New Remedy For An Aging Workforce

As the population ages, so does the onset of chronic illness conditions. The term chronic illness covers a broad range of medical maladies, explained June Eichner, senior research associate with the National Academy of Social Insurance, a non-profit think tank on social insurance issues based in Washington, D.C.

Usually, one thinks of such diseases as diabetes, heart disease, asthma and others. But the definition for a chronic condition, she said, is any disease that lasts a year or is expected to last a year or longer, limits what the person can do and requires ongoing care.

"There is no question that people are living longer, but there is a question of how good their health is in those years," said Catherine Hill, director of income security for the National Academy of Social Sciences.

Whether they find it difficult to make ends meet or just dont want to totally quit working, more and more members of the aging population are continuing to work, she said. And with that, employers need to look at a range of issues.

For one thing, as workers grow older, some are finding they need to work longer as they get closer to retirement for a variety of reasons.

The age for Social Security recipients to begin receiving retirement benefits is increasing from 65 to 67. This was a change Congress made a few years ago to help save the system. She said the program is currently going through a slow transition where those who were born in 1940, when they reach 65 in 2005, can retire and receive Social Security benefits. However, with each advancing wave of retirees, the program moves up the retirement age by two months until those born in 1960 are required to work until the age of 67 before they can apply for benefits.

Because these retirees may have a chronic illness, she explained, they might need to continue past their retirement age in order to have the health care coverage to cover their illness.

There is also the issue of the safety net. Medicare, the federal medical insurance program for those on Social Security, takes a little while to kick in. Workers need a security net, which they would find in their employer, she went on, that helps them bridge that gap in coverage.

On the other side of the coin, however, some employers may like the idea of keeping older employees onboard because they cant replace their experience with a younger workforce, she pointed out.

"We used to encourage early retirement as a way to get younger workers into the workforce," said Ms. Hill. "Those policies are not as relevant today. The new policy is to extend the working lives of people."

In light of this new reality, insurers have to devise new plans to help control costs. A popular program for industry is disease management.

Alison J. Johnson, health care consultant for Seattle-based Milliman U.S.A., an international consulting firm, said that the idea of disease management is less than 10 years old and its growth in use has only come within the last five years.

Originally, she said, the program had a limited focus. But it has expanded to cover a host of core diseases common among an aging population. The programs can range from psychological support to active participation in the care that patients deliver to themselves each day. The programs can cover a broad range of diseases or just concentrate on one disease that is showing up at a high rate within a business.

Ms. Johnson, who is also the author of a Milliman report, "Disease Management: the Programs and the Promise," says the core of these programs is a nurse talking to patients over the phone. The nurses involvement can range from educational tips to active oversight of the patients wellness programs.

An example she gave is of a nurse sending a heart patient a special scale to monitor his or her weight. The scale transmits data to the nurse. The nurse can discuss the data and recommend what the patient can do to control weight, something that can be crucial to heart patients.

But, Ms. Johnson said, the whole basis of this program is that the patients take active roles in the management of their health.

Implementing an effective disease management program does require some work and analysis, said Cindy Gates, vice president and senior clinical consultant with Aon Consulting, a subsidiary of Chicago-based insurance broker Aon.

In first determining what diseases should be managed, Aon reviews the health claims data of a commercial client. Using this data, the broker puts together a disease management program, either through the clients health provider or an outside firm. The emphasis of the program, she said, is teaching self-management.

Getting that information falls under the same HIPAA (Health Insurance Portability Act) regulations as other health providers. The program becomes part of a clients overall health care program, though it might not involve the clients health care provider, Ms. Gates said.

The work at Aon consulting involves not only recognizing the need for such a program, but also means finding the proper disease management agency for the client.

"More companies are exploring the option of disease management," said Ms. Gates. "They are looking toward disease management as a new tool to manage cost and the health outcomes of their employees."

Kenneth Mitchell, vice president, return-to-work development for Chattanooga, Tenn.-based UnumProvident, a life and disability carrier, said while diabetes remains the biggest health disease employers deal with in disease management programs, other areas of concern are growing. They include obesity, hypertension, chronic stress and other types of chronic depression.

"Those are things that affect productivity and the ultimate ability of people to be at work," said Mr. Mitchell.

Historically, the programs have concentrated on keeping people out of the hospital and controlling their medications, but now are asking questions about the programs effectiveness. He noted that the programs are very similar to workers compensation programs developed over the years and aimed at reducing claims and injury.

"Its the same concept. Its just being applied to chronic illness," observed Mr. Mitchell.

And the popularity of these programs seems to be growing. According to a Mercer Human Resource Consulting report, "National Survey of Employer Sponsored Health Plans, 2002 Survey Report," 64 percent of large employers with 20,000 or more employees offer a disease management plan for diabetes; 59 percent offer such a plan for heart disease; and 61 percent offer a plan for asthma.

"Early intervention is key. The sooner you get in to deal with the patients illness the better," Ms. Johnson observed. The sooner people are helped to manage their conditions for themselves, the more complications you can avoid, she said.

Reproduced from National Underwriter Property & Casualty/Risk & Benefits Management Edition, August 18, 2003. Copyright 2003 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.