Transcript Slide 1

Project Title Goes Here
Second Line Optional
Beyond the Disease:
TheSubhead
Impact Goes
of Cancer
Here Survivorship
on employers, benefit managers,
health & disability insurers
Implications & Opportunities
Kristin Tugman, MS, CRC, LPC
Director, Health and Productivity
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Five-year Relative Survival (%)*
during Three Time Periods by Cancer Site
Sites
1975-1977
1984-1986
1996-2002
All sites
50
53
66
Breast (female)
75
79
89
Colon
51
59
65
Leukemia
35
42
49
Lung and bronchus
13
13
16
Melanoma
82
86
92
Non-Hodgkin lymphoma
48
53
63
Ovary
37
40
45†
Pancreas
2
3
5
Prostate
69
76
100
Rectum
49
57
66
Urinary bladder
73
78
82
*5-year relative survival rates based on follow up of patients through 2003.
†Recent changes in classification of ovarian cancer have affected 1996-2002 survival rates.
Source: Surveillance, Epidemiology, and End Results Program, 1975-2003, Division of Cancer Control and Population Sciences, National Cancer Institute, 2006
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Cancer Survivorship: A Unum Snapshot
• Point of Reference:
Over the past 5 years, cancer has been the number one long term disability
claim within the Unum US book of business. There has been a 16% increase in paid cancer claims from
2001 to 2005
• Cancer Claims Account for:
– Distribution:
• 12% of all LTD claims - 28,400 LTD claims (2001 – 2005); 31,000 STD malignant
cancer claims were filed over the same 5 year period (2001 – 2005)
– Gender:
• 65%
• 73%
LTD cases are female, 21% of LTD cases are breast cancer cases
STD cancer cases are female
– Age:
• 87% LTD cancer cases are > age of 40 53% LTD cancer cases are between 50 to 65
• Average age STD cancer claim - 52; Average age of LTD cancer claim - 51.4
• Age of cancer claimant trending up over 5 year time frame
– Claims Source:
• The healthcare industry is #1 employer source of LTD cancer claims (18%)
• 50% of LTD cancer claims originate from employers with > 2,000 employees 30%
come from employers with a work force size of < 500 employees
– Outcomes:
• 19.6% of LTD cancer cases closed as RTW
• 26.0% of STD cancer cases closed as RTW
• 23% of LTD cancer cases close due to death
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Selected Cancer Disability Claim Summary
2001-2005
LTD
STD
8,400 estimated cases
17,000 estimated cases
By percent
Open
Died
RTW
Closed*
Died
RTW
Closed*
Breast
10.3%
24.3%
51.0%
14.4%
2.0%
46.9%
51.1%
Colon
13.6%
44.5%
30.2%
11.7%
4.9%
41.4%
53.7%
Prostate
12.7%
34.9%
31.0%
21.4%
1.1%
66.3%
32.6%
*Other reasons to close a claim:
● Maximum benefits
● Not disabled – no RTW
● Not own occ. disabled
● Required information not provided
©2007 Unum Group. All rights reserved June, 2007
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STD RTW Rates
LTD RTW Rates
• Return to work, STD by year of claim
receipt
• Return to work, LTD by year of claim
receipt
• Increased STD RTW success over 5year claims period
• Increased LTD RTW success over 5-year
claims period
©2007 Unum Group. All rights reserved June, 2007
5
Short Term Disability: Observations & Findings
• STD Profiles & Patterns
There was a significant improvement in RTW by year of claim receipt.
STD Breast cancer
96% increase
STD Colon cancer
65% increase
STD Prostate cancer
72% increase
Some variation in RTW outcomes was seen by the industry.
Manufacturing had uniformly better than average RTW results.
Hospitals and other healthcare were uniformly worse.
• STD RTW Predictors:
Age does not predict RTW success during the STD claim period.
Claimants with higher salaries have a greater chance of a RTW
in STD period.
©2007 Unum Group. All rights reserved June, 2007
6
Long Term Disability: Observations & Findings
• Patterns & Profiles:
There was a significant improvement in RTW rates by year of
claim receipt.
LTD Breast cancer
14% increase
LTD Colon cancer
23% increase
LTD Prostate cancer
36% increase
RTW decreases rapidly as claimant age increases and time on claim.
STD to LTD integration was a positive factor in RTW for breast cancer
claimants, a negative factor for prostate cancer claimants, and made
no difference for colon cancer claimants.
• LTD RTW Predictors:
Age does predict RTW success.
Claimants with higher salaries have a greater chance of a RTW.
Females with colon cancer have 47% more likelihood of a RTW.
©2007 Unum Group. All rights reserved June, 2007
7
Points of Impact
STD RTW Percent by age of claimant
LTD RTW Percent by age of claimant
Age
Breast
Colon
Prostate
Age
Breast
Colon
Prostate
20-29
49.6
41.2
50.0
20-29
69.4*
52.6*
0.0
30-49
46.4
40.8
66.5
30-49
56.8*
38.2*
39.5
50-54
46.5
43.4
69.2
50-54
49.7
28.7
33.3
55-59
49.7*
43.2
66.8
55-59
43.9*
26.7
31.4
60-64
46.6
37.6
66.5
60-64
38.3*
22.9*
32.9
65-69
40.8
43.1
61.7
65-69
35.3*
23.9*
30.4
70+
40.0
37.2
48.1
70+
27.8
11.8
6.1
Total
46.9%
41.4%
66.3%
Total
51.0%
30.2%
31.0%
STD RTW percent by claimant’s employer
Industry
LTD RTW percent by case size
Breast
Colon
Prostate
51.4*
45.1
73.5*
Under 500 lives
Data processing
47.5
45.1
62.91
500 – 1,999 lives
Doctors
45.6
45.8
80.0
2,000+ lives
Education
36.1*
41.7
65.5
Finance insurance
50.9*
40.1
71.5
Total
Hospitals
42.6*
36.1
62.7
Law firms
45.5
38.5
82.4
Manufacturing
54.1
45.7
69.8
Banking
Other health
Breast
Colon
Prostate
48.9
31.3
26.1
53.8*
31.6
33.0
50.9
29.1
33.3
51.0%
30.2%
31.0%
STD RTW percent by case size
42.1*
35.5
45.7
Under 500 lives
Breast
Colon
Prostate
40.6*
37.0*
59.3*
53.4*
45.8
66.6
500 – 1,999 lives
45.2
45.7
64.4
Wholesale retail
44.1
39.8
63.8
2,000+ lives
41.3*
36.9*
62.5*
Other
45.8
38.8
63.6
ASO cases
56.2*
47.3*
75.3*
Total
46.9%
41.4%
66.3%
46.9%
41.4%
66.3%
Trans & utility
*Indicates statistical significant difference at 95% confidence.
Total
©2007 Unum Group. All rights reserved June, 2007
8
Cancer Survivor Critical Issues:
Productivity:
“ChemoBrain,” i.e. short term memory, word association difficulties, a type of dyslexia
was reported as a common experience. Fatigue was felt to be the single biggest
productivity barrier. Fatigue was not resolved by sleep or rest. Work-site flexibility was
considered the key to continued productivity – work tasks need to be adapted to
chemotherapy demands. Work transitions out and back to work are an absolute.
Benefits & Financial Security:
Beyond survival, loss of job was reported to be the #1 concern of the survivors. An
early affirmation of job security or continued connection to company was felt to be a
critical part of the treatment process. Providing benefit programs that support
continued work and cover the ongoing cost of medical care (especially pharmacy)
were considered a necessary part of the ongoing work life of a cancer survivor.
Emotional Survival & Coping Strategies:
All reported significant depression during the course of treatment. The
depression fluctuated daily, weekly by the outcome of the treatments,
changing lab tests. For some, a chronic depression continues. All
indicated that a dramatic change in their point of view and priorities
occurred. A new identity was shaped to a new reality.
©2007 Unum Group. All rights reserved June, 2007
9
Transitional Work & Work site Accommodations
Employer Applications
for Fatigue
• Flexibility at work station
Employer Applications
for Chemo-brain
• Accurately define impairments
that enhance or limit work
capacity
• Time/space for breaks
• Set expectation upfront
• Address co-workers issues
• Plan most productive work
schedule around worst
fatigue times
• Set productivity expectations
clearly and up-front
•
Coach and provide feedback
on performance
•
Define solutions for specific
job tasks issues, such as
checklists to ensure accuracy
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Covering Financial Gaps
• Opportunities for employers
– PTO or vacation donation
– Flexible schedules
– Setting expectations
– Communication to other employees
– Workplace accommodations
• Offer employees:
– Access to a comprehensive health plan (employer and/or employee paid)
– Access to disability plans through work
– Option to buy additional coverage (cancer, critical illness) through the worksite.
• Education regarding the value of benefits and benefit options
– Case Study #1 – Working and in treatment
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A Product/Research Application: Critical Illness
** "Illness and Injury as Contributors to Bankruptcy," Himmelstein et al., Health Affairs Web
Exclusive, http://releases.usnewswire.com/GetRelease.asp?id=42456. Cited Feb. 2, 2005.
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Employer Message: A Productivity Rx
• Manage the productivity
impact @ diagnosis:
• Avoid premature work or career
decisions. Diagnosis does not
mean disability or death.
• Provide appropriate
communication with co-workers.
• Give “permission” to engage
in treatment.
• Understand employee &
caregiver presenteeism.
• Build transitions:
• Expect financial gaps
created by non treatment
costs – fill the gaps.
• Explore employer-healthcare
insurer partnerships that
create accessibility to new
therapies.
• Performance Management:
Understand the “good”
employee to “bad” employee
progression.
Transitional Work
Transitional Work
Full work Capacity
Stay
Stayat
atwork
Work
)
(preserveproductivity)
productivity
(preserve
Absence
Absence
from work
Work
from
Return to Work
work
)
(restore productivity
productivity)
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