern-most county, which includes many affluent commuter towns for New York City.

$381: Alaska.

*Unlike other states, Vermont does not let insurers charge more to older people and less to younger ones. Its ranking therefore will differ depending on the ages of the consumers.