Health outcomes and costs among employees with fibromyalgia treated with pregabalin vs. standard of care.

OBJECTIVE: To compare comorbidities, drug use, benefit costs, absences, medication persistence/adherence between employees with fibromyalgia initiating treatment with pregabalin (PGB) vs. antidepressant Standard of Care ([SOC] amitriptyline, duloxetine, or venlafaxine). METHODS: Retrospective study of 240 adults initiating PGB or SOC after 7/1/2007. Multivariate regression models on propensity-score-matched cohorts compared postindex costs, absences, and adherence between cohorts. RESULTS: Pregabalin users had significantly more preindex muscle pain and dizziness and less depression than SOC (each P < 0.05). Use of some non-PBG/SOC drugs differed. No differences were found in total medical, drug, or absenteeism cost. PGB had more sick leave (9.8 vs. 6.8 days, P = 0.04), but other absence types were similar. All adherence metrics were nonsignificantly greater for PGB vs. SOC. CONCLUSION: Despite several comorbidity and drug use differences, most employee benefit outcomes and adherence did not differ between the cohorts.

Improvements in Resilience, Stress, and Somatic Symptoms Following Online Resilience Training: A Dose-Response Effect.

OBJECTIVE: To determine if participation in an online resilience program impacts resilience, stress, and somatic symptoms. METHODS: Approximately 600 enrollees in the meQuilibrium resilience program received a series of brief, individually prescribed video, and text training modules in a user-friendly format. Regression models tested how time in the program affected change in resilience from baseline and how changes in resilience affected change in stress and reported symptoms. RESULTS: A significant dose-response was detected, where increases in the time spent in training corresponded to greater improvements in resilience. Degree of change in resilience predicted the magnitude of reduction in stress and symptoms. Participants with the lowest resilience level at baseline experienced greater improvements. CONCLUSION: Interaction with the online resilience training program had a positive effect on resilience, stress, and symptoms in proportion to the time of use.

The Positive Effect of Resilience on Stress and Business Outcomes in Difficult Work Environments.

OBJECTIVE: To examine whether resilience has a protective effect in difficult work environments. METHODS: A survey of 2063 individuals measured individual resilience, stress, burnout, sleep problems, likelihood of depression, job satisfaction, intent to quit, absences, and productivity. It also measured work characteristics: job demands, job influence, and social support. Multivariate and logistic regression models examined the main effects and interactions of resilience and job characteristics. RESULTS: High strain work environments (high demand, low influence, and low support) have an unfavorable effect on all outcomes. Resilience has a protective effect on all outcomes. For stress, burnout, and sleep, higher resilience has a more protective effect under low-strain conditions. For depression, absence and productivity, resilience has a more protective effect when job strain is high. CONCLUSIONS: Workers with high resilience have better outcomes in difficult work environments.

Health Care Use And Spending Patterns Vary By Wage Level In Employer-Sponsored Plans.

Employees face an increasing financial burden for health services as health care costs increase relative to earnings. Yet little is known about health care utilization patterns relative to employee wages. To better understand this association and the resulting implications, we examined patterns of health care use and spending by wage category during 2014 among 42,936 employees of four self-insured employers enrolled in a private health insurance exchange. When demographics and other characteristics were controlled for, employees in the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1,000 versus 17 per 1,000), more than four times the rate of avoidable admissions (4.3 individuals per 1,000 versus 0.9 per 1,000), and more than three times the rate of emergency department visits (370 individuals per 1,000 versus 120 per 1,000) relative to top-wage-group earners. Annual total health care spending per patient was highest in both the lowest-wage ($4,835) and highest-wage ($5,074) categories relative to the middle two wage groups ($3,952 and $3,987, respectively). These findings provide new insights about wage-associated variations in health care use and spending in employer-sponsored plans. For policy makers, these findings can inform employer benefit design strategies and research priorities, to encourage effective use of health care services.

Documenting participation in an employer-sponsored disease management program: selection, exclusion, attrition, and active engagement as possible metrics.

OBJECTIVE: The objective of this study was to document participation in a large employer-sponsored disease management program. METHODS: This retrospective study tracked participation and attrition rates for asthma, diabetes, coronary heart disease, and congestive heart failure programs over a 4-year period. RESULTS: Across all four illnesses, only 25% of those identified had any participation. Over 12 months, only 7% continued participating. Of the 93% who were lost, 35% were excluded, 15% could not be contacted, 25% declined to participate, and 17% dropped out over time. All groups improved their adherence to recommended treatment guidelines. Nonparticipants showed the greatest absolute improvement in receiving recommended medical services; however, they also had the lowest rate of service use at baseline and remained lowest at follow up. CONCLUSIONS: Documenting active engagement and attrition rates may provide useful information for decision-makers.

The association between health risks and medical expenditures in a Japanese corporation.

PURPOSE: To examine the relationship between health risks and medical care expenditures in an employer setting in Japan. DESIGN: A cross-sectional, correlational study. SETTING: A large Japanese corporation. SUBJECTS: A total of 6543 employees of a large Japanese electronics company, for whom medical expenditures, lifestyle risks and biometric data were available, were included in the analysis. Seventy-six Percent were male, and subjects were primarily white-collar workers. MEASURES: Medical expenditure data were available for fiscal year 2000, including inpatient, outpatient, and total expenditures, measured in Japanese yen. Binary expenditure indicators for those having no claims and those having high claims (90th percentile) were also created. Risk measures included biometric assessment of high blood pressure and high body mass index (BMI, body weight and height) and self-reported stress, lack of exercise, excess alcohol consumption, poor nutrition, current smoking, and recent quitting. High cholesterol and high blood glucose measures were also available for some subjects from company physicals. RESULTS: Average total expenditures were 48,017 yen (US$445). The 90th percentile of the expenditure distribution was approximately 111,750yen (US$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35 %), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1 %), and high blood glucose (9.4 %). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76 % higher for recent quitters and 22.6% higher for employees with high blood pressure. Males and younger employees had consistently lower expenditures. Current smoking poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors. CONCLUSIONS: This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees. The investigation uncovered some significant levels of risk for lack of exercise, smoking, and stress. Although results indicate some significant associations between health risks and medical expenditures, several unexpected assocations were noted that require further study. Such information provides a solid foundation for health promotion efforts in Japan and direction for subsequent investigations of health risks and medical expenditures. Future studies should address important issues of health risk measurement, data collection, and research design.

Consumers' understanding of and interest in provider- versus practice-level quality characteristics: findings from a focus group study.

Quality measures are currently reported almost exclusively at the facility level. Forthcoming physician quality data are expected to be reported primarily at the level of the group practice. Little is known about consumers' understanding of and interest in practice-level measures. The research team conducted 4 focus groups, half with individuals who had a chronic illness and half with individuals who did not. Most consumers correctly understand the concept of a physician practice. However, consumers exhibit little interest in practice-level characteristics, preferring information about their personal doctor. Understanding of and interest in practice-level quality does not differ by chronic disease status. Additional work must be done to design, develop, and test promotional and educational materials to accompany the planned reports to highlight the relevance of practice-level characteristics for consumer decision making.

Validity of a New Patient Engagement Measure: The Altarum Consumer Engagement (ACE) Measure.

OBJECTIVE: The objective of this study was to report on the validation of new scales [called the Altarum Consumer Engagement (ACE) Measure] that are indicative of an individual's engagement in health and healthcare decisions. The instrument was created to broaden the scope of how engagement is measured and understood, and to update the concept of engagement to include modern information sources, such as online health resources and ratings of providers and patient health. METHODS: Data were collected through an online survey with a US population of 2079 participants. A combination of Principal Component Analysis (PCA) and detailed Rasch analyses were conducted to identify specific subscales of engagement. Results were compared to another commonly used survey instrument, and outcomes were compared for construct validity. RESULTS: The PCA identified a four-factor structure composed of 21 items. The factors were named Commitment, Informed Choice, Navigation, and Ownership. Rasch analyses confirmed scale stability. Relevant outcomes were correlated in the expected direction, such as health status, lifestyle behaviors, medication adherence, and observed expected group differences. CONCLUSIONS: This study confirmed the validity of the new ACE Measure and its utility in screening for and finding group differences in activities related to patient engagement and health consumerism, such as using provider comparison tools and asking about medical costs.

Prevalence of arthritis and associated joint disorders in an employed population and the associated healthcare, sick leave, disability, and workers' compensation benefits cost and productivity loss of employers.

Arthritis is a common condition among the working population in the United States. Despite its high prevalence, the total cost of arthritis from the employer perspective has not been fully evaluated. This study quantifies the employer cost for additional health care, absence, disability, productivity, and workers' compensation costs related to arthritis and associated joint disorders (AJD) for a large sample of employees over 4 years. Results showed that AJD affected 15.5% of the employee population at some time. After adjusting for confounding factors, employees with AJD had significantly higher costs for health care ($998), prescription drug ($195), absence ($84), short-term disability ($184), long-term disability ($54), and workers' compensation ($287); totaling $1802. Adjusted productivity output was 4% lower for the AJD group, equal to $7454 in lost revenue (P < .05). Implications for an aging workforce are also discussed.

Factors affecting the frequency of value-focused health activities and policies by employers.

OBJECTIVE: We sought to gather employer perspectives about value-focused activities (VFAs), intentions to make decisions based on value, and other factors affecting decisions. METHODS: Health decision-makers (n = 174), both American College of Occupational and Environmental Medicine members and corporate HR/benefits directors, responded to an Internet-based questionnaire. RESULTS: Of a total of 32 listed VFAs, companies reported, on average, performing 5.2 activities currently and considering 2.6. Twenty-five percent of companies reported doing eight or more. The most common VFAs were providing access to flu shots, centers of excellence, and wellness programs. Greater access to detailed outcome data was associated with doing more VFAs, as was greater accountability for absence, disability, and productivity outcomes. CONCLUSIONS: Employers vary widely in the number of VFAs in which they participate. Decision-makers with more information about, and accountability for, value outcomes reported doing more VFAs.

Missing variables: how exclusion of human resources policy information confounds research connecting health and business outcomes.

When corporate health researchers examine the effects of health on business outcomes or the effect of health interventions on health and business outcomes, results will necessarily be confounded by the corporate environment(s) in which they are studied. In this research setting, most studies control for factors traditionally identified in public health, such as demographics and health status. Nevertheless, often overlooked is the extent to which company policies can also independently impact health care cost, work attendance, and productivity outcomes. With changes in employment and benefits practices resulting from health care reform, including incentives and plan design options, consideration of these largely neglected variables in research design has become increasingly important. This commentary summarizes existing knowledge regarding the implications of policy variations in research outcomes and provides a framework for incorporating them into future employer-based research.

The association of smoking with medical treatment adherence in the workforce of a large employer.

PURPOSE: Prior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer. PATIENTS AND METHODS: This study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression. RESULTS: Controlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%-13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79) than nonsmokers (P=0.10). While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers. CONCLUSION: Current smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and direct management should be considered as part of a comprehensive population health-management strategy.

The relationship between smoking and health care, workers' compensation, and productivity costs for a large employer.

OBJECTIVE: To quantify and compare employee health- and productivity-related costs for current smokers versus nonsmokers for a large US employer. METHODS: Multivariate regression models were used to compare medical, pharmacy, workers' compensation, and short-term disability costs, self-reported absenteeism, and presenteeism by smoking status. Costs were aggregated over 3 years, from 2008 to 2010. RESULTS: Controlling for demographic variables, smokers had significantly different health care utilization patterns, as well as higher absenteeism and presenteeism costs. Overall, employees who smoke were estimated to cost employers $900 to $1383 more than their nonsmoking counterparts. CONCLUSIONS: Current smokers experience incrementally greater lost productivity than nonsmokers, contributing to employer costs associated with smoking. Increased employer focus on smoking cessation may help mitigate these organizational costs.

Direct and indirect costs of women diagnosed with menopause symptoms.

OBJECTIVE: To quantify employee burden of those diagnosed with menopause symptoms. METHODS: This regression-based study analyzed 2001-to-2010 medical, pharmacy, sick leave, disability, workers' compensation, and productivity data of large US employers. A cohort of employed women with diagnosed menopause symptoms (DMS), aged more than 40 years, were identified using medical claims International Classification of Diseases, Ninth Revision, Clinical Modification codes 627.xx. Control employees were propensity matched on age, employer, plan enrollment length, and enrollment end date. RESULTS: The study included 17,322 in each cohort. Employees with DMS had significantly higher medical ($4315 vs $2972, P < 0.001), pharmacy ($1366 vs $908, P < 0.001), sick leave costs ($647 vs $599, P < 0.001), and sick leave days (3.57 vs 3.30, P < 0.001). Employees with DMS had 12.2% (P = 0.007) lower hourly productivity and 10.9% (P = 0.014) lower annual productivity than controls. CONCLUSIONS: Although all women experience menopause, women with DMS have significantly higher utilization and productivity burdens.

Effect of antihypertensive medication adherence among employees with hypertension.

OBJECTIVES: To determine if antihypertensive medication adherence is associated with decreased medical and drug costs, medical service utilization, and work absence days. STUDY DESIGN: Retrospective database study using medical, pharmacy, sick leave, short-term and long-term disability, and workers' compensation claims data from multiple large US employers from 2001 to 2008. METHODS: We used medical and pharmacy claims to identify employees with hypertension. The index date was the date of the first hypertension-related pharmacy claim. Eligible employees had health plan enrollment 6 months before the index date and at least 12 months after the index date. Employees younger than 45 years were excluded from the study. Regression models estimated the effect of the proportion of days covered (PDC) by hypertension medication on outcomes after the index date, including health benefit costs, medical service utilization, and work absence days, as well as some clinical outcomes calculated separately for high-prior-cost and low-prior-cost employees. High-prior-cost employees were those who accounted for the top 60.0% of total medical costs during the 6 months before the index date. The regression models controlled for demographics, job-related variables, and comorbidities. RESULTS: Among low-prior-cost employees, high PDC was associated with increased medical and drug costs and work absence days. Among high-prior-cost employees, high PDC was associated with decreased medical and drug costs, fewer work absence days and inpatient hospital days, and increased hypertension-specific medical costs. CONCLUSION: Antihypertensive medication adherence was associated with improvement in some short-term utilization measures among high-prior-cost employees, but significant short-term improvement was not seen among low-prior-cost employees.

The impact of morbid obesity and bariatric surgery on comorbid conditions: a comprehensive examination of comorbidities in an employed population.

OBJECTIVE: Find conditions with significantly different prevalence among employees diagnosed with morbid obesity (DMO). Examine the effect of bariatric surgery on the prevalence of all categories of comorbid conditions after surgery. METHODS: This large employer retrospective database analysis used matching to create two cohorts: Those with a DMO and those without. RESULTS: The DMO cohort had higher diagnosis rates in every Agency for Healthcare Research and Quality major diagnostic category except pregnancy, and it had significantly higher prevalence in 147 of 261 Agency for Health care Research and Quality specific categories. Those electing to undergo bariatric surgery experienced significant prevalence decreases in 26 of 261 specific categories. CONCLUSION: Employees DMO are at higher risk for many serious diseases. Bariatric surgery has been effective in promoting weight loss and decreasing the rates of many serious comorbidities.

The association of insulin medication possession ratio, use of insulin glargine, and health benefit costs in employees and spouses with type 2 diabetes.

OBJECTIVE: Measure the impact of insulin utilization on health costs and absenteeism. Compare outcomes between users of insulin glargine and other insulin. METHODS: Using a large retrospective database, this regression analysis examined annual health costs and absenteeism among employees and spouses with type 2 diabetes who used insulin. The analysis studied impacts of medication possession ratio (MPR) and glargine use, controlling for demographic factors, salary, and prior health care. RESULTS: Higher MPR was associated with significantly lower health costs for patients with high prior costs. Glargine users' MPR was higher than other insulin users' MPR (66% vs 54%, P < 0.0001). Among all insulin users, those using glargine had significantly lower total ($6771 vs $7969, P = 0.0046) and circulatory-specific ($312 vs $636, P < 0.0001) costs. CONCLUSIONS: Insulin MPR and the use of insulin glargine were associated with lower health care costs.