National Accounts
Perspectives
Health Care and Employee Productivity
How optimizing employee health enhances
their productivity – and your bottom line
Changing the health care conversation
Businesses have long defined health care
spending in two ways:
Authored by
Steven J. Serra, MD, MPH
Senior Medical Director
National Accounts
1. Providing health insurance for employees is a required expense
that eats into the bottom line.
2. Focusing on employees who are ill and getting them better.
This is a flawed approach to health care. A better approach is to
redefine the impact of employee health to your bottom line:
• The price of health insurance and well-being programs for employees is an
investment, and the return on this investment is a workforce of healthier, happier,
more productive employees, who can help the company grow financially.
• Paying to treat an employee with an illness or injury costs far more than
paying to prevent it.
Health insurance is how a company protects its greatest asset – its employees.
They develop ideas and products, manage operations, solve problems, grow sales
and serve customers. Healthy employees miss less time from work for sick days
and disability, are better focused on projects, are less sleepy on the job, move
better, worry less about their health and have more energy. Healthy employees
deliver better quality work, have better attitudes and morale, and provide better
participation and teamwork ­­­­­-- all of which make for a successful company. In this
paper, we will review the impact productivity has on a company’s bottom line and
how you can start changing your definition of health care.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary
companies, including Aetna Life Insurance Company and its affiliates (Aetna).
©2016 Aetna Inc.
90.03.996.1 (6/16)
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National Accounts
Perspectives
Health Care and Employee Productivity
Showing up to work, but little work to show
Dave* is the top salesperson at All-Star Sales, and he is on a hot streak
having increased his sales numbers four years straight. He is one of the
company’s most important assets to growing income, but his streak
of increasing sales will end this year.
His obesity has forced him to have a hip replacement and his morale
is low. He has trouble walking, which impacts his ability to meet with
customers. He will miss three months of work for hip replacement
surgery and rehabilitation. All-Star Sales has to pay for Dave’s medical
costs and allocate resources to serve his clients while he is away, and
three months of lost sales from the top salesperson means revenue
will drop. At work, poor health prevents Dave from performing his best.
While out of work to recover from surgery, Dave can’t do much. Dave’s
health care costs are going up, and his productivity is going down.
If All-Star Sales offered a weight loss program and financial
incentives in the form of health care premium credits for participating,
Dave might have lost enough weight to avoid surgery and continue
his streak of high sales.
*For illustrative purposes only. All-Star Sales is not a real company, and Dave is not a real person.
Healthy employees are vital to business success.
Consider this: The stock values of 26 public companies that received
the C. Everett Koop National Health Award appreciated by 325 percent
compared with the average appreciation of 105 percent for the Standard
& Poor’s 500, based on a simulation study from 2000 to 2014 reported in
the Journal of Occupational and Environmental Medicine.1 The Koop award
represents the highest recognition for a workplace health program among
experts. Award applicants need to show expert reviewers that their program
achieves measurable health and economic benefits.
How do you change the conversation and address chronic conditions
to create an environment of healthy, happy and productive employees?
Look at how the math adds up.
©2016 Aetna Inc.
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Healthy
employees take up to
40%
fewer sick days
per year2
National Accounts
Perspectives
Health Care and Employee Productivity
Value of investment in employee
health, productivity and well-being
TIV
I TY (
H &P ) S TR ATE G
E M P L O YE E IN V
Y
H&
ME
• Active participation
in H&P programs
• H&P program
completion rates
• Employee involvement
in H&P programs
H&P program costs
Worksite modifications
Staffing costs
Communication costs
Incentives
IM
P AC
T ON
E M P L O YE E
HEA
LT
L TH
•
•
•
•
•
HEA
H E AL T
ES T
IN
PR
C
DU
NT
O
Components of a value
of investment analysis³
“
Employers can save an average of $3 for
every $1 they invest in improving their
workers’ health, so there are opportunities
for companies to increase profits and
wages while they improve worker health.
H
• Healthy behaviors and
risk factors
• Prevalence of chronic
conditions
• Health care utilization
• Injury rates
B US
• Health care costs
• Disability costs
• Workers’ comp
costs
I N E S S O U TC O M E
Workforce
Health &
Safety
The Integrated Benefits Institute reported that
poor health costs the U.S. economy $576 billion
per year. Of that, $227 billion is lost productivity
because of absenteeism and presenteeism from
poor health.⁴ Presenteeism measures how much
health problems negatively impact the job
performance and productivity of employees
when they are at work.4
- Sean Nicholson, a professor of policy analysis
and management at Cornell University.⁴
S
Productivity
&
Performance
• Absenteeism
• Presenteeism
• Performance
Employer
of Choice
• Turnover
• Recruitment
• Workforce engagement
If the value of the incentives is built into the service fee or premium,
incentives would be cost-neutral to the employer.
³Value of investment in employee health, productivity and well-being: A National Business Group on Health toolkit. 2015.
Available at https://www.businessgrouphealth.org/toolkits/et_voi.cfm. Accessed April 28, 2016.
©2016 Aetna Inc.
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”
National Accounts
Perspectives
Health Care and Employee Productivity
Profession
% Above normal
weight or 1+
chronic conditions
Extra missed work days
each month among those
with subpar health
Productivity
loss
Productivity
perper
year
year
absenteeism
duedue
to to
absenteeism
(in(in
billions)
billions)
Professionals
74.8
0.30
$24.2
Managers or executives
78.8
0.29
$15.7
Service workers
76.4
0.31
$8.5
Clerical or office
76.5
0.39
$8.1
Sales
75.2
0.29
$6.8
School teacher (K-12)
72.6
0.30
$5.6
Nurses
73.7
0.36
$3.6
Transportation
86.0
0.41
$3.5
Manufacturing or production
82.0
0.24
$2.8
Business owners
79.2
0.34
$2.0
83.0
0.23
$1.5
80.5
0.11
$1.3
67.9
0.04
$0.25
78.8
0.08
$0.16
(excluding physicians, nurses and teachers)
Installation or repair
Construction or mining
Physicians
Farmers, foresters and fishers
Cost of lost productivity
per year by major
U.S. corporations5
The annual cost to the U.S. in lost
productivity across 14 job types due to
absenteeism tied to poor health ranges
from $160 million among agricultural
workers to $24 billion among
professionals, according to the
Gallup-Healthways Well-Being Index.
The total yearly bill across the
14 job types for lost productivity due to
workers being above normal weight or
having a history of chronic conditions
is $84 billion.⁵
⁵Witters, Dan and Liu, Diana. In U.S., Poor Health Tied to Big Losses for All Job Types. Gallup. May 7, 2013. Available at
http://www.gallup.com/poll/162344/poor-health-tied-big-losses-job-types.aspx. Accessed April 28, 2016.
Research by the Global Corporate Challenge, a Virgin Pulse company that works with businesses to improve
employee health and work performance, shows that on average, employees in a sample group took about
four sick days off each year, but when they reported how many days they lost while on the job because of
presenteeism, that number increased to 57.5 days per year per employee.6
“
That’s almost 12 full working weeks – or one quarter of
the entire year – that employees admit they really aren’t
performing at their best.
”
- Olivia Sackett, data scientist for the Global Corporate Challenge.⁶
As employers assess their employee health strategies, their most compelling cost issue is the link between
poor health and reduced productivity. On average, for every $1 employers spend on worker medical or
pharmacy costs, they absorb at least $2 to $4 of health-related productivity costs in the form of absenteeism
and presenteeism associated with chronic conditions, according to a study in the Journal of Occupational and
Environmental Medicine. “Integrating productivity data with health data can help employers develop effective
workplace health human capital investment strategies,” the study said.⁷
©2016 Aetna Inc.
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National Accounts
Perspectives
Health Care and Employee Productivity
Solutions for health risks in the workforce
Employers and health insurance companies have shifted beyond just addressing basic health issues, such as
healthy eating, physical fitness and smoking cessation, to focusing on the overall physical and mental health
and social well-being of employees and their chronic conditions.
Robust behavioral health and lifestyle management programs, plus disease management tools, mitigate the
future high costs of treating more serious conditions. These offerings also include biometric and metabolic
syndrome testing to increase awareness of health risks and well-being programs for emotional health.
Behavioral health and
Disease and illness
management
Metabolic syndrome
(a group of risk factors)
Biometric
testing
Wellbeing
•Tobacco free
•Physical fitness
•Stress reduction
•Clean eating
•Managing cholesterol
•Weight loss
•Diabetes
•Asthma
•Heart disease
•High blood pressure
•High blood sugar
•Unhealthy cholesterol levels
•Abdominal fat
•Cholesterol levels for full lipid panel
•Blood pressure
•Blood glucose levels
•Height
•Weight
•Body mass index
•Better sleep
•Yoga
•Meditation
•Anxiety
•Depression
•Mind-fullness
lifestyle management
Items noted above are examples. Lists are not meant to be comprehensive.
Employees who engaged in well-being programs experience 17 minutes per week of improved productivity,8
and 36 percent of employees who participate in stress reduction programs in the workplace experience
decreased stress levels.9
Doctors Richard Milani and Carl Lavie studied a random sample of 185 workers and their spouses at a single
employer, according to the Harvard Business Review. The participants were not heart patients, but they received
cardiac rehabilitation and exercise training from an expert team. Of those classified as high risk when the study
started – based on body fat, blood pressure, anxiety and other measures – 57 percent were converted to low-risk
status by the end of the six-month program. Medical claim costs declined by $1,421 per participant, compared
with those from the previous year. A control group showed no such improvements. Every dollar invested in the
intervention yielded $6 in health care savings.10
©2016 Aetna Inc.
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National Accounts
Perspectives
Health Care and Employee Productivity
Employee participation is crucial for successful health and wellness programs. Employers who offer incentives to
employees, such as discounts on health insurance contributions or gift cards, for health screening activities report
higher participation rates than those who do not (63 percent versus 29 percent for completing a health risk
assessment and 57 percent versus 38 percent for clinical screenings), according to research by the
RAND Corporation.¹¹ A health risk assessment is a questionnaire on health-related behaviors, such as exercise,
and risk factors, such as body weight, and may include clinical screenings to collect data on height, weight, blood
pressure and blood glucose levels. Employers use health risk assessments to determine health needs of their employees
and the type of programs to offer.¹¹
These five factors boost wellness program participation,
based on the RAND Corporation’s research11
1
5
3
Strong communication
to employees
2
Convenient and easily
accessible wellness
activities
Senior manager
participation
and support
Continuous evaluation
and quality improvement
4
Intergrated
approach
Refocusing your health benefits strategy to create a more productive culture
Employers also can drive productivity improvement in their workforce by making worker productivity
part of their benefits strategy. And this doesn’t mean disrupting your program or complicating things
for your employees:
• Collaborate with your medical, disability, workers’ compensation and well-being vendors to align and integrate
health promotion and health protection.
• Follow guidelines from reputable national organizations and think tanks, such as the Integrated Benefits
Institute and the Institute of Health, Productivity and Human Capital.
• Examine the physical and mental health of job candidates, post offer, to assess their work ability prior to hiring.
Measure the employee’s functional capacity against essential job functions in the job description.
• Work with the employee’s health care provider, or an occupational health provider, to address issues connected
to the Americans with Disabilities Act through a reasonable accommodation process.
• Introduce or update your drug and alcohol policy to ensure testing for current drug abuse, such as synthetic opioids.
• Implement an exam policy to assess work-fitness after employees return from short- or long-term disability.
• Work with your employee assistance program partner to train supervisors how to recognize common workplace
physical and mental conditions in their workforce.
©2016 Aetna Inc.
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National Accounts
Perspectives
Health Care and Employee Productivity
Healthy employees
= A healthier bottom line
A well-known quote on the study of health care and employee productivity
says, “Worklessness is the single greatest cause of poor health, morbidity
and early mortality.”
Healthier employees are more productive
and companies supporting workplace
health have a greater percentage of
employees at work every day, according
to the Centers for Disease Control
and Prevention.12
A significant opportunity for employers to impact their bottom line in the
future is to invest dollars into programs that target their potential risks.
The idea is to get employees - human capital - to do something
different tomorrow than they did yesterday to become healthier.
“
We prefer to define health like this
‘A healthy individual is productive, a
productive individual is economically
viable and an economically viable
person is happy,’ rather than as the
absence of illness that must be fixed
when it’s broken. Using our definition,
we can create better health person
by person and community by
community. And this is the way we
can rebuild the health care system
as a whole.”13
”
- Mark Bertolini, Aetna chairman and CEO
Focusing on sick days is gone. We prefer
to refocus thinking on creating more
healthy days. This creates a cycle of
continuous improvement – healthy
individuals are happier, and happier
individuals are more productive. A more
productive workforce means you reach
your goals faster and continue to grow
your company.
How to get started
or learn more
For more information on
how productivity can impact
your balance sheet, contact
your Aetna representative.
©2016 Aetna Inc.
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National Accounts
Perspectives
Health Care and Employee Productivity
Sources:
¹Goetzel, Ron Z. PhD; Fabius, Raymond MD; Fabius, Dan DO; Roemer, Enid C. PhD; Thornton, Nicole BA; Kelly, Rebecca K. PhD, RD; Pelletier,
Kenneth R. PhD, MD (hc). The stock performance of C. Everett Koop award winners compared with the Standard & Poor’s 500 index. Journal
of Occupational and Environmental Medicine. January 2016; Volume 58 (Issue 1): 9–15. Available at http://journals.lww.com/joem/Fulltext/2016/01000/The_Stock_Performance_of_C__Everett_Koop_Award.3.aspx. Accessed April 28, 2016.
²Merrill, Ray M. PhD, MPH; Aldana, Steven G. PhD; Pope, James E. MD; Anderson, David R. PhD, LP; Coberley, Carter R. PhD; Grossmeier, Jessica J.
PhD; Whitmer, R. William MBA; HERO Research Study Subcommittee. Self-Rated Job Performance and Absenteeism According to Employee
Engagement, Health Behaviors, and Physical Health. Journal of Occupational Environmental Medicine. January 2013; Volume (55): 10-18.
Available at http://journals.lww.com/joem/Abstract/2013/01000/Self_Rated_Job_Performance_and_Absenteeism.3.aspx. Accessed November 25, 2015.
³Value of investment in employee health, productivity and well-being: A National Business Group on Health toolkit. 2015.
Available at https://www.businessgrouphealth.org/toolkits/et_voi.cfm. Accessed April 28, 2016.
⁴Poor Health Costs U.S. Economy $576 Billion According to the Integrated Benefits Institute. PR Newswire. September 12, 2012.
Available at http://www.prnewswire.com/news-releases/poor-health-costs-us-economy-576-billion-according-to-the-integrated-benefits-institute-169460116.html. Accessed April 28, 2016.
⁵Witters, Dan and Liu, Diana. In U.S., Poor Health Tied to Big Losses for All Job Types. Gallup. May 7, 2013.
Available at http://www.gallup.com/poll/162344/poor-health-tied-big-losses-job-types.aspx. Accessed April 28, 2016.
⁶Clocking on and checking out: Why your employees may not be working at optimal levels and what you can do about it. White paper
published by GCC Insights. 2016. Available at http://info.gettheworldmoving.com/rs/018-WUL-420/images/presenteeism-whitepaper.
pdf. Accessed April 28, 2016.
⁷Loeppke, Ronald MD, MPH; Taitel, Michael PhD; Haufle, Vince MPH; Parry, Thomas PhD; Kessler, Ronald C. PhD; Jinnett, Kimberly PhD.
Health and productivity as a business strategy: A multiemployer study. Journal of Occupational and Environmental Medicine. April 4, 2009;
Volume 51 (Number 4): 411-428. Available at https://www.acoem.org/uploadedFiles/Healthy_Workplaces_Now/HPM%20As%20a%20
Business%20Strategy.pdf. Accessed April 28, 2016.
⁸Program results are based on self-reported information 2/2013 - 11/2014 for participants provide during the pre- and post-program assessments.
⁹Wolever RQ1; Bobinet KJ; McCabe K; Mackenzie ER; Fekete E; Kusnick CA; Baime M. Effective and viable mind-body stress reduction in the
workplace: A randomized controlled trial. Journal of Occupational Health Psychology. April 2012; Volume 17 (2): 246-258.
Available at http://www.ncbi.nlm.nih.gov/pubmed/22352291. Accessed December 9, 2015.
¹⁰Berry, Leonard L.; Mirabito, Ann M.; Baun, William B. What’s the hard return on employee wellness programs? Harvard Business Review.
December 2010. Available at https://hbr.org/2010/12/whats-the-hard-return-on-employee-wellness-programs. Accessed April 28, 2016.
¹¹Mattke, Soeren; Liu, Hangsheng; Caloyeras, John P.; Huang, Christina Y.; Van Busum, Kristin R.; Khodyakov, Dmitry; Shier, Victoria.
Workplace Wellness Programs Study. Conducted by RAND Health, a division of the RAND Corporation, and sponsored by the
U.S. Department of Labor and the U.S. Department of Health and Human Services.2013.
Available at http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.sum.pdf. Accessed April 28, 2016.
¹²Workplace health programs can increase productivity. Centers for Disease Control and Prevention. Accessed April 28, 2016.
¹³Techonomy Media interview, September 20, 2015.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary
companies, including Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance
plans contain exclusions and limitations. For more information about Aetna plans, refer to www.aetna.com.
©2016 Aetna Inc.
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