Breathing Easier at Cleveland Clinic: Asthma Care Management and Major Work Disruptions

The Issue: Many employers implement care management (CM) programs as a way to help improve employees’ health and reduce the use of costly types of medical care. For health conditions that can be remedied fairly quickly, CM may also result in better near-term worker productivity – particularly, the avoidance of major productivity disruptions in the form of disability leaves. Evidence: To examine the issue of CM and productivity, IBI used CM and disability data from Cleveland Clinic to assess whether participation in an asthma CM program may help employees avoid disability leaves from work. As with all voluntary programs, it is possible that employees who choose to participate in CM may be more highly motivated workers. This poses a challenge to the interpretation of any beneficial outcomes. Therefore we also examined disability outcomes among employees with disease that respond more gradually to treatment (diabetes and hypertension) – with the expectation that employees with these diseases would realize fewer productivity improvements even when well-managed. We find that:

• The disability incidence rate among employees with asthma, diabetes or hypertension was more than twice as high as what would be expected for the overall population of employees; annually one in four employees in the study had a disability leave in any given year, compared an industry average of about one in eight.
• Asthma CM participants had a lower likelihood of disability use than comparable non-participants. These findings suggest that asthma CM can reduce productivity losses over a relatively short period of time. However, the benefits may accrue primarily to the most seriously ill employees – in this case, those with previous disability leaves.
• For Cleveland Clinic, the estimated number of disability claims among all asthma sufferers would have been 13% higher if it did not offer CM. Assuming typical STD claim outcomes, for every 100 employees with asthma, CM saved the company about 131 lost workdays (half an FTE) and about $12,500 in wage replacement payments (which equates to about $400 per asthma CM participant). The savings are likely greater when further considering the value of opportunity costs such as overtime and overstaffing.
• Employees in diabetes CM had better disability outcomes than comparable non-participants. However, the results were weaker that what was observed for asthma CM and not statistically significant. We did not observe any difference in disability outcomes for hypertension CM. These findings suggest that the observed outcomes for asthma are not likely due to CM participants’ higher motivations to stay on the job through bouts of illness. On the other hand, it may take longer than one year for employees with well-managed diabetes and hypertension to realize appreciable productivity improvements.

Solution: In addition to helping employers control health care costs, asthma CM can help employees avoid costly productivity disruptions – and repeated episodes in particular. As such, the findings point to the potential costs savings of coordinating the management of health care and disability benefits. The results of this study are likely conservative. They do not take into account any reductions in health-related incidental absences or presenteeism, nor do they consider that CM may help shorten the duration of disability leaves once they occur. On the other hand, appreciable productivity improvements for employees with well-managed diabetes and hypertension likely take longer than one year to be realized.

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