Diedrich, CEBS Consultant, Employee Benefits

Home , Gallup (company)

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

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

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TODAY’S AGENDA

Realizing what could come next…

• What is the Concern • Why it is Important • The Complicity • What CAN be Done • Expected Results

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1 Section #1 WHAT IS THE CONCERN??? (A.K.A. Who Cares?)

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ABSENCE IMPACT ON SCHOOLS It’s Twofold

Budget Student Achievement

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STUDENT ACHIEVEMENT

• 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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2 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)

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* 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)

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DATA SUMMARY 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

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3 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

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WORKERS’ COMP MEDICAL CLAIM COSTS RISE

Medical Average Medical Cost Per Lost-Time Claim Claim Cost ($000s) $30 +2.0% +5.4% Annual Change 1991–1993: +5.0% +1.9% $25 +6.1% Annual Change 1994–2001: +6.1% +8.9% +9.1% Annual Change 2002-2009: +5.4% $20 Cumulative+6.6% Change = +7.7%

+8.8% $27.7 $27.1

238% $25.7

+13.5% $24.5 $23.1

(1991-2010p) $21.8

$15 +7.3% $20.0 +10.6% $18.9 $17.6

+8.3% $16.2

+10.1% $14.2 $13.3

+7.4% $12.0 $11.1

$10 +9.0%+5.1% $10.1 $9.4 $8.9 +6.8%+1.3% -2.1%$8.2 $8.4 $8.2

$5 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10p

2010p: Preliminary based on data valued as of 12/31/2010 10 MARSH & McLENNAN AGENCY LLC 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

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.”

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4 WHAT DOES THIS MEAN?

They are watching

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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.

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ANOTHER PIECE OF THE COST EQUATION

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5 FURTHER BREAK OUT

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TYPES OF EMPLOYEE ABSENCES

• Sick Time • Sabbatical • Bereavement • Workers Compensation • Jury Duty • Paternity/Maternity • Short term disability • Military • Long term disability • Education • PTO • Adoption • Vacation • FML

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ONES WE CAN INFLUENCE

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6 SIGNIFICANT BUDGET SUCKERS

• Sick leave • Short Term Disability (STD) • Long Term Disability (LTD) • Workers Compensation • Health Insurance

General Fund

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Section #2 A CLAIM IS OFTEN MORE THAN SIMPLY A SICK DAY What is the Underlying Cause?

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WHAT WE PERCEIVE AS “WELLNESS”

Low Number of Sick Days Regular Preventive Care

Healthy Weight Normal Cholesterol Eating Fruits Physically Active Use alcohol in moderation Manage Stress Normal Blood Pressure Non-Smoker Normal Glucose Getting Enough Sleep Eating Vegetables Use Sunscreen Low Fat, High Fiber Diet Wear Seatbelts

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7 WHEN EMPLOYEES FEEL “UN-WELL”

Company Doesn’t Care Pulled in too many directions at work & home No time for me

OVERWHELMED Not enough Worried about resources layoffs Too much to do Co-workers Don’t Feel Trapped in my job Care Unrealistic Company Don’t like what All work and no play Demands I’m doing

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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, Ahhh the good ole days…. an increase of 15 percentage points over 36% of teachers reporting that level in 1985. Source: The MetLife Survey of the American Teacher: Challenges for School Leadership

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8 RELATIONSHIPRELATIONSHIP OF WORK OF WORKAND SELF AND SELF

Outcomes Outcomes

Part 1 – Part 1 – Work Side Work Side

Part 2 – Part 2 Self Side Self Side

Source: Byrum, Ph.D. / Judgment Index™ MARSH & McLENNAN AGENCY LLC 24

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) MARSH & McLENNAN AGENCY LLC 25

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9 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. • 70-100 = riving • 40-69 = Struggling • Struggling/Suffering people have 2x • <40 = Suﬀering 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 MARSH & McLENNAN AGENCY LLC 28

LIFE EVALUATION & MEDICAL CLAIMS

Thriving Average 20% Lower Medical Costs 7.0

Struggling 4.0

Suffering Average 50% Higher Medical Cost

MARSH & McLENNAN AGENCY LLC Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey (2008) 29

10 33 COMPANIES, 3 MEDICAL 3 MEDICAL COST COST STORIES STORIES

Predicted Medical Costs Healthiest $6,000 $4,981 $5,000 Most Wellness $4,000 $3,536

$3,000 $2,705

$2,000

$1,000

$0 Company #1 Company #2 Company #3

Source: Wendy Lynch, PhD., HCMS Group (2007) MARSH & McLENNAN AGENCY LLC 30

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

Exponentially Disengaged Engaged

Source: Adrian Gostick & Chester Elton, All In: How the Best MARSH & McLENNAN AGENCY LLC 34 Managers Create a Culture of Belief and Drive Big Results (2012)34

APATHY The Hallmark of Disengaged Employees

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12 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) MARSH & McLENNAN AGENCY LLC 36

ENGAGEMENTENGAGEMENT & PHYSICAL & PHYSICAL HEALTH HEALTH Effect of Work Life on Health

2% 1% 1% 12% 22% 30% 39% 62% 54%

25% 23% 30%

Engaged Not Engaged Actively Disengaged

Source: Crabtree, Gallup Management Journal (2005) MARSH & McLENNAN AGENCY LLC 37

DISENGAGEMENT & MENTAL WELL- BEING

10.4% 8.8% 7.6% 6.4% 6% 4.6% 1.7x Increase for Disengaged EEs compared to Engaged EEs

Engaged Not Engaged Actively Disengaged

% Dx with Depression Over the Next Year

% Dx with Anxiety Over the Next Year

MARSH & McLENNAN AGENCY LLC Source: Robison, Gallup Management Journal (2010) 38

13 COMPONENTSCOMPONENTS OF A OF A PSYCHOLOGICALLYPSYCHOLOGICALLY HEALTHY HEALTHY WORKPLACE WORKPLACE

Work-Life Balance Employee Health & Well-Being Employee Safety Involvement Communication

Employee Organizational Employee Growth & Functioning Recognition Development

MARSH & McLENNAN AGENCY LLC Source: American Psychological Association (APA), Psychologically Healthy Workplace Program (PWHP) 39

BENEFITS OF A PSYCHOLOGICALLY HEALTHYBENEFITS WORKPLACE OF A PSYCHOLOGICALLY HEALTHY WORKPLACE U.S. Average 2012 PHWA Winners

80% 70% 60% 50% 40% 30% 20% 10% 0% EE Turnover EEs Reporting EEs Intending to EEs Who Would EE Satisfaction Chronic Work StressSeek Employment Recommend as Elsewhere Good Place to Work

Source: American Psychological Association (APA), Psychologically Healthy Workplace Program (PWHP); APA’s 2012 Work Stress Survey MARSH & McLENNAN AGENCY LLC 40

ORGANIZATIONAL CULTURE

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14 IMPACT OF A NEGATIVE WORK ENVIRONMENTIMPACT 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 MARSH & McLENNAN AGENCY LLC 42

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A CULTURE OF BELIEF: Exponential Engagement

Attachment to Engaged the company & willingness to give extra effort A work Enabled environment that supports productivity & performance

Individual physical, social Energized & emotional well-being at work

Source: Adrian Gostick & Chester Elton, All In: How the Best MARSH & McLENNAN AGENCY LLC Managers Create a Culture of Belief and Drive Big Results (2012) 44

15 COMPETITIVE ADVANTAGE OF E + E + E

3x Higher

Source: Adrian Gostick & Chester Elton, All In: How the Best MARSH & McLENNAN AGENCY LLC Managers Create a Culture of Belief and Drive Big Results (2012) 45

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

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IT ALL STARTS WITH CULTURE

CULTURE SUPPORTS HEALTHY/SAFE ENVIRONMENT

“HEALTHIER” EMPLOYEES FEEL ORGANIZATION VALUED

REDUCED COSTS (CLAIMS, BENEFITS, EMPLOYEE ACTIVELY PREMIUMS) ENGAGED

FEWER INCIDENTS/ HIGHER PRODUCTIVITY

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16 Section #3 WHAT CAN BE DONE???

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DON’T RAISE THE WHITE FLAG YET

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SEPARATE PROBLEMS, SEPARATE SOLUTIONS

STD & LTD Health Sick Insurance Leave

Workers Compensation

Well-Being Safety FMLA Programs

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17 NO, THEY ARE ALL CONNECTED

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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

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RED FLAGS

• Claims reported after termination of employment • Soft tissue claims • Hernia claims • Rashes • Frequent Headaches

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18 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

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CONNECT THE DOTS

• Understand FMLA • How to Intervene in an Absences – Managing the Claim/ Absence • Take a New Look

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Section #4 FAMILY MEDICAL LEAVE ACT (FMLA) The Least You Need to Know…

19 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

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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

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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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20 FMLA To Whom Does it Apply…

• Private employers with at least 50 employees within a 75 mile radius • Public & governmental employer regardless of size

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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!

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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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21 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

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MANAGING LEAVES & FMLA Coordination is Key!

• Employers can (and should) run FMLA concurrent with sick leave – Employers may require employees to use accrued Sick paid leave during FMLA Leave leaves - E.g. PTO, sick leave, vacation or other paid leave FML

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MANAGING LEAVES & FMLA Coordination is Key!

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

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

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22 MANAGING LEAVES & FMLA 12 Weeks

FMLA provides a total of 12 weeks per year, regardless of the leave reason except: Sick Leave • Military leaves are an Workers exception to the 12 Compensation week rule

FML 12 weeks

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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!

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Section #5 HOW TO INTERVENE Doing Nothing Doesn’t Work Well!

23 EARLY INTERVENTION What Could be Saved?

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REMEMBER 3 DAYS

• FML trigger • Wage Benefit for w/c • Dr. Note by contract language • Medical Consultation • Short term disability

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HISTORICAL DISTRICT PRACTICE

Long Term Sick Leave 1-89 Disability days 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 STD LTD (1-3 days) (4-89 days) (90-Finish)

Intervention starts here

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SICK LEAVE vs. SHORT TERM DISABILITY (STD)

Sick Leave STD • Unmanaged • Managed • Viewed as entitled pay • Emphasis on returning employee to work • Meant for short illness • Intended to bring help sooner • Paid out as used or to employee potentially at retirement • Helps prevent claims from lingering • Predictable expense

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25 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

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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

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HEALTH FACTORS

• Obesity is creating havoc in our health insurance claims. • What does it do to our worker compensation claims?

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26 OBESITY & WORK COMP

Weight Class Rate of Lost Work Medical Indemnity Claims Days Claims Claims

Obesity III (BMI > 40) 11.65 183.63 $51,091 $59,178

Normal Weight 5.8 14.19 $7,503 $5,396 (BMI 18.5-24.9)

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

Source: Ostbye, et al. (2007, April). Obesity and Workers’ Compensation: Results from the MARSH & McLENNAN AGENCY LLC Duke Health and Safety Surveillance System. Arch Intern Med, 167, 766-773. 78

OBESITY AND HEALTHCARE COSTS

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

SILO MANAGEMENT DOESN’T WORK!

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27 WE NEED TO COLLABORATE

• Who is talking to who? • We need to rethink the connectivity of these programs

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Section #6 A NEW LOOK

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

Yesterday’s Today: Organizational Well-Being Approach

Work HA Environment Cognitive Total Well- Stimulation Being Biometric Ind. & Org. Screenings Assessment Strengthen Increase Incent Judgment I>E>S Behaviors Biometrics Optional Limited in scope; lacking in sustainability Engagement & Sustainability MARSH & McLENNAN AGENCY LLC 83

28 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

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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

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SCHOOLS IMPACTING THE FAMILY

• Activity Bursts in the Classroom • www.davidkatzmd.com/abcforfitness.aspx

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29 SUPPORTING CHILDREN

• Dr. David Katz: • www.davidkatzmd.com/nutritiondetectives

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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)

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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 MARSH & McLENNAN AGENCY LLC 89

30 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. MARSH & McLENNAN AGENCY LLC 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

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FIND TIME TO LAUGH

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

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