During a session at the RIMS 2018 Annual Conference, Denise Algire, Director, Risk Initiatives | National Medical Director, Albertsons Safeway Inc and Michael Coupland, Network Medical Director, IMCS Group Inc. discuss how specific claims and medical management steps can prevent delayed recovery of your injured workers.
Early intervention objectives include identify employees at risk for delayed recovery and intervene as early as possible, prevent needless disability, prevent chronic pain and poly-pharmacy dependency, and enhance employee engagement and resilience. The most important of these objective is to enhance employee engagement and resilience. What is driving these workers’ compensation medical expenditures? Those costs driving are increasing severity, facility costs, pharmacy, co-morbidities, utilization, trends in our society(obese and mental health). Two of the top are stress and mental health. More workers are absent from work because of stress and anxiety than physical injury.
Delayed recovery is when some people develop persistent pain and recovery is postponed due to non-medical psychosocial risk factors. Delayed recovery and overutilization is driven by inadequate coping skills and lack of knowledge of pain generator. Chronic Pain (and poly-pharmacy) is the final common pathway of delayed recovery. The dynamics of delayed recovery are medical diagnosis legitimized injured worker’s distress, the diagnostic/treatment process permits transferral of psychosocial issues, provide or advocate accepts “locus of control”, and the injury is “medicalized”.
Albertsons Safeway created an early intervention policy that focused on low back pain and pilot started in 2013 then rolled out nationally in 2015. There was a clinical risk management screening questionnaire administered by initial PTP/Triage tool. The delay in patient identification was due to lack of clarity of initial workflow. There was a large underestimated organizational execution issues. The early intervention approach focuses on functional restoration, consistent with national treatment guidelines, focus on skill acquisition, improved function, and RTW independent self-management is the goal, but those “at risk” require more attention/care. There was only 505 screenings in the first year but recently in 2017, there was more than 5,400 screenings and only 570 were considered unsuccessful screenings. Over five years of this program there have been almost 16,000 screenings.
CBT is cognitive behavioral therapy. This is brief and time-limited and based on an educational model. This program is structure and directive to get the injured employed back to focus on recovery and back to work. Focus here is on function.
Keys to Successful Implementation
- Outline program goals, plan and workflow
- Map the workflow from claims identification through the claim life cycle
- Identify a single point of contact to serve as the implementation liaison
- Use dedicated resource(s) to conduct screening
- Outline a communication plan
- Schedule formal provider, claims and medical staff training
- Consider utilizing straight-through authorization
- Identify how you will measure success/performance measures
The program trends are on average there is 12% of claims score high for delayed recovery risk PTPs beginning to refer earlier. Employees showing positive results with RTW. The average sessions of CBT is 6. About half of at-risk injured workers’ understand new skill acquisition for resilience is in their best interest. About half of at-risk injured workers’ have other agenda(s) and will not engage.
In conclusion, this is encouraging and exciting results to date. The high risk claims that participate in the intervention demonstrate statistically significant better claims outcomes. Employees return to work and claims are settled reasonably in approximately 50% of cases and estimated 30% reduction in total claims costs.