General Session – Tuesday, 9:30-10:30 amdmec.org/wordpress/wp-content/uploads/2016/04/CC16... ·...

General Session – Tuesday, 9:30-10:30 am

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Behavioral Health Interactions with Presenteeism, FMLA, ADA, and Disability

Aetna Presenters:

Adele Spallone, LMHC, LMFTVP, Business Integration & Strategy

Michael Lacroix, Ph.D.Associate Medical Director

26.25.144.1 (4/16)

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Thriving in a competitive global marketPressures on American employers and workforce• Corporate budgets shrinking

• Public companies more accountable to shareholders and Wall Street• Competition to differentiate and build company brand and reputation

• Workers shouldering more responsibilities and workplace stress

Human Capital is a company’s most important asset• More than 1 in 20 people in the United States are depressed• 80% say their depression interferes with their ability to work• Annual disability-related average costs

• $1,038 for depressed people • $325 for non-depressed people

Rankin, D. (2010, August 23). Lower costs and raise productivity in your business by improving employees' mental health. E-Zine, 2010, August 23. 2

Mental Health trends in the United States

Centers for Disease Control and Prevention (2013)www.cdc.gov/workplacehealthpromotion/evaluation/topics/depression.html

18.8 20%

80% 29% 4.8

American adults who suffer with depression in

a given year

Adults 55 years or older who experience a mental

health condition

People with depression who report functional

impairment

People with depression who contact a mental

health professional

Number of average workdays missed in a

3-month period

million

days

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Impact on employers

Frequent Absences

Low Morale

Loss of Work

Interest

Problems Concentrating

Conflictswith

Co-workers

Frequent Complaints/

Excuses

Safety Concerns/Accidents

Lack of Cooperation

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Impacts of stress to work and personal life

• Stress-related illnesses: Heart disease, diabetes, anxiety and depression

• Reduced productivity (presenteeism)• Increased work absences and disability

– Depression, anxiety, substance abuse – Employers are deprived of dynamic, knowledgeable talent

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The longer employees are away from work, the less likely they are to return

Realizing the health benefits of work. The Australasian Faculty of Occupational and Environmental Medicine. August 2010.

Chance of returning

to work

70%

20 Days out of work

Chance of returning

to work

50%

45 Days out of work

Chance of returning

to work

35%

70 Days out of work

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3

Employee

Supervisor

RTW/HR Rep

Medical Provider

Company

The Stakeholders

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Our Focus:Behavioral Health Interactions

Presenteeism Prevalence

Cost

Interventions

Recommendations

FMLA

ADA

Disability

FMLA = Family Medical Leave ActADA = Americans with Disabilities Act

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PRESENTEEISM

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Presenteeism

“Presenteeism is attending work even though one is ill. As such, it represents a state between sickness absenteeism and health, full work engagement.”

Productivity loss

Poor health and exhaustion

Workplace epidemics

Johns, G. 2015. Presenteeism. Wiley Encyclopedia of Management. 5:1.

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Employees often go to work sick*

Migraines

20%

Anxiety/stress and/or depression

15% Back and/or neck pain

12%

Asthma

10%Menstrual Cramps

9%

50% reported sometimes going to work sick 10% often going to work sick

Obesity

2%

*Prater, T., & Smith, K. Underlying factors contributing to presenteeism and absenteeism. J Business and Economics Research, 2011, 9, No. 6.,

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The Cost

• Presenteeism costs represent 18% - 60% off all costs for medical conditions studied.*

• In 2010, annual cost to employers was $180 billion, surpassing the cost of absenteeism, $118 billion**

• Non-related medical issues can consume 2.4 work hours per week.***

• 7 days of presenteeism per employee per month.***

* Goetzel, R.Z., Long, S.R., Ozminkowski, R.J., Hawkins, K., Wang, S., & Lynch, W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occ Env Med, 2004, 46, 398-412.** Weaver, R. (2010, June 8). Cost of presenteeism surpasses absenteeism.http://www.examiner.com/human-capital-in-detroit/cost-of-presenteeism-surpasses-absenteeism. Cited in Prater & Smith, 2011, op. cit.*** Gurchiek, K. Managers, employees view presenteeism differently. HR News. 2009, February 2. http://www.shrm.org/Publications/HRNews/Pages/ViewPresenteeismDifferently.aspx

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5

Going Beyond Medical & Pharmacy to Absence and Presenteeism

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

Cost per 1000 EEs

Medical Pharmacy Absence lost prod Presenteeism lost prod

Prater, T., & Smith, K. Underlying factors contributing to presenteeism and absenteeism. J Business and Economics Research, 2011, 9, No. 6.

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EAP referrals and Behavioral Health:The data are consistent

Between 2012 and 2014:

• Depression cases up 58%

• Anxiety cases up 74%

• Employee “stress” cases up 28%

Sobering new stats on employee stress. Safety.BLR.com, December 22, 2015.

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FMLA

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Department of Labor 2012 Survey13% of all employees took a qualifying FMLA leave during the year

Most leave is short. Nearly half of all leave events last 10 days or less (42%); less than a fifth (17%) last more than 60 days

Average number of FMLA leaves per leave taker: 1.5 in previous 12 months

Number of medical FMLAleaves per leave taker, previous 12 mths

% of cases

1 75.7%

2 17.0%

3 3.6%

4 1.5%

5+ 2.2%

Family and Medical Leave in 2012, Dpt of Labor. September 13, 2013

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A28 days

29 days

26.9 days

27.2days

CASINOS

- 49% of employees on FMLA at any

given time- Lengthiest FMLA

absences overall, averaging 29 days

per employee

HEALTH CARE

39% of employees on FMLA at any

given time

MANUFACTURING

Total FMLA time off increased 62% from 2008 to 2012

CALL CENTERS

Total FMLA time off increased 30% from 2008 to 2012

Industry Outliers: Top Users of FMLA

GOVERNMENT

36% of employees have an open FMLA

at any given time

23.6 days

Employee Benefits News, 2016: http://www.benefitnews.com/slideshow/top-users-of-fmla

Average time off per employee:

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7

A

Leave Types

17

9.1

6.8

3

7

50

17

109

2

4

2

64.1

Provide care for a loved one

Cancer

Depression/Anxiety Asthma/COPD

Migraine

Employees’ own health conditions

Pregnancy

Care for a new child

Other

*CompPsych 2015 - 29,000 organizations, 78M people

Surgery & Hospitalization

Pregnancy

Bonding

Accident/Injury

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Behavioral Health Issues and FMLA: Aetna leave data (Note that there is no mandate for employees to report)

LOA request reason % of casesNo reason given * 34.0%

“Other” * 29.4%

All pregnancies 8.5% overall; 12.9% of reasons given

Pregnancy – uncomplicated 5.6% overall; 8.5% of reasons given

Pregnancy - complications 2.9% overall; 4.4% of reasons given

Headache 2.0% overall; 3.0% of reasons given

Anxiety 3.1% overall; 4.7% of reasons given

Depression 3.0% overall; 4.5% of reasons given

Stress 1.3% overall; 2.0% of reasons given

All behavioral health entries 7.5% overall; 11.4% of reasons given

*Mental health stigma is still very much alive, among both patients and doctors

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Good News: Most FMLA Claimants Return to Work

DOL 2012Return to work after FMLA

% of cases

RTW, same employer

94.4%

RTW, different employer

0.2%

Did not RTW 4.8%

Don’t know / Refused

0.6%

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How are FMLA Leaves paid for?

Vacation 10.5%

Sick Leave 22%

Short Term Disability 9.2%

Family & Medical Leave

36.6%Long Term

Disability .1%

Don’t Know/ Refused 5.0%

Other 26.6%

* DOL 2012

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In Summary

FMLA is in fact used by employees fairly extensively, some much more than others01

Because employees do not have to provide details, a large proportion of leaves are listed as “other” or have no reason given – and therefore the data are not solid02

Nonetheless, behavioral health issues do appear to be present in a significant proportion of FMLA requests03

In many cases FMLA ends up being a paid leave, often by filing an Short Term Disability claim

.04* DOL 2012

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ADA

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Can the ADA help us out here?

The LawThe Law

• An employer is required to accommodate a "known" disability

• The requirement is triggered by a request

• Employer and employee work together to identify an accommodation




The Law




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Behavioral health issues often do show up in ADA disabilities – and increasingly so

Basis for Impairment % of cases 2004 % of cases 2009 % of cases 2014

Mental Health diagnosis related

18.2 24.7 25.7

“Relationship” 1.4 1.5 2.1

Respiratory diagnosis 3.6 3.5 3.2

Neurological diagnosis 8.7 9.2 7.6

Sensory-Motor condition 6.4 6.0 5.5

Orthopedic diagnosis 16.7 19.4 18.7

Diabetes 4.7 5.5 4.4

Other medical conditions 10.5 12.1 11.2

“Other Disability” 12.3 24.2 30.1

“Regarded as Disabled” 18.2 14.1 11.2

“Record of Disability” 5.3 6.9 7.3

TOTAL 106.0 127.3 127.0Note: Some claims include multiple bases for impairment

U.S. Equal Employment Opportunity Commission. Charge Statistics FY 1997 through FY 2015. 26

Increase in mental health cases are primarily due to Anxiety and PTSDMENTAL HEALTH DIAGNOSTIC CATEGORY

% of ADA claims (2004)



Alcoholism 0.8 0.9 0.7

Anxiety 2.4 5.3 7.1

Autism 0.0 0.2 0.2

Depression 6.9 7.1 7.0

Drug addiction 0.5 0.6 0.4

Intellectual Disability 0.4 0.3 0.8

Learning Disability 1.7 2.1 1.6

Bipolar 2.7 3.9 3.0

Other Psych 1.3 1.5 1.4

PTSD 1.0 2.2 3.1

Schizophrenia 0.5 0.6 0.4

Total 18.2 24.7 25.7

*US Employment Opportunity Commission, 2014 27


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For consideration…

1

.

What limitations is the employee experiencing?

How do these limitations affect job performance?

What specific job tasks are problematic?

What accommodations are available to reduce or eliminate these problems?

Are all possible resources being used to determine possible accommodations?

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Behavioral Health Accommodations

• Employees with time-flexible work policies report:– less stress,– higher levels of commitment to their

employer– reduced costs to the organization– fewer missed deadlines*

• Changes in scheduling and reassignment of duties

• Time for outside appointments• Allow frequent breaks• Reassign to less stressful job• Restructure job to only include essential

functions• Modify supervisory methods• There are no ergonomic accommodations for

mental health claims

*Halpern, 2005, US National Study of the changing workforce

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If possible…

The Equal Employment Opportunity Commission argues that, on occasion, working from home must be considered as a reasonable accommodation option, even if the employer has no existing telecommuting program. However, federal courts of appeal have concluded that regular, on-site attendance is often an essential function of many jobs and, in those circumstances, an employer is not required to offer the employee the option to work at home.

https://www.laboremploymentperspectives.com/2015/11/16/telecommuting-employees-enter-the-sharing-economy-part-1

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Absence is on a continuum: Challenges in preventing FMLA and ADA from becoming a Disability event

• We don’t have a full understanding of the diagnostic bases for many FMLA leaves because employees don’t have to provide such details

• Most employers use different vendors for FML, ADA, STD, and / or LTD, making it difficult to track claims

• Even with the same vendor, demonstrating an impact of interventions at the FML event stage on concurrent or later STD claims is statistically very difficult (proving a non-event)

• Many employers don’t provide job accommodations, regardless of what they say

• Many employers don’t know how to accommodate behavioral health claims

• Yet it IS possible to provide interventions at the Leave of Absence stage and impact the duration of those leaves

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DISABILITY

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Disability Claim Drivers

Pertinent Psychosocial

Factors

Pertinent Psychosocial

Factors

Supervisor friction

Supervisor friction

Resistance to new work

demands

Resistance to new work

demands

Downsizing / Financial stressors

Downsizing / Financial stressors

Change in family

demands

Change in family

demands

Family history of disability

Family history of disability

Change in job site or

shift

Change in job site or

shift

Poor work evaluationPoor work evaluation

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Disability Claim Challenges

• Lack of “verifiable” clinical data• Incomplete or missing job

descriptions• Non-specialty medical providers

treating for behavioral health disorders

• Stigma• Co-morbid conditions

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Return-to-work challenges

• Medical providers have limited knowledge about work functions• Patients ask for delayed return to work• Educating medical providers that “organizational changes” are unlikely• Medical provider focus on diagnosis• Workplace conflict + lengthy

period of time away from work = decreased willingness to return to work

• Workplace accommodations/modifications

• Psychosocial factors

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It is more important to know what type of person has the

disease than what type of disease the person has.

“

“

—Hippocrates

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Can-do model

An emphasis on work capacity

Recognition of non-medical drivers (motivational, psychosocial, financial, etc.)

Early intervention

Multidisciplinary interventions

Work accommodation options

Summary: rethink productivity with an innovative return-to-work focus

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Impact of Accommodations

STD

Mandatory Rehab Plans

• More likely to get more members back to work sooner

• Members spend an average of 8.2 fewer days on disability

Higher Rates of employee retention

EmployerSupport

VocationalRehabilitation

Higher Probability of Return to Work

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In Conclusion…

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Implications

Know your Data, Know your Metrics and then Track, Measure, Trend

Link health improvements to business metrics

Foster a culture of health

Encourage use of EAP

Workers who are happy with their employers want to get back to work

1

2

3

4

5

6

Accountability

Encourage/Incentivize use of Disease Management Programs

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Thank you

Disability insurance plans/policies are offered, administered and/or underwritten by Aetna Life Insurance Company (Aetna). This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. Information is believed to be accurate as of the production date; however, it issubject to change. Disability insurance plans/policies contain exclusions and limitations and are subject to United States economic and trade sanctions. Policies may not be available in all states. Disability insurance plans/policies contain certain exclusions, limitations, reductions and waiting periods, which may affect the payable benefit. See policy or contact an Aetnarepresentative for details. For more information about Aetna plans, refer to www.aetna.com. Policy form numbers issued in Idaho and Oklahoma include: GR-9/GR-9N and/or GR-29/GR-29N.

©2016 Aetna Inc.

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