Comparative Effectiveness Research: What Will Employers Do With the Information?

For years now, employers have expressed concern about the cost of providing health care to their employees and its impact on the competitiveness of their businesses, domestically and internationally. The impact of rising health care costs are seen all too often as more businesses, especially small businesses, are cutting or scaling back insurance coverage, or shifting more of the cost burden to employees.

Running in parallel to this issue of rising costs has been the disturbing national trend of declining health status.* U.S. employers, large and small, experience the consequences of a less healthy population directly through their own work forces. Faced with these dual challenges of rising costs and decreased health of their employees, what are employers to do? Nearly all of them have been focusing on the cost side of the equation. But now a growing universe of employers are more aggressively tackling the “wellness” side of the equation because they understand that healthier employees are good for business.

Healthy employees are absent less frequently and are more productive on the job. While this seems intuitive, until recently, little research has been done in this area. Recently, however, the emerging evidence shows promise, and companies are starting to look at wellness programs that can help employees stay healthy or improve their health, which goes toward an improved bottom line in terms of increased productivity, and which also can lead to lower health care costs through fewer claims and hospital visits.

This trend of employers looking for tools to reduce absenteeism and increase productivity is merging with the rising issue of Comparative Effectiveness Research (CER)—an area where the federal government is now highly invested to identify recommended courses of treatment based on strong evidence of what works best.

In a recent survey of 75 employers, the Benfield Group, supported by the National Pharmaceutical Council, found that one of the benefits employers are looking for from CER is more information about which treatments help with productivity.  While data is beginning to emerge regarding the links between good health, productivity and employee wellness programs, this survey shows that most companies (or the benefit consultants they work with) do not have access to this type of information or any ability to use it in their decision making. 

Specifically, while fewer than one-third of employers or their vendors currently use information about absence, disability and return to work assessing the impact of alternative treatments, 70% indicate that such information would be “Important” or “Very Important” within CER. And, while fewer than 25% now use information about the impact of alternative treatments on work productivity in making their decisions, over 60% rate this information as “Important” or “Very Important” in CER.

So it is not surprising that nine out of 10 employers surveyed indicated the importance of “the idea of including productivity-related outcomes pertaining to absence, disability and work performance within CER.”

In a more direct analysis of the benefit of CER to employers, respondents were asked how they would handle two specific scenarios related to treatments for low back pain and diabetes. According to the findings, employers are generally more likely to take action based on CER evidence regarding diabetes.  The reasons given include the “perceived higher total costs” of treating diabetes and a belief that it would be easier to make changes to address diabetes based on “already generally accepted guidelines for treatment.”
In addition to productivity related information, additional survey findings of note include clear messages about what other types of information employers want: “clinical outcomes of alternative treatments; information comparing utilization and cost of treatments; information about which treatments work best for a specific population, and; comparative safety of alternative treatments.”

What this and the other findings from the survey indicate is that employers are paying attention to the unfolding CER issue, they want the output of this process to be helpful practically, and they are looking for CER to include the emerging area of employee productivity related information. In other words, employers want help in reducing health care costs and boosting employee productivity, and they hope that CER can be a potential tool in these objectives. As CER stakeholders move ahead with the development and publication of new research, taking these employer needs into consideration can maximize the opportunity for CER to improve health and health care value.

* See references listed in the survey.