employee absence the...1 employee absence the impact on budgets and student achievement may 2, 2013...

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EMPLOYEE ABSENCE The Impact on Budgets and Student Achievement May 2, 2013

Amy Diedrich, CEBS Consultant, Employee Benefits Rosie Ward, Ph.D., MPH, MCHES, BCC, Certified Intrinsic Coach® Health Management Services Manager RJF, a Marsh & McLennan Agency LLC company

MARSH & McLENNAN AGENCY LLC

Seriously… Monitoring absences is not worth my time with everything else on my plate!

1 April 22, 2013


TODAY’S AGENDA

Realizing what could come next…

• What is the Concern

• Why it is Important

• The Complicity

• What CAN be Done

• Expected Results

2 April 22, 2013

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Section #1

WHAT IS THE CONCERN??? (A.K.A. Who Cares?)


ABSENCE IMPACT ON SCHOOLS It’s Twofold

Budget Student Achievement

4 April 22, 2013


STUDENT ACHIEVEMENT

5 April 22, 2013

•  Teacher Absence is a Leading Indicator of Student Achievement

New National Data Offer Opportunity to Examine Cost of Teacher Absence

Relative to Learning Loss

Source: Center for American Progress, Raegen Miller (Nov. 2012)

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ABSENCE IMPACTS STUDENT ACHIEVEMENT

• The Department of Education calls the measure a “leading indicator,”* a reasonable label given the documented relationship between absence rates measured at the teacher level and student achievement.

Source: Center for American Progress (Nov. 2012)

* Ellen Foley and others, “Beyond Test Scores: Leading Indicators for Education” (Providence, RI: Annenberg Institute for School Reform at Brown University, 2008), available at http://annenberginstitute.org/publication/beyond-test-scores-leading-indicators-education


TEACHER ABSENTEEISM

• 37% of teachers (approximately 900,000 teachers) in the CRDC sample were absent for 10 or more days of school, for non-school-related reasons.

Source: Civil Rights Data Collection (2012)


State averages on the Civil Rights Data Collection measure of teacher absence range from: •  20.9% (Utah) - 50.2% (Rhode Island)

•  Minnesota is at 42.3%

–  Mean Rank for MN 11out of 50

DATA SUMMARY

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A PORTION OF THE COST EQUATION • Example: District X substitute teacher pay is $180 per day.

There are 400 teachers.

•  *On average 5.3% of teachers are absent on any given day –  Average daily sub costs = $3,816 –  Annualized sub costs = $705,960

•  In Minnesota 42.3% of teachers are absent >10 days per year –  10 days for 42.3% of teaching staff = $304,560.

Source: Center for American Progress, November 2012

9 April 22, 2013

MARSH & McLENNAN AGENCY LLC 10

WORKERS’ COMP MEDICAL CLAIM COSTS RISE

Annual Change 1991–1993: +1.9%

Annual Change 1994–2001: +8.9%

Annual Change 2002-2009: +6.6%

Medical Claim Cost

($000s)

2010p: Preliminary based on data valued as of 12/31/2010 1991-2008: Based on data through 12/31/2008, developed to ultimate

Based on the states where NCCI provides ratemaking services; Excludes the effects of deductible policies

Cumulative Change = 238%

(1991-2010p)

$8.2

$8.9

$9.4

$10.1

$11.1

$12.0

$13.3

$14.2

$16.2

$17.6

$18.9

$20.0

$21.8

$23.1

$24.5

$25.7

$27.1

$27.7

$8.4

$8.2

$5

$10

$15

$20

$25

$30

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10p

+2.0% +5.4% +5.0%

+6.1% +6.1%

+9.1% +5.4%

+7.7% +8.8%

+13.5%

+7.3% +10.6%

+8.3% +10.1%

+7.4% +5.1% +9.0% -2.1% +1.3% +6.8%

Average Medical Cost Per Lost-Time Claim


CIVIL RIGHTS DATA COLLECTION New Data Request in 2009: Teacher Absences

“Notwithstanding concerns about equity, attention to this issue is appropriate for two reasons:

1.  Teachers are the most important school-based determinant of students’ academic success. It’s no surprise researchers find that teacher absence lowers student achievement.

2.  Resources are scarce, and any excess of funds tied up in teacher absence, which costs at least $4 billion annually, should be put to better use.”

11 April 22, 2013

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WHAT DOES THIS MEAN?

12 April 22, 2013

They are watching


WHAT “THEY”ARE SAYING…. • State policymakers should revisit statutes governing

employees’ leave privileges.

• All states should follow the lead of California and New Jersey to ensure that employees have access to family and medical leave insurance

• Encourage local policymakers to “right-size” leave privileges and initiate incentive policies designed to reduce levels of teacher absence. The cost associated with smart incentive plans can be covered by the savings realized from reduced absence rates. Improved student achievement would be a likely and desirable side benefit of such initiatives.

13 April 22, 2013


ANOTHER PIECE OF THE COST EQUATION

14 April 22, 2013

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FURTHER BREAK OUT

15 April 22, 2013


TYPES OF EMPLOYEE ABSENCES

• Sick Time

• Bereavement

• Jury Duty

• Short term disability

• Long term disability

• PTO

• Vacation

• Sabbatical

• Workers Compensation

• Paternity/Maternity

• Military

• Education

• Adoption

• FML

16 April 22, 2013


ONES WE CAN INFLUENCE

• Sick Time

• Bereavement

• Jury Duty

• Short term disability

• Long term disability

• PTO

• Vacation

• Sabbatical


• Paternity/Maternity

• Military

• Education

• Adoption

• FMLA

17 April 22, 2013

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SIGNIFICANT BUDGET SUCKERS

• Sick leave

• Short Term Disability (STD)

• Long Term Disability (LTD)


• Health Insurance

General Fund


Section #2

A CLAIM IS OFTEN MORE THAN SIMPLY A SICK DAY What is the Underlying Cause?

MARSH & McLENNAN AGENCY LLC 20 April 22, 2013

WHAT WE PERCEIVE AS “WELLNESS”

Healthy Weight Eating Fruits

Normal Blood Pressure Non-Smoker

Normal Glucose

Normal Cholesterol

Eating Vegetables

Physically Active

Getting Enough Sleep

Low Fat, High Fiber Diet Wear Seatbelts

Use Sunscreen

Use alcohol in moderation Manage Stress

Regular Preventive Care Low Number of Sick Days

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WHEN EMPLOYEES FEEL “UN-WELL”

Company Doesn’t Care

Too much to do Co-workers Don’t

Care

No time for me

Don’t like what I’m doing

OVERWHELMED

Unrealistic Company Demands

Pulled in too many directions at work &

home

Feel Trapped in my job

Worried about layoffs

All work and no play

Not enough resources


THE REALITIES OF WORKPLACE STRESS IN AMERICA

•  39% of adults report increased stress over past year; 44% report increased stress over past 5 years. (APA, Jan. 2012) -  Main sources of stress: Money (75%) , Work (70%)

•  80% of workers feel stress on the job. (American Institute of Stress, 2011)

• Workplace stress is as bad for the heart as smoking & high cholesterol. (JAMA, Oct. 2007)

•  90% of all visits to primary care doctors are related to stress. (JOEM, Oct. 1998)

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STRESS IN SCHOOLS • Teacher satisfaction has

declined 23 percentage points since 2008, from 62% to 39% very satisfied, including five percentage points since last year, to the lowest level in 25 years.

• Half (51%) of teachers report feeling under great stress several days a week, an increase of 15 percentage points over 36% of teachers reporting that level in 1985.

23 April 22, 2013

Source: The MetLife Survey of the American Teacher: Challenges for School Leadership

Ahhh the good ole days….

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RELATIONSHIP OF WORK AND SELF

Outcomes

Part 1 – Work Side

Part 2 – Self Side

Outcomes

Part 1 – Work Side

Part 2 Self Side

Source: Byrum, Ph.D. / Judgment Index™

RELATIONSHIP OF WORK AND SELF


THE CRISIS OF CAPACITY

• Humans are NOT Computers! –  Continuously, at high speeds, for long periods of time,

running multiple programs at the same time.

Source: Tony Schwartz (The Energy Project, www.theenergyproject.com) 25


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INDIVIDUAL WELL-BEING

5 Universal, Interconnected Elements: • Career Well-Being

• Social Well-Being

• Financial Well-Being

• Physical Well-Being

• Community Well-Being

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WELL-BEING CONSIDERATIONS

•  66% of people thriving in 2 areas. –  Only 7% of people thriving in all 5 areas.

• Struggling/Suffering people have 2x higher new medical costs due to disease burden (2008-2009) compared to those who are Thriving.

• People with high quality friendships at work are 7x as likely to be engaged in their work.

Source: Rath & Harter (2010), The Economics of Wellbeing

•  70-100 = riving •  40-69 = Struggling •  <40 = Suffering

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LIFE EVALUATION & MEDICAL CLAIMS

Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey (2008)

Thriving Average 20% Lower

Medical Costs

Struggling

7.0

4.0

Suffering Average 50% Higher

Medical Cost

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3 COMPANIES, 3 MEDICAL COST STORIES

$3,536

$2,705

$4,981

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

Company #1 Company #2 Company #3

Predicted Medical Costs

Most Wellness

Healthiest

Source: Wendy Lynch, PhD., HCMS Group (2007)

3 COMPANIES, 3 MEDICAL COST STORIES

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OTHER DRIVERS OF HEALTHCARE UTILIZATION

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WHAT IS BEING ASSESSED?

1.  Would you describe your work as monotonous?

2.  How satisfied are you with your job?

3.  How tense or anxious have you been in the past week?

These three questions are part of a screening that is more than 80% accurate at predicting what?

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INJURY COSTS TO EMPLOYERS

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ENGAGEMENT CONTINUUM

34 Source: Adrian Gostick & Chester Elton, All In: How the Best

Managers Create a Culture of Belief and Drive Big Results (2012)

Disengaged Exponentially

Engaged

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APATHY The Hallmark of Disengaged Employees

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ENGAGEMENT & WORKPLACE INJURIES

•  Workgroups in bottom 25% of engagement average 62% more accidents than workgroups in top 25% of engagement.

•  Building on employee strengths and improving engagement substantially impacts productivity, employee retention and safety, and customer experiences.

Source: Gallup Consulting (2007)

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ENGAGEMENT & PHYSICAL HEALTH

Source: Crabtree, Gallup Management Journal (2005)

22% 54%

23%

Engaged Not Engaged Actively Disengaged

39% 30%

30%

62% 12%

25%

2% 1% 1%

Effect of Work Life on Health

ENGAGEMENT & PHYSICAL HEALTH

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DISENGAGEMENT & MENTAL WELL-BEING

4.6%

6.4% 6%7.6%

8.8%10.4%

Engaged Not Engaged Actively Disengaged

% Dx with Depression Over the Next Year

% Dx with Anxiety Over the Next Year

Source: Robison, Gallup Management Journal (2010)

1.7x Increase for Disengaged EEs compared to Engaged EEs

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MARSH & McLENNAN AGENCY LLC Source: American Psychological Association (APA), Psychologically Healthy Workplace Program (PWHP)

COMPONENTS OF A PSYCHOLOGICALLY HEALTHY

WORKPLACE

Communication

Work-Life Balance

Employee Involvement

Health & Safety

Employee Recognition

Employee Growth &

Development

Employee Well-Being

Organizational Functioning

COMPONENTS OF A PSYCHOLOGICALLY HEALTHY WORKPLACE

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MARSH & McLENNAN AGENCY LLC Source: American Psychological Association (APA), Psychologically Healthy Workplace

Program (PWHP); APA’s 2012 Work Stress Survey

BENEFITS OF A PSYCHOLOGICALLY HEALTHY WORKPLACE

BENEFITS OF A PSYCHOLOGICALLY HEALTHY WORKPLACE

0%10%20%30%40%50%60%70%80%

EE Turnover EEs ReportingChronic Work Stress

EEs Intending toSeek Employment

Elsewhere

EEs Who WouldRecommend as

Good Place to Work

EE Satisfaction

U.S. Average 2012 PHWA Winners

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ORGANIZATIONAL CULTURE

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IMPACT OF A NEGATIVE WORK ENVIRONMENT

•  Elements of negative work environment: –  Dissatisfaction with job –  Authoritative rather than collaborative leadership –  Lack of trust and openness at work –  Lack of focus on individual strengths

•  Employers eliminating even just ONE of these negative factors will see one of the greatest improvements in well-being and return on employee investment

Source: Gallup-Healthways Well-Being Index – Oct. 2008 Results

IMPACT OF A NEGATIVE WORK ENVIRONMENT

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A CULTURE OF BELIEF: Exponential Engagement

Engaged

Enabled

Energized

A work environment that supports productivity & performance

Attachment to the company & willingness to

give extra effort

Individual physical, social

& emotional well-being at

work Source: Adrian Gostick & Chester Elton, All In: How the Best

Managers Create a Culture of Belief and Drive Big Results (2012) 44

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COMPETITIVE ADVANTAGE OF E + E + E

Source: Adrian Gostick & Chester Elton, All In: How the Best Managers Create a Culture of Belief and Drive Big Results (2012)

3x Higher

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IF YOU DON’T MANAGE CULTURE, IT WILL MANAGE YOU

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IT ALL STARTS WITH CULTURE

CULTURE SUPPORTS HEALTHY/SAFE ENVIRONMENT

EMPLOYEES FEEL VALUED

EMPLOYEE ACTIVELY ENGAGED

FEWER INCIDENTS/ HIGHER

PRODUCTIVITY

REDUCED COSTS (CLAIMS, BENEFITS,

PREMIUMS)

“HEALTHIER” ORGANIZATION

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Section #3

WHAT CAN BE DONE???

48


DON’T RAISE THE WHITE FLAG YET

49 April 22, 2013


SEPARATE PROBLEMS, SEPARATE SOLUTIONS

50 April 22, 2013

Health Insurance

Safety Programs

Well-Being

Workers Compensation

Sick Leave

STD & LTD

FMLA

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NO, THEY ARE ALL CONNECTED

51 April 22, 2013


RED FLAGS

• Claims or absences on Fridays or Mondays

• Employee has another employer

• Claims that are reported “late” – best practice is that employees should report claims within 24 hours

• Work Performance Issues

• Fine day before and often too sick to work the next day

52


RED FLAGS

• Claims reported after termination of employment

• Soft tissue claims

• Hernia claims

• Rashes

• Frequent Headaches

53

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LETS NOT WORRY ABOUT THE LABEL • Understand what is important to improving the situation

•  Look for the commonality

• The same general process works for all

•  Look at them together and understand how they impact each other

54 April 22, 2013


CONNECT THE DOTS • Understand FMLA

• How to Intervene in an Absences – Managing the Claim/

Absence

• Take a New Look

55 April 22, 2013

Section #4

FAMILY MEDICAL LEAVE ACT (FMLA) The Least You Need to Know…

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MANAGING LEAVES & FMLA

• What is the Family Medical Leave Act (FMLA)? –  Enacted in 1993 –  Provides up to 12 weeks

per year of unpaid, job-protected leave from work

57 April 22, 2013


MANAGING LEAVES & FMLA Allowable Leave Types

•  Your serious health condition

•  Military exigency

•  Military caregiver

•  Birth, Adoption

•  To care for a family member’s serious health condition

58 April 22, 2013


MANAGING LEAVES & FMLA Tracking is Key!

• Leave may be taken consecutively or intermittently –  Example of consecutive FMLA leave: typical maternity leave

–  Example of intermittent FMLA leave: severe migraine headaches

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FMLA To Whom Does it Apply…

• Private employers with at least 50 employees within a 75 mile radius

• Public & governmental employer regardless of size

60 April 22, 2013


WHO IS ELGIBLE FOR FMLA Employee Eligibility

• For an employee to be eligible for FMLA, the employee must: –  Have worked for the employer at least 12 months

–  Have worked at least 1,250 hours in the past 12 months and work at a site with at least 50 employees in a within 75 (surface mile) radius.

–  Therefore, very small school districts may be subject to FMLA, but their employees may never be eligible!


WHEN IS IT FMLA? Application

•  When to apply FMLA to your employee’s absence: –  When the serious health condition:

-  is certified as a chronic condition that causes occasional periods of incapacitation (e.g. severe migraines) or

-  incapacitates employee for 3 consecutive days

–  FMLA should be triggered when the employee has a health-related unexcused absence lasting 3 or more days

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FMLA OR NOT?

Which of the following absences may qualify for FMLA?

A. Susan who is on maternity leave B. Luis who is called to active military duty C. Karen who has suffered a severe work comp injury D. All of the above E. None of the above


MANAGING LEAVES & FMLA Coordination is Key!

• Employers can (and should) run FMLA concurrent with sick leave –  Employers may require

employees to use accrued paid leave during FMLA leaves - E.g. PTO, sick leave,

vacation or other paid leave

64 April 22, 2013

Sick Leave

FML


MANAGING LEAVES & FMLA Coordination is Key!

• Employers can (and should) run FMLA concurrent with work comp leaves:

–  Tighten up administration processes so that FMLA is appropriately tracked for work comp AND sick leave

65 April 22, 2013

Sick Leave

FML

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MANAGING LEAVES & FMLA 12 Weeks

FMLA provides a total of 12 weeks per year, regardless of the leave reason except:

•  Military leaves are an exception to the 12 week rule

66 April 22, 2013

Sick Leave Workers

Compensation

FML 12

weeks


FMLA Triggers

• Work Comp leaves and maternity leaves are easily-identifiable FMLA triggers –  Example: Julie is absent due to a work comp claim for 3

weeks. Later that year, she has a baby. Since Julie already used 3 weeks in the last 12 months, she has 9 weeks remaining of FMLA

–  Homework: be sure your work comp and non-work comp FMLA is tracked in a single bucket!

Section #5

HOW TO INTERVENE Doing Nothing Doesn’t Work Well!

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EARLY INTERVENTION What Could be Saved?

69 April 22, 2013


REMEMBER 3 DAYS

•  FML trigger

•  Wage Benefit for w/c

•  Dr. Note by contract language

•  Medical Consultation

•  Short term disability

70 April 22, 2013


HISTORICAL DISTRICT PRACTICE

Sick Leave 1-89 days

Long Term Disability 90-NSSA

No involvement until 90 days into a claim

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Often times we don't manage the situation until it is almost beyond a point of positive change

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IMPROVED MODEL

Sick Leave (1-3 days)

STD (4-89 days)

LTD (90-Finish)

Intervention starts here

73


SICK LEAVE vs. SHORT TERM DISABILITY (STD)

Sick Leave • Unmanaged

• Viewed as entitled pay

• Meant for short illness

• Paid out as used or potentially at retirement

STD • Managed

• Emphasis on returning employee to work

•  Intended to bring help sooner to employee

• Helps prevent claims from lingering

• Predictable expense

74 April 22, 2013

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LITTLE STEPS TO FULL STD

• Advice to pay

• Using a TPA to administer absences over a certain length

• Usually needs to be paired with another product like LTD

75 April 22, 2013


SAME THING IN WORKERS COMP

• Get professional involved early

• Use managed care

• Use a return to work program

• Unlimited sick leave is not a good management

76 April 22, 2013


HEALTH FACTORS

• Obesity is creating havoc in our health insurance claims.

• What does it do to our worker compensation claims?

77

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OBESITY & WORK COMP

Source: Ostbye, et al. (2007, April). Obesity and Workers’ Compensation: Results from the Duke Health and Safety Surveillance System. Arch Intern Med, 167, 766-773.

Weight Class Rate of Claims

Lost Work Days

Medical Claims

Indemnity Claims

Obesity III (BMI > 40)

11.65

183.63

$51,091

$59,178

Normal Weight (BMI 18.5-24.9)

5.8

14.19

$7,503

$5,396

N = 11,728 x 7 years; *Rates per 100 FTEs

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OBESITY AND HEALTHCARE COSTS

Source: Goetzel et. al. J Occup Environ Med. 2010 Jan;52 Suppl 1:S52-8. 79


SILO MANAGEMENT DOESN’T WORK!

80

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WE NEED TO COLLABORATE

• Who is talking to who?

• We need to rethink the connectivity of these programs

81 April 22, 2013

Section #6

A NEW LOOK

82


Yesterday’s Approach

HA

Biometric Screenings

Incent Behaviors

Limited in scope; lacking in sustainability

Biometrics Optional

Total Well-Being

Strengthen Judgment

Cognitive Stimulation

Increase I>E>S

Work Environment

Ind. & Org. Assessment

Engagement & Sustainability

Today: Organizational Well-Being

A CULTURE OF WELL-BEING: A Different, Sustainable Approach

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THE RISKS OF POOR WELL-BEING •  Decreased Employee Engagement

•  Increased Employee Turnover

•  Adverse Selection for Retention and Recruitment

•  Reduced Productivity

•  Increased Workplace Injuries

•  Increased Off-the-Job Injuries

•  Increased Health Risks

•  Increase in Insurance Claims (Medical and Work Comp)

•  Increased Benefits Utilization

•  Decrease in innovation, customer service, quality 84


WELL-BEING PLUS™ 6 Keys to Effective Well-Being 1.  Data Collection / Analysis

2.  Strategic and Annual Planning

3.  Establish Foundation for Ongoing Support

4.  Quality Coaching and Support

5.  Environmental Support

6.  Resource Allocation

85


SCHOOLS IMPACTING THE FAMILY • Activity Bursts in the Classroom

• www.davidkatzmd.com/abcforfitness.aspx

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SUPPORTING CHILDREN • Dr. David Katz:

• www.davidkatzmd.com/nutritiondetectives

87


FOCUS ON HEALTHCARE CONSUMERISM Low-Hanging Fruit • Phase 1: Self-Care 101 (kits & training) plus ongoing reinforcement.

• Phase 2: Healthcare Safety 101 (kits & training) plus ongoing reinforcement

• Phase 3: WiseHealth™ Workshop (interactive, hands-on workshop)


THE IMPACT OF SOCIAL WELL-BEING • Social WB Closely Intertwined with Career WB:

–  Only 10% of people with low Social WB are thriving in Career WB; 49% of people thriving in Social WB also thriving in Career WB.

–  People with high quality friendships at work are 7x as likely to be engaged in their work.

•  Only 5% of workers strongly agree their organization helps them build stronger personal relationships.

Source: Rath & Harter (2010), The Economics of Wellbeing 89

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SOCIAL CONNECTEDNESS MATTERS!

• Higher levels of social connectedness associated with:

–  Lower blood pressure

–  Lower obesity rates

–  Lower risk of cancer and diabetes

–  Better immune responses

–  Lower levels of stress hormones

Source: Uchino, et al. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119 (3), 488-531.

90


WORK- LIFE BALANCE Some ideas could include: •  Make it clear that work-life balance is a priority for the school

•  Increase numbers of support staff to tackle teacher workload issues

•  Introduce of a 'work-life balance week' in which (for example) –  no after-school events or meetings are scheduled –  staff are actively encouraged to stop work when the final bell goes –  stress-busting activities are on offer at lunchtimes and after-school –  free (healthy) refreshments are available at break

•  Set realistic expectations and timescales for tasks asking staff to review the 'leverage' (ratio of impact made to effort expended) of any activity they plan to undertake


FIND TIME TO LAUGH

92 April 22, 2013

Walking on steps while reading is in direct violation of our safe workplace policy, however having hope is not

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Legal/regional regulatory statement to be added here if required.

employee absence the...1 employee absence the impact on budgets and student achievement may 2, 2013...

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