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Reducing Total Health Burden From 2001 to 2009: An Employer Counter-Trend Success Story and Its Implications for Health Care Reform

Allen, Harris PhD; Rogers, William H. PhD; Bunn, William B. III MD, JD, MPH; Pikelny, Dan B. MA, MBA, CEBS; Naim, Ahmad B. MD

Journal of Occupational and Environmental Medicine: August 2012 - Volume 54 - Issue 8 - p 904–916
doi: 10.1097/JOM.0b013e318267f1b1

Objectives: To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs.

Methods: Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001–2002 to 2008–2009.

Results: Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred.

Conclusions: Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; Tufts Medical Center (Dr Rogers), Boston, Mass; Health, Safety, Security & Productivity (Dr Bunn), Navistar, Inc, Lisle, Ill; Health and Productivity (Mr Pikelny), Navistar, Inc., Lisle Ill; and Health Economics & Outcomes Research (Dr Naim), Janssen Scientific Affair, LLC, Horsham, Pa.

Address correspondence to: Harris Allen, PhD, Harris Allen Group, LLC, 150 Walnut Street Road No. 2, Brookline, MA 02445 (

This study was funded by an unrestricted educational contract to the Harris Allen Group from Janssen Scientific Affair, LLC, and Navistar, Inc. Dr. Allen has received consulting fees from Janssen Scientific Affairs, LLC and Navistar.

No conflicts of interest have been declared for any of the authors.

©2012The American College of Occupational and Environmental Medicine