Fundamentals for Executives Overseeing Workers’ Compensation
At the 2018 National Workers’ Compensation and Disability Conference & Expo, a session discussed some of the key concepts that executives new to overseeing a workers’ compensation program need to understand. The speakers were:
- Paul Braun – Managing Director, AON
- Monica Manske – Senior Manager Workers’ Compensation, Rochester Regional Health
Workers’ Compensation Advocacy
This concept has gained a lot of traction the last few years. As an employer, your employees are your greatest asset. When they are injured on the job, how are you helping them manage the workers’ compensation claims process? How can you help the injured worker have a better experience? This involves extending the customer service approach your business gives to your customers to your injured workers. Being more of an advocate for your injured workers will ultimately result in lower costs for your program because of less conflict and litigation.
There is an opioid epidemic in this country that is receiving a lot of coverage in the news. This is something that workers’ compensation has been dealing with for years. In many ways the workers’ compensation industry has been ahead of the healthcare industry in terms of recognizing the problems with opioids and trying to address them. There is a need to realize that there is no magic pill to cure chronic pain and that in the long-term opioids do more harm than good. Payers need to be open to alternatives to opioids when it comes to pain management.
Claims predictive analytics is a buzz word you hear a lot. There is so much data available and so many things that can be measured. What you need to do is figure out what measurements are important, Once you figure out key metric and flags to watch out for, you need a strategy of how you are going to approach the claims differently to achieve a better outcome.
Getting injured workers back into the workplace as soon as practical is one of the keys to a successful workers’ compensation program. A good program will have a library of all jobs and their essential functions in advance of any injuries. When someone has work restrictions you can then use that information to assist in finding the appropriate modified job for the worker while they have restrictions. Sometimes modifying existing jobs is not practical so employers need to have ideas around other tasks that need to be done which could be used to provide a temporary assignment for the injured worker. Complicating disability management is the need to maintain compliance with local, state and federal leave of absence programs including AMA and FMLA.
Addressing Human Resource Performance Issues
It is important to be consistent with how you treat employees, regardless of whether or not someone has a workers’ compensation claim. Could this lead to higher costs on the workers’ compensation claim? Possibly. But you will avoid getting pulled into expensive issues on the employment law issues because of inconsistent application of policies.
Medical management is an important aspect of the workers’ compensation industry. There are many components to this including nurse case managers, bill review, occupational health networks, equipment providers, speciality networks, and utilization/peer review. It is important that payers are evaluating the use of various medical management components to see what you are spending and whether that investment is actually saving you money. Every program is different so while using nurse case managers frequently may make sense on one program that doesn’t mean it is the correct approach on all programs.
Workers’ compensation is a state regulated system. That means you are dealing with 50 different sets of rules and regulations. This creates significant complexity for employers with multi-state programs. Most states require use of paper forms instead of things being electronic and paperless and many states still require paper checks instead of electronic payments. The bureaucracy of workers’ compensation adds a lot of complexity and costs to the system while doing very little to enhance the benefit delivery process.