It's no secret that chronic disease is the major driver of health care costs in the United States, accounting for two-thirds of the rise in health care expenditures since 1980. (1) While there are major efforts to reduce the incidence of chronic diseases and appropriately treat those conditions, it’s also no secret that we can do better and improve both the rates of treatment and the quality of treatment provided. Additionally, there is growing recognition that health care expenditures capture only part of the cost of chronic disease, and that workplace absence, disability, and reduced productivity on the job have large economic costs that affect employers’ bottom lines. Across a large number of chronic conditions, health-related productivity costs average more than twice direct medical and pharmacy costs. (2)
These are important public health concerns that the US is working to address through both existing and developing strategies. Although we have the strategic “blueprints” for diabetes, cardiovascular, and other conditions, we are still struggling to follow those plans, recognizing both the barriers to improvement as well as the full effects of better care. One of the keys to these improvements is better use of prescription medicines, and the patient’s role in adhering to prescribed therapies is a key component of the blueprints for many chronic conditions. Improving medication adherence is the theme of a major new campaign undertaken by the National Consumers League and supported by NPC that is intended to raise awareness among patients and providers about the need to close the gap in adherence.
But providers and patients are only part of the critical audience for improving care and adherence to care recommendations. Employers have a key role to play as well, because the overwhelming majority of working age adults and their dependents receive their health benefits through their work. The important questions that remain are what are the effects on both the direct and indirect costs of chronic conditions by making improvements in addressing those conditions and are there net positive benefits that result. Employers care about the answers to these questions and the strategies that are needed to improve the health and productivity of their employees. Recently published research funded by NPC found that there are productivity gains to be realized by improving use of statin and diabetes therapies, even in an employee population that is more adherent to therapy than most. (3) What benefits could we anticipate by improving adherence in populations with typically lower rates of adherence, for example, in hypertensive patients among whom only 30% to 50% take their medication as prescribed? (4)
Strategies to encourage employers to be active participants in improving care and adherence to therapy will be successful only with better evidence and real world success stories of the health and productivity payoffs associated with better adherence. More research is needed to provide this evidence. We need to know more about where patients are in the continuum of care, what is needed to move them in a positive direction in that continuum, and what benefits can be expected from that positive movement. Employers want healthier employees, but they need to know that efforts to make them healthier are worth it at the end of the day.
1 Thorpe K. Factors accounting for the rise in health-care spending in the United States: the role of rising disease prevalence and treatment intensity. PublicHealth. 2006;120:1002–1007.
2 Loeppke R, Taitel M, Haufle V, Parry T, Kessler RC, Jinnett K. Health and productivity as a business strategy: a multiemployer study. J Occup Environ Med. 2009;51:411–423.
3 Loeppke R, Haufle V, Jinnett K, Parry T, Zhu J, Hymel P, Konicki D , Medication Adherence, Comorbidities, and Health Risk Impacts on Workforce Absence and Job Performance. Journal of Occupational and Environmental Medicine. 2011:53: 595-604.
4 Wang PS, Bohn RL, Knight E, Glynn RJ,Mogun H, Avorn J. Noncompliance with antihypertensive medications. The impact of depressive symptoms and psychosocial factors. J Gen Int Med. 2002;17:504–511.