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The Power of Prevention

By Jacob Wayman, Kansas City Internal Medicine Corporate Medicine and Wellness Division –

Currently in the United States, 133 million Americans suffer from one or more chronic conditions and over 75% of our $2 trillion health-related expenditures are directly related to the care of chronic conditions1. In fact, more than $1 trillion of our health-related expenditures are directly caused by seven chronic conditions (cancer, heart disease, hypertension, mental disorders, diabetes, pulmonary conditions and stroke)1. And with over 137 million Americans in the labor force, the cost of poor health on the workplace is estimated at $1.8 trillion2.

What Constitutes as Total Health-Related Costs?
In a multi-employer study, the American College of Occupational and Environmental Medicine and the Integrated Benefits Institute examined over 300,000 pharmacy claims, 120,000 medical claims, and 15,000 employees’ health-related productivity costs. Utilizing only medical and drug costs, the study found the top ten health conditions driving costs for employers were the following1:
. Cancer (other than skin cancer)
. Back/neck pain
. Coronary heart disease
. Chronic pain
. High cholesterol
. Gastroesophageal reflux disease
. Diabetes
. Sleeping problems
. Hypertension
. Arthritis

When productivity costs were added using the Kessler Health and Work Performance Questionnaire (HPQ) employee survey instrument as a health-related productivity assessment method, they found the top ten health conditions that drive the total costs (medical + pharmacy + presenteeism (showing up for work while sick) + absenteeism) for employers were the following1:
. Musculoskeletal conditions
. Depression
. Fatigue
. Chronic pain
. Sleeping problems
. High cholesterol
. Arthritis
. Hypertension
. Obesity
. Anxiety

While many employers still continue to relate their organization’s total health-related costs to medical and pharmacy claims, they fail to recognize the costs associated with employee absenteeism and presenteeism due to poor health are, on average, two to three times higher than their medical and pharmacy claims costs alone3.

With over 75% of employer’s healthcare and productivity losses being directly related to employee lifestyle choices4, employers need to take action.

Many Health Conditions are Primarily Preventable
As employers begin their journey towards Workplace Wellness, they need to understand the health conditions preceding are primarily preventable. In fact, it is estimated that 40% of cancer, 80% of heart disease, and 80% of type 2 diabetes are preventable5. But in our current medical care system, our focus remains on treatment and repair, but pays very limited focus on prevention and promoting the health of people.

With more and more organizations pushing the rising costs of healthcare premiums onto their employees, through consumer-driven health plans and health savings accounts, the burden of costs are now being seen on both sides of the spectrum, employees are beginning to take notice and are open to behavior change.

Employers have the opportunity to empower staff to be a wise consumer of healthcare. But if uneducated, an employee will avoid care due to higher co-pays and deductibles thus leading to unattended health consequences7 because shifting costs does not lower cost, just as shifting risk does not reduce risk1.

Even though they may shift some cost to the consumer, employers should not fully relinquish their role in assisting their employees to attain better health, because employers need a healthy workforce to yield a productive workforce1.

What Can Employers Do To Help Create a Healthy Workforce?
Employers of all sizes and types can utilize varying wellness strategies based on the relationship between health and productivity to lower health risks, reduce the burden of illness, improve wellness and human performance, and enhance the quality of life for workers and their families, while reducing total health-related costs8. First of all, an organization needs to have the initiative and commitment to create a healthier workplace. It is then a matter of the employer to identify which strategy will work best within their organization. Such programs help employers more accurately determine which health conditions have the greatest impact on overall productivity and design strategies to help their employees prevent or better manage these conditions8.

One of the biggest barriers an organization will need to overcome is culture change. First and foremost, culture change needs to be established among the top management within the organization because culture change is difficult and people tend to conform to the behaviors of the people around them. So, without the commitment and dedication from the C-suite, no Workplace Wellness program will succeed. Gaining the support and participation from the management team will provide motivation to an organizations’ employees.

Employers have the ability to implement programs and policies that foster health, wellness, and safety among their employees. Improving the health of our nation’s workforce is beneficial for both employees and employers. It improves productivity, reduces health expenditures, and encourages economic growth8.

What is an Effective Strategy to Implement Workplace Wellness?
As the old adage goes, “an ounce of prevention is worth a pound of cure.” When correctly administered, preventive strategic measures have been tested and proven to improve and keep employees working and healthy1. Organizations would be well served if they would invest in a strategy of prevention and health enhancement. Even the National Prevention Strategy aims to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness8. The overarching goal for not only the Nation, but every organization should be to increase the number of Americans who are healthy at every stage of life.

How Can Prevention and Health Enhancement be Administered in the Workplace?
Essentially, prevention and health enhancement can be implemented within the workplace in three strategies: primary, secondary, and tertiary.

1. Primary
Primary prevention strategies are administered through health promotion, health education, lifestyle management, safety engineering, job ergonomics and organizational design, nutrition, immunization, and other wellness services. Each of these strategies has the goal of helping people stay healthy and productive1.

2. Secondary
Screening and early detection programs, health coaching, biometric testing, and proactive work disability prevention programs are seen as secondary prevention strategies because they can identify conditions earlier than they would have been by typical clinic manifestation1.

3. Tertiary
Tertiary prevention strategies are administered through disease management, evidence-based quality care management, return to work programs, disability management, and vocational rehabilitation. These strategies provide earlier interventions, limit the destructive impact of serious medical conditions on basic functionality, can protect or restore lifestyles, and reduce future costs1.

Invest in a Global Strategy of Prevention and Health Enhancement
Corporations would be well suited if they would invest in a global strategy of prevention and health enhancement because primary, secondary, and tertiary prevention strategies are good for individuals, populations, businesses and industries, governments, and nations8.

Essentially, it comes down to aligning incentives among the key stakeholders (patients/
consumers, providers, purchasers, and payers) to promote wellness, reduce risk, enhance health and improve quality of care for those that already have a medical condition8.

Kansas City Internal Medicine Can Help
Kansas City Internal Medicine’s Corporate Medicine and Wellness Division has the resources of our 50+ multidisciplinary providers to customize and administer a product that will fit the needs of your particular organization.

We understand that prevention is the foundation of not only medical care, but of an effective Workplace Wellness program. For more information, please feel free to contact Jacob Wayman with Kansas City Internal Medicine at 913-319-7308 or visit us online at


1 Loeppke, R. (2008). The value of health and the power of prevention. International Journal of Workplace Management, 1(2), p. 95-108. 2 Bureau of Labor Statistics. The Employment Situation: December 2008. Washington, DC: US Department of Labor; 2009. 3 Loeppke, R. and Hymel, P. (2006), “Good health is good business”, Journal of Occupational and Environmental Medicine, Vol. 48 No. 5, pp. 533-7. 4 Condon, M. (2012, March 27). The Cost of Health . [PowerPoint Slides]. Greater Kansas City Healthcare Symposium. Retrieved from 5 Kenneth, T. (2008). Keynote Presentation at the American College of Preventive Medicine and Prevention 2008 Conference. Austin, TX. 6 Loeppke, R., Taitel, M., Richling, D., Parry, T., Kessler, R.C., Hymel, P. and Konicki, D. (2007), “Health and productivity as a business strategy”, Journal of Occupational and Environmental Medicine, Vol. 49, pp. 712-21. 7 Employee Benefit Research Institute (2008), “Findings from the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey”, Issue Brief, March, Employee Benefit Research Institute, Washington, DC. 8 National Prevention Council, National Prevention Strategy, Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General, 2011.

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