Although addressing absence has traditionally been a key driver of uptake of health insurance and related benefits, some employers are beginning to place more emphasis on improving productivity across their ‘at-work’ workforce, as Tessa Norman reports
As the debate around corporate health insurance has evolved in recent years, employers have focused increasingly on getting sick employees back to work as quickly as possible through early intervention and absence management.
And now, according to those on the coalface speaking to employers each day, the debate has moved into a new phase: sickness prevention and maximising productivity.
While the idea of wellbeing is nothing new, intermediaries and insurers are reporting a growing willingness among employers to invest in this area, driven by a mounting body of evidence for the outcomes of wellness and engagement initiatives.
Meanwhile, many in the industry are reporting that absence levels – despite being a focus for years – are no longer top of employers’ concerns, while productivity is becoming increasingly important.
But what evidence should intermediaries be employing when discussing this area with clients, and what are insurers offering to cater for this shift in the market?
‘Absence’ – yesterday’s word?
Despite the industry’s focus on reducing absence in recent years, statistics suggest this has brought about little change in rates.
The latest available Confederation of British Industry (CBI)/Pfizer Absence and Workplace Health Survey shows the UK economy lost 190 million days to absence in 2010, equating to 6.5 days per employee, up slightly from 6.4 days the previous year.
The Chartered Institute of Personnel & Development’s (CIPD’s) 2011 Absence Management Survey puts the figure slightly higher at 7.7 days absence per employee but, crucially, this is unchanged from the year before.
And intermediaries report that a growing number of companies are prepared to accept absence as long as it falls within a level they deem acceptable.
“You are never going to be able to get everyone at work so many companies feel they should keep the people who are at their desk engaged and productive,” says David Dolding, director of consulting at Portus Consulting, the employee benefits adviser.
“It is easy to focus on the minority who are absent and forget that you have the vast majority at work and even if they are primarily happy and engaged, why not make them happier?”
What is more, according to Stephen Hackett, head of health and risk at corporate adviser Bluefin, ‘presenteeism’ – staff coming into work when ill – both costs employers more than absenteeism and carries greater risks.
“The Centre for Mental Health estimates that presenteeism costs the UK economy £15.1bn a year, whereas absenteeism costs almost only half that at £8.4bn,” he says.
“Presenteeism should be a far greater focus for corporates, because the risk of an employee doing something wrong while they are off sick is minimal, but if someone is at work and under pressure or unwell, there is a greater risk of them making a mistake which could damage the business.”
But while ‘presenteeism’ has become a popular term in recent months, portrayed as being symptomatic of recession-hit offices where staff are too scared to take a day off for fear of losing their jobs, how are those in the industry defining the term and is it a genuine growing phenomenon or just another buzzword?
Chris Rofe, senior consultant for Buck Consultants’ UK health & productivity practice – which was rebranded from its healthcare business in April 2009 to signal a greater focus on promoting wellness and improving employee engagement – says there is much more to presenteeism than an employee coming in with a cold.
“Presenteeism could describe an employee who is not engaged – your classic ‘nine to five’ worker,” he says.
“On the other hand it could describe someone who, with the best intentions, is coming to work but due to a medical issue is not being productive.”
However, Rofe cautions against centring the debate around a single phrase such as ‘absenteeism’ or ‘presenteeism’ and says intermediaries should be focusing on what is appropriate for individual clients.
Meanwhile, Bluefin’s Hackett says a lot of instances of presenteeism are related to mental health issues such as stress and depression, and Will McNaughton, senior employee benefits consultant at Lorica Employee Benefits, says the rise of stress in the workplace will have exacerbated presenteeism.
McNaughton notes, however, that presenteeism may well have always existed but is only now being identified – and it is this process of identification which he highlights as being the first step to implementing an effective strategy.
“This could involve health risk assessments [HRAs], giving managers extra training to help identify people at risk, or including absence rates within department targets,” he says.
David Castling, commercial sales manager at Engage Mutual, says the problem with health assessments and screenings, however, is that take up remains very low despite such benefits being widely available on cash plans.
He says that health screenings would also be unlikely to pick up cases of low productivity, but believes that therapy benefits are where cash plans can really make a difference in this area.
“If somebody has a bad back and physiotherapy is on offer they are more likely to get it sorted before it becomes a bigger problem and results in long-term absence,” he says.
“It is about having those choices readily available and visible to staff.”
Meanwhile Steve Sharrock, head of intermediary sales at cash plan provider Westfield Health, believes providers can help improve employee engagement by getting workers’ health worries diagnosed as quickly as possible to ensure they can be fully focused on their work.
“If someone has quick access to a diagnostic appointment it can help them to stop worrying about their health,” he says.
“We also offer a GP helpline benefit on our cash plan, whereby members can arrange for a GP to call them at a convenient time rather than waiting weeks for a surgery appointment.”
Lara Rendell, marketing manager at Health Shield, another cash plan provider, says her organisation will also be introducing a GP helpline on some of its products next year.
The helpline will be in addition to Health Shield’s existing 24-hour helpline which provides services including counselling and legal and financial advice, while the provider also offers benefits such as physiotherapy and massage.
“I have always said that cash plans are not just for when people are ill; they are to keep people fit and in work,” says Rendell.
“Stress is a huge factor nowadays and it is about getting people help before they become so stressed they have to go off sick.”
Meanwhile, private medical insurance providers highlight benefits such as dieting tools and lifestyle seminars as effective methods of keeping staff happy and healthy at work.
AXA PPP healthcare says it has plans to offer cognitive behaviour therapy for sleep in recognition of the impact poor sleep can have on other aspects of health such as stress and diet.
However, many in the industry acknowledge that there is an inherent challenge in persuading finance directors to invest in these initiatives, when productivity and wellbeing are so difficult to measure.
“Return on Investment is always going to be a difficult one,” says Lorica’s McNaughton.
“You almost need more companies to invest in this area in order to get the analysis to prove where the returns are.”
But AXA PPP healthcare and PruHealth say that research is starting to filter through, while others note a growing acceptance among employers that keeping their workforce happy and healthy is simply ‘the right thing to do’ regardless of numerical returns.
Dr Chris Tomkins, head of personal health risk management at AXA PPP healthcare, says there are statistics to show that people with a sedentary lifestyle are more likely to have poor reasoning skills, while there is a proven linear relationship between high blood pressure and poor memory.
“So cognitive performance is going to be affected if people are overweight,” he says. “These things are subtle but significant.”
David Priestly, sales director at PMI provider PruHealth, says the key driver for change in this market is that much better quality research is starting to come through.
“There is a lot of evidence showing that the extent to which a workforce is engaged has an impact on productivity, which in turn leads to higher profitability and higher customer advocacy.”
And Buck’s Rofe says these metrics – and targeting them specifically to the right companies – are crucial.
“You have got to find the right data that is meaningful to the business,” he explains.
“Productivity might mean client numbers to one employer, whereas it may mean revenue to another.”
Another major challenge, however, is encouraging employees to engage with initiatives.
“One of our biggest problems is that employers have bought wellbeing products in the past but they have not delivered,” says Dr Tomkins.
“For instance, they may have launched a HRA and done nothing with the data, but there is no intrinsic value in a diagnostic like that – the value is in what you do afterwards.
“You need to have a coherent, sustainable programme with proven outcomes.”
Priestley adds that the next step on from the debate around what employers should be providing is how to get workers to engage with those initiatives
“We feel that cleverly targeted incentives can play an incredible role in that,” he says.
Portus’ Dolding adds that the challenge lies in keeping wellbeing programmes at the forefront of employees’ minds, and suggests putting in place a seasonal programme of events or encouraging competition between workers as ways of achieving this.
And while both intermediaries and insurers concede that many employers are currently far off this final stage, the message from the market is clear: measuring absence levels is no longer enough.