While reduced absenteeism and caregiver burden are important factors for employers, they don't resonate quite as much with payers. (Photo: Shutterstock)
When assessing the value of a new drug or medical treatment, insurance companies and other payers place a premium on efficacy, safety and cost.
Employers also care about whether adopting an innovation within their health care plan would result in reduced absenteeism and caregiver burden, as well as increased presenteeism and quality of life. However, payers place a low priority on such "indirect benefits," according to new study published in the Journal of Occupational and Environmental Medicine by researchers at the National Pharmaceutical Council and RTI Health Solutions.
"Several factors may explain this disconnect, including the fact that employers can shift the cost and risk of health care to payers, but they cannot shift broader impacts of lost productivity and functional status outside of their organizational boundaries," Michael Ciarametaro, vice president of research at NPC and one of the study's authors, says in a NPC blog post.
"While the employer values improvements in productivity and can gain economically by the use of medications that improve it, payers do not economically gain from workers' productivity," Ciarametaro says.
To be sure, it can be difficult for payers to measure worker productivity when determining whether they will cover a new drug or treatment, due to the lack of resources to collect and analyze the data, all of the survey respondents concede. However, a majority of the respondents agree that measuring reduced absenteeism might be easier, and could provide useful insight in the other indirect benefits, particularly for longer-term medical conditions that could result in disability.
"Because the absenteeism measure has the fewest measurement challenges and is valued by employers, efforts to incorporate broader benefits into value assessment should begin with absenteeism," says David Wamble, director of health economics at RTI Health Solutions and a study author.
"Value assessment frameworks" to help in purchase and coverage decision-making are becoming more popular, the researchers say.
"The goal of these frameworks is to estimate the improvement in patient outcomes from a pharmaceutical product or technology and the increased and/or offsetting costs associated with use of that technology compared with other available treatments," they say.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
