Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25% were the result of avoidable medical errors.

Medical errors are a significant source of lost health care funds every year. For example, the study found that $1.1 billion was from lost productivity due to related short-term disability claims, and $1.4 billion was lost from increased death rates among individuals who experienced medical errors. The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability. The average total cost per error was approximately $13,000.

The study identified the 10 medical errors that are most costly to the U.S. economy each year. Approximately 55% of the total error costs were the result of 5 common errors: pressure ulcers, postoperative infections, mechanical complications of devices, implants, or grafts, postlaminectomy syndrome, and hemorrhages complicating a procedure.

For a full copy of The Economic Measurement of Medical Errors, go here.

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“Our study showed that people do respond to reminders,” said April Armstrong, director of the UC Davis Teledermatology Program. “Cell phones are a smart way to communicate regularly with patients because people take them everywhere.”

Using technology people already have is a relatively inexpensive way for health care providers to improve compliance and prevent disease—in this case, by encouraging the regular use of sunscreen to prevent skin cancer.

Armstrong said she hopes that these results will encourage other health care professionals [and wellness practitioners] to use text messaging in similar ways.

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The report, produced by the MetLife Mature Market Institute with the National Alliance for Caregiving in conjunction with the University of Pittsburgh Institute of Aging, also found that younger caregivers (ages 18 to 39) cost their employers 11% more for health care than non-caregivers, while male caregivers cost an additional 18%. It also found that eldercare may be closely associated with high-risk behaviors such as smoking and alcohol consumption. Even worse, the potential impact to employers is the possibility that these medical conditions may also lead to disability-related absences.

The MetLife report was drawn from an analysis of 17,000 employees of a major multinational U.S. corporation who completed health risk assessment questionnaires (12% were found to be caregivers for an older person).

To meet the health care needs of caregivers while reducing the associated costs, employers should consider integrating their wellness and eldercare programs. In addition to practices such as flexible hours, paid time off, and telecommuting, the report contains suggestions to connect their employees who are caregivers with wellness programs that will reduce their stress, positively impact their health, and provide needed support:

Suggestions—

• Stress-reduction seminars expanded to include onsite yoga and exercise classes, relaxation techniques, and massage therapy
• Decision-support systems providing information about available services
• Financial incentives to encourage participation in preventive benefits offered by employers (for example, premium reductions for those who obtain annual physicals, mammograms, Pap tests, smoking cessation classes, and exercise)
• Expanded onsite medical screenings
• Free legal and financial advice, especially pertaining to Medicare, Medicaid, and insurance

The MetLife Study of Working Caregivers and Employer Health Care Costs can be downloaded: www.metlife.com/mmi/research/working-caregiver-employer-health-care-costs.html#findings.

From the Corporate Health Report, a monthly industry-insider e-letter available by subscription only at www.health-eheadlines.com. Email publisher for an exclusive free 3-month trial subscription for ID Wellness readers.

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Leslie Hammer, Director of the Occupational Health Psychology program at Portland State University, and Ellen Ernst Kossek, who teaches HR management and organizational behavior at Michigan State University’s School of Labor and Industrial Relations, say changes in workplace flexibility and improved supervisor support for workers, such as managers showing interest in an employee’s personal life or caring about an employee’s family needs, can result in a win-win situation.

“There is a health care debate going on right now in America, and that is important, but we should also be looking at ways flexible workplaces can benefit work and the family and their health as well,” Kossek said.

Through their research, conducted over the past 4 years, Hammer and Kossek found that employees with managers trained in supporting a flexible workplace had better physical health, were more satisfied with their jobs and experienced less turnover than those employees in [12 participating grocery] stores where managers did not have the training in family supportive behavior.

“There’s a definite link between supportive management and employee well-being,” Kossek said. They presented their findings at a congressional briefing titled Workplace Practice, Health and Well-Being: Initial Research Findings from the Work, Family & Health Network.

The lesson for the worksite: Managers can be trained on how to engage in family supportive supervisory behavior. Structural support includes taking the time to work with employees to reduce scheduling conflicts between work and family obligations. Emotional support includes such actions as acknowledging employees’ responsibilities outside of the workplace and understanding the conflicts that can arise.

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Limits or bans on smoking may keep smoke out of the workplace but they do little to curb the smoking habits of workers, according to a new study from Agnes Scott College and the University of California, Irvine, published in Health Economics. When workplace smoking bans—often a result of state clean indoor air laws—were first considered, many experts argued that in addition to protecting employees and customers from secondhand smoke, the bans also would limit the number of places smokers could indulge in their habit and thereby reduce the appeal of smoking altogether. It was hoped that the workplace limits on smoking would help smokers kick the habit.

Researchers looked at data on workers’ smoking behaviors from 1992 to 2007 in private businesses, government, schools, restaurants, and bars. In almost every sector, researchers found that state laws had very little measurable effect on how likely workers were to light up. The one exception was bartenders, among whom smoking rates fell after anti-smoking laws that applied to bars were passed. Many workplaces had already limited smoking; employees were already protected from secondhand smoke; and smokers were smoking where they could.

Discussion question: Are electronic cigarettes covered under your company’s smoking or tobacco use policy? Can employees use them in your workplace? Do these self-contained “cigarettes” continue a pattern of habituation and addiction? Read more at www.ecigarettesnational.com. We’ll offer workplace policy solutions as you address them and report back to the editor at publisher at health-eheadlines.com.

Smoke gets in your workplace. The majority of smokers worldwide support smoking bans in the workplace, according to a new study by RTI International and Harris Interactive. The study, published in the International Journal of Public Health online edition, surveyed more than 3,500 employees who smoke and more than 1,400 employers (both smokers and nonsmokers) in 14 countries about their attitudes toward workplace smoking and cessation. The results showed that 74% of smoking employees and 87% of employers felt that the workplace should be smoke-free.

The study also found that overall employees estimated spending an average of one hour per day smoking at work, but most employees did not believe that smoking had a negative financial impact on their employer. However, about half of employers interviewed did believe that smoking had a negative financial impact on their organization.

FREE article on smoking cessation. By Dean Hatfield, SVP and Health Practice Leader for Sibson Consulting, Employee Health and Productivity and Employer Dollars Are All Going Up in Smoke … Unnecessarily—examines the importance of smoking cessation programs and looks at how these programs can save on health care costs, now and later.

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The truth is that nobody and nothing will lower your health care costs. That’s the first startling revelation in a new HWI Commentary entitled Healthcare vs. Sickcare: It’s Time to Level-Set prepared by Michael Samuelson, President and CEO, The Health & Wellness Institute in Providence, Rhode Island

The other revelations Samuelson sets forth and discusses in detail include these:

• Death is not a curable disease.

• “Wellness” is an amorphous, dangerous, and distracting term.

• The primary areas of focus should be affordable health care for all, universal coverage, health promotion, disease prevention, employee productivity and more.

• Organizations measure success according to mission and margin, while individuals (your employees) measure success in terms of subjective well-being.

• There is no political will to change health care in a meaningful way.

• If “greed” is good, “sickness” is better.

• Pogo was right: We have met the enemy and he is us.

• Health care spend and focus needs to shift from disease management (survival and costly) to primary prevention (thrival and inexpensive)

Guaranteed to change your perspective or give you one. For a copy of the complete paper, email michael.samuelson@hwinstitute.com.

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The ongoing workforce health management/wellness movement gained momentum in 2009, as virtually every type of program—from health risk assessments to disease management to behavior modification—rose significantly, according to the National Survey of Employer-Sponsored Health Plans, conducted annually by Mercer, a consulting firm.

“A lot more employers were willing to bet on health management in 2009,” said Linda Havlin, Mercer’s global health and benefits intellectual capital leader. “There’s growing anecdotal evidence that well-designed and communicated health management programs can improve outcomes, but we need to better understand and eliminate missed opportunities like noncompliant patient behavior.”

Trends for 2010 and beyond

Reducing health care cost increases is the overwhelming goal for wellness programs in American businesses, according to the Buck Consultants’ 3rd annual global wellness survey. Other parts of the world focus on improving productivity by keeping employees healthy and working (in Asia the most important objective is improving workforce morale). Other trends from the survey:

Stress is consistently cited as the top health risk driving wellness programs in all areas of the world except for the U.S. and Latin America where lack of exercise and poor nutrition are of top concern.

Wellness programs are most prevalent in North America where 77% of respondents offer them.

The fastest growing components of wellness initiatives around the world are technology-driven tools, such as Web portals, online healthy lifestyle programs, and personal health records.

Onsite programs expected to rapidly increase include caregiver support, personal health coaching, and healthy vending machine food choices.

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Along with HIPAA and ADA, now add another alphabet-soup acronym of GINA to your “watch list” because your wellness program will have to comply.

As is our custom at Health-e headlines, we find experts to interpret legal stuff that can be confusing to us non-lawyers, so we called upon employment law experts at the national law firm of Ogletree Deakins to answer the questions you might ask. Stephanie Smithey and Tim Stanton answered our questions in this interview.

How does GINA affect my company’s wellness program?

If your company’s wellness program collects any genetic information—such as family medical history—GINA may require you to rethink the design of your program. Often a wellness program that is part of a group health plan will include a health risk assessment (HRA) that asks for family medical history. Under Title I of GINA you cannot collect that information prior to or in connection with enrollment in the health plan or for underwriting purposes. “Underwriting” includes any premium discount or rebate, among other things. If you offered a 10% premium discount [to employees] for completing that health risk assessment, your program would be in violation of Title I of GINA.

You would want to redesign the program to eliminate either the reward or the questions about family medical history. Another option would be to create a two-step HRA process in which the reward is tied only to the completion of an initial health risk assessment after enrollment that does not seek family medical history, followed by a second voluntary health risk assessment that offers no reward and does not in any way impact the reward already earned.

What would be an example of a forbidden family history question about genetics?

In the health plan context, remember you can always ask the question, so long as you are not collecting the information prior to or in connection with enrollment or for underwriting. If you are conducting the health risk assessment before enrollment, or if you have tied any kind of a reward such as a premium discount to completing the health risk assessment, then you need to avoid asking any questions about genetics or family medical history.

Here’s a simple example:  Has a close blood relative (grandparent, parent, brother, sister) had any of the following health conditions (check all that apply)? ___ heart disease ___ diabetes ___ skin cancer ___ breast cancer ___ colon cancer ___

By contrast, it is okay to ask the employee if they themselves have had any of these conditions.

How will GINA affect a company’s relationship with a third-party disease management company?

The new regulations include an example of a disease management program that would violate GINA. A health plan might use a health risk assessment (that includes family medical history) to identify certain participants who would be eligible for a disease management program. According to the GINA regulations, the request for family medical history is a request for genetic information for underwriting purposes because it could result in eligibility for benefits that would not otherwise be available. This is one example of how GINA might impact a disease management program.

Employers should consider GINA’s potential impact on any disease management program that collects genetic information, requests or requires genetic testing, or adjusts premiums based on genetic information.

By giving a disclaimer about not revealing family health history/genetic info or using the two types of HRAS, do you really think companies will do this?

Yes, we have worked with several clients and their wellness program vendors to redesign their wellness program so that they are consistent with the new rules. Many clients are choosing to implement a two-step health risk assessment process in which both HRAs occur after enrollment and the only “underwriting” is a premium discount linked to the first HRA, which does not ask any questions about family medical history or other genetic information. Some other clients have just deleted family medical history questions.

Smart companies use HRA information to drive wellness programming, to assess needs of employees coupled with claims data (not available for small companies, however), and to then use that aggregate information to set programming priorities for wellness programs the rest of the year. Can they still get aggregate data from HRAs?

In designing their wellness programs, companies need to consider what their goals are and what information they legitimately need to implement a program that meets their goals. Remember that GINA does not preclude employers from collecting medical information about their employees for purposes of running a wellness program. If in fact the genetic or family medical history information is crucial to the program, the employer may continue to collect it—so long as the collection isn’t prior to or in connection with enrollment or for underwriting purposes.

So, in other words, if having the information is crucial to the program, collect it after enrollment in the health plan and do not offer any premium discount or other incentive that would be considered underwriting.

Also, remember that other laws will impact the wellness program, including HIPAA nondiscrimination, HIPAA privacy, the ADA, and Title II of GINA if the wellness program is an employment practice that is not a group health plan. Each of those laws should be consulted when deciding what is a permissible program and what is a permissible use of the data generated by the program.

Is there some good news for employers here?

GINA also amends the HIPAA Privacy Rules to make it clear that genetic information is protected health information. Note, however, that those rules do not place a blanket prohibition on sharing that information with insurers or employers who administer group health plans. The Privacy Rules acknowledge that the insurance companies and plan administrators may need the medical information to pay claims and administer the terms of the health plans. The Privacy Rules already place limits on what information employers can receive outside their role as health plan administrator and prohibit use of protected health information for employment purposes, such as hiring, firing, promotion, etc. GINA doesn’t change that framework of privacy laws, but it does make it clear that genetic information will receive the same protection as other health information, and it places limits on the use of genetic information for underwriting purposes.

Read more from attorneys Smithey and Stanton in their article entitled “Do Your Health and Wellness Plans Violate GINA?” at www.ogletreedeakins.com/publications/index.cfm?Fuseaction=PubDetail&PublicationID=946. Health-e headlines welcomes your continuing questions on this topic and any others. We will find experts to clear up the confusion. Coming in future issues: interpretation of GINA from an insurer’s perspective.

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