Numerous studies have illustrated the cost of unhealthy workers to their employers in terms of increased medical, pharmacy and disability claims. In 2006, more than $2 trillion was spent on health care with three fourths of that amount focused on treating chronic conditions (Goetzel, 2009). Research in abundance demonstrates not only does employee health affect direct health care costs, but impacts performance and productivity as well. For every dollar of medical and pharmaceutical costs spent, an employer lost an additional $2.30 of health-related productivity costs (Loeppke R, 2009). Health-related presenteeism was shown to have a larger impact on lost productivity than absenteeism, with comorbidities demonstrating the largest effects on productivity loss. (Loeppke R, 2009).

Unlike absenteeism which is marked by employees deliberately or habitually not showing up to work, with presenteeism, employees clock in, they just may be checked out from the events of the day. Presenteeism is defined as “being at work but having impaired functioning due to mental or physical symptoms.” (Robertson, Leach, Doerner, & Smeed, 2012). Collectively, these two areas are important to consider as metrics for evaluating both health management program opportunities and impact. Drs. Parry and Sherman suggest employers should pay close attention to these when shifting focus moving from simply managing claims costs to a more proactive population health management approach (Parry T., 2012). They suggest lost work time (including days absent and time lost at work resulting from health-related performance decrements); and lost financial business productivity (defined as the financial burden of wage replacement payments made to absent employees and the additional financial consequences— such as extra staffing, overtime, temporary help, and lost revenue— borne by the employer in response to absent employees and to employees who do not perform fully while at work because of their health conditions) (Parry T., 2012) should be closely examined in the course of workforce health improvement strategies.

According to HERO research, employees were more likely to have high presenteeism when it was reported difficult to exercise during the day (96% more likely); reported it difficult to eat healthy at work (93%); reported their employer had little interest in supporting employee efforts to becoming more physically active (123%); and most striking, those employees who indicated that their employer was not supportive in helping them become emotionally healthy were 320% more likely to have high presenteeism ((HERO), 2013). This emotional health may be impacted by a number of influences and organizations need to track how their work environment is affecting their employees. They need to do this not only because it affects employees’ quality of life, but also because it affects organizational effectiveness. (Gilbreath & Karimi, 2012). In addition to illness-related presenteeism, employers should pay particular attention to stressors linked to financial/ social-related presenteeism, and work engagement-related (ie: job stress) presenteeism. According to a study by Robertson, a substantial minority (20%) indicated their manager as a source of pressure. Psychosocial workplace factors are predictive of presenteeism, and efforts to control them, including the use of more effective management, may impact presenteeism rates and the resulting levels of productivity. (Robertson, Leach, Doerner, & Smeed, 2012)

For example, a study by Gilbreath and Karimi found both negative and positive supervisor behavior can be associated with employees’ jobstress-related presenteeism. Negative supervisor behaviors have the strongest associations with employee job-stress-related presenteeism, while positive supervisor behaviors also affect the degree to which employees experience presenteeism. Supervisor behaviors which help employees keep their work in perspective may be especially helpful. This may be due to the pressure many employees experience in attempting to balance their work and home life. A supervisor with the attitude that there is more to life than work could help employees maintain balance in the face of competing demands, thereby helping to reduce role conflict, stress, and presenteeism (Gilbreath & Karimi, 2012).

There are many ways employers can positively impact the financial repercussions of presenteeism by creating a work culture supportive of making healthy choices; designing benefits to encourage proper health care; aligning incentives with business objectives; developing strong supervisory teams and providing adequate resources to make it easier for employees to care for illnesses and reach their full potential at work. Potential strategy components for reducing lost work time and the financial implications of it can include:
• Provide access to an EAP and include work/life components – communicate availability thoroughly to employees – provide depression screenings
• Offer financial planning assistance to employees
• Train managers/supervisors on recognizing symptoms of mental health issues and how to make EAP referrals
• Allow time for physical activity during the workday
• Provide adequate breaks and rest times for employees
• Provide healthy food/snack options in cafeterias and vending machines
• Offer health assessments/biometric screenings conveniently for employees and incent participation
• Screen for work limitations (with WLQ) as part of HRA process
• Incentivize employees to identify a PCP and have an annual visit with him/her
• Provide coverage of and access to chronic condition management programs to include $0 copay for evidence based treatment (med/ pharmacy) when engaged with clinician coach
• Offer flu shots at the work site to prevent the spread of the flu within the population
• Structure incentives around performance related factors versus attendance records
• Allow work from home flexibility (when possible) so employees can stay home when sick and still get necessary tasks accomplished • Create policies and procedures supportive of work/lifebalance
• In a 2011 report by WorldatWork, more than 80% of employers surveyed offer flexible schedules, 60% use this offering as a recruitment tool, and over 70% say it has a positive effect on employee engagement, motivation and over 80% say on employee satisfaction • Provide ongoing supervisor training to ensure supportive attitudes and behaviors toward staff

Health is so much more than the absence of disease. To be healthy is to live with energy and vitality (Edington, 2009). Implications of a healthy workforce go far beyond the obvious costs of claims associated with illness. It extends to encompass employees’ ability to come to work and their performance once they get there. Employers need to address factors contributing to presenteeism and strive to create work environments supportive of healthy employees, healthy productivity and healthy bottom.

Works Cited
(HERO), H. E. (2013). New Findings and Realistic Solutions to Employee Presenteeism. HERO.
Chapman, L. (2005). Presenteeism and its role in worksite health promotion. The Art of Health Promotion, 1-8. Edington, D. (2009). Zero Trends. Ann Arbor: Health Management Research Center.
Gilbreath, B., & Karimi, L. (2012). Supervisor behavior and employee presenteeism. International Journal of Leadership Studies, 114-131.
Goetzel, R. (2009). Do prevention or treatment services save money? The wrong debate. Health Affairs, 37–41. Loeppke R, T. M. (2009). Health and productivity as a business strategy: a multiemployer study. Journal of Environmental and Occupational Medicine, 411-428.
Parry T., S. B. (2012). A pragmatic approach for employers to improve measurement in workforce health and productivity. Population Health Management , vol. 15.
Robertson, I. P., Leach, D. P., Doerner, N. P., & Smeed, M. M. (2012). Poor Health but Not Absent: Prevalence, Predictors, and Outcomes of Presenteeism. Journal of Occupational & Environmental Medicine:, Volume 54 – Issue 11 – p 1344–1349.

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