title: Reducing total health burden from 2001 to 2009: an employer counter-trend success story and its implications for health care reform.
abstract: OBJECTIVE
  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.
authors: Harris Allen Group, LLC, Brookline, MA 02445, USA. harris@harrisallengroup.com
authors: Harris
authors: H
authors: Allen
authors: William H
authors: WH
authors: Rogers
authors: William B
authors: WB
authors: Bunn
authors: Dan B
authors: DB
authors: Pikelny
authors: Ahmad B
authors: AB
authors: Naim
mesh_terms: D000041:Absenteeism; D017049:Employer Health Costs; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007345:Insurance Claim Review