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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 1 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 2 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 3 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 4 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 10 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 11 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. 12 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) 13