Leveraging data to combat substance abuse in the workforce

Most employers are aware of the impact that substance abuse and addiction have in the workplace. But many may not fully understand how the pandemic is causing a dramatic rise in drug and alcohol misuse and how that’s affecting employee well-being. Isolation, grief, anxiety, financial worries, and upheavals in home and work routines are exacerbating substance use disorders for some employees and endangering others who are at risk of developing one. The data on pandemic-sparked drug use is still coming in but, as of October 2020, more than 40 states had reported spikes in fatal opioid overdoses that are connected to the pandemic.¹

The National Safety Council also states that 75% of adults with a substance use disorder are in the workforce, which means it’s likely that nearly every employer in the country faces the responsibility of supporting those urgent health needs. Unfortunately, many corporate health and wellness programs don’t include the prevention and treatment resources necessary to deal with substance misuse.

The rise of substance misuse and its associated health issues, coupled with previously unforeseen health costs such as COVID-19 treatment, will cause health plan sponsors to face difficult and challenging plan renewals in the coming years. The good news is that most employers actually have data at their disposal that can help
them better prevent substance abuse among their employees. Following are examples of ways that data can be used for substance abuse prevention.

Understand Productivity and Absenteeism to Monitor Employee Behavior

Numerous studies have documented the correlation between substance abuse and excessive employee absenteeism. Before the pandemic, it was easier to notice when an employee consistently missed work or identify patterns in changing work output and engagement since workers gathered in communal office buildings and other
work venues.

With so many employees now “officing” remotely at home, it isn’t as easy for employers to know when someone isn’t fully present for the workday. Therefore, managing expectations, frequent communication and reviewing data about absences to reveal patterns indicating potential problems are more important than ever. If an employer isn’t already leveraging this type of remote management data (tracking due dates, participation in meetings, productivity trends, etc.) to help spot potential abuse or addiction issues within their workforce, the time to start is now. It’s important to recognize that this data exists, but many organizations have not tracked it or used it at this level before.

With the shift to working from home, the line between work and the home environment has become blurred. Those who have no space for a separate workstation in their home are forced to work in an area where they also eat, sleep or relax. Add to this partners and children all working and schooling from home, and it becomes difficult to keep distinct working hours and switch off during downtime. In fact, according to research by Executive Grapevine, employees who are working remotely are racking up an extra 28 hours of monthly overtime since lockdown began, which equates to nearly four days of work. But that doesn’t mean all that extra time is productive, and that’s where presenteeism comes into play.

Presenteeism can be difficult to track since it doesn’t have concrete data that can be analyzed. It can take many forms:

• Working when sick
• Staying “at work” longer than needed beyond standard hours
• Regularly responding to communications (emails, messages) outside of working hours (referred to as technological presenteeism)
• More or frequent mistakes in work output
• Starting late and finishing early on work assignments
• Producing work at a lower standard than before and/or lower levels of productivity
• Lack of care about results and output
• During one-on-one or team meetings, employee looks tired or exhausted or has a general lack of participation that is not considered typical based on past performance.

Presenteeism is not just lack of engagement, however. It also includes employees not “shutting down” and working during off-hours or working excessive hours to “prove” they are working, as well as never taking any time off. To avoid the burnout and disengagement these habits can cause, it is essential for companies to support their remote employees by articulating in various ways that quality of work matters, not quantity. When it comes to policies that employers can create to combat the above habits, the policy established should have clear guidelines and be communicated to all levels of the organization. Providing sufficient paid sick leave or time off can also help reduce the instances of people working when sick. Employees should also understand under what conditions they should stay home and when they can return to work. Substance use disorders may fuel a rise in presenteeism. Frequent communication, check-ins with employees, and social interaction with managers, supervisors and teams are good examples of ways to validate employee output and build trust.

Use Medical Claims and HRIS Data to Identify Red Flags

Traditionally, many employers relied on identifiers such as behavior changes at work or slurred speech, lack of participation and/or inability to focus during meetings as cues that an employee may be struggling with a substance use issue. In today’s work-from-home environment, however, those red flags are not as readily available.

That’s where an organization’s medical claims and other human resource information systems (HRIS) data such as records of paid time off, vacation and sick time, leave of absence (LOA), Family and Medical Leave Act (FMLA) leave, performance reviews and performance improvement plans can not only fill the gap but enhance the ability to recognize employees who may be struggling. Self-funded plan sponsors can look at deidentified health claims data such as prescription refills for anomalies. This information can be used to assist in communication efforts and plan design to help keep employees safe. Self-insured employers should review aggregated claims data regularly for such markers of prescription drug abuse.

There are nuances to data that are important to keep in mind. For example, according to McKinsey, opioid dosing patterns vary by ZIP code.2 In other words, no two regions of the country—even no two ZIP codes within the same region—practice the same dosing patterns for the same clinical problems. Plan sponsors with members scattered across counties, states and the country need to be aware of these dosing inconsistencies as they look for patterns and work with their brokers and administrators to design plans that tailor approaches and behavioral health resources when data indicates possible substance abuse issues.

The same McKinsey study states that while patients may have opioid use in common, other factors including coexisting behavioral or medical conditions, along with socioeconomic factors, correlate strongly with utilization patterns such as emergency room visits. Again, integrating and analyzing HRIS data including claims information, salary levels and addresses can help employers recognize patterns, which can then enable them to extend the appropriate behavioral health assistance.

Once employees at risk are identified, employers, consultants and vendor partners should work together to ensure that plan design and programs address the employees’ underlying health conditions while managing cost, thereby generating the best health outcome or the employee and the best value for everyone’s dollar.

What to Look for and What to Do When You Find It

It’s a question of when rather than if employers will start to see evidence cropping up in their data that points to increased substance misuse stemming from the pandemic. More employees are going to need further support and resources now and into the foreseeable future. Employers can take the initiative to stem the coming tide by turning to their data, identifying employees who may need help and offering them the needed support. For example:

• An increase in health claims for opioids to manage chronic pain conditions can indicate a developing addiction. Employers should train and empower managers
  on how to properly approach employees who may be struggling. They should clearly outline when and how to lead an employee to services such as a wellness
  vendor, addiction treatment provider, employee assistance program (EAP) or teletherapy.
• It’s common practice for employees to schedule elective surgeries at the end of the year. Plans that see such a spike should be sure that workers are educated on the risks of opioids, pain management alternatives and safe disposal methods for unused medications once postsurgical pain management is no longer warranted. Rather than encouraging workers to flush unused prescriptions down the sink or toilet or toss them in the trash (both harmful to the environment and, if found, opens up the possibility for misuse), employers can distribute drug deactivation and disposal pouches manufactured specifically for scientifically proven, safe, at-home drug disposal.
• Should an employee’s paid-time-off use escalate although no diagnosed illness or scheduled vacations are indicated, employers should make sure that managers are trained to address the issue and that policies are in place to support intervention.