Strategies to Manage the Pandora’s Box of Comorbid Conditions

“Sitting is as bad as smoking.” 10,000 Americans a day turn 65, increasing the possibility of comorbid conditions on claims. Claims with a comorbidity diagnosis are increasing. A comorbid diagnosis can give the provider, injured worker and payer more realistic expectations for return to work and recovery.

Eric Patten, Director of Clinical Management and Complex Care, One Call Care Management, and Richard Graham, Director, Workers’ Compensation, SEPTA, discussed what they referred to as “Pandora’s box” of comorbid conditions at the RIMS 2017 Annual Conference. Some common comorbid conditions are obesity, diabetes, high blood pressure, depression, and insomnia.

Mental health issues such as major depressive disorder, chronic mild depression and anxiety disorders are also included. Injured workers often experience depression. This comes from the cumulative effects of stress, decrease of daily activities, concerns over money, and feelings of worthlessness or helplessness. There are prolonged and increased effects of pain, which then can increase narcotic use and extend claims duration.

Tobacco use is considered a comorbid condition, even though it a choice. This results in conditions that impair respiratory function and physical activity, including Chronic Obstructive Pulmonary Disease (COPD). This has been found to prolong recovery from lower back injuries and carpal tunnel, among other injuries. Smoking cessation may be essential to recovery from an injury. Smoking remains to be the second leading cause of death and disability. Businesses actually pay an average of $2,189 in workers’ compensation costs for smokers, compared to $176 for non smokers.

South Eastern Pennsylvania Transportation Authority (SEPTA) 

SEPTA is the nation’s sixth largest provider of public transportation, providing service to Philadelphia and the five surrounding counties. There are over 9,300 employees, including 611 railroad employees and 261 sworn police officers. These are long-term employees. They are often hired at 25-years old and work at SEPTA for 25-40 years. This is very sedentary work and employees retire with multiple health issues. They have excellent health benefits and generous sick leave. This includes low copays, generous prescription plan, incentives for gym memberships and wellness programs.

SEPTA has set up pre-loss strategies that include a wellness program consisting of nutrition counseling, Weight Watchers and reimbursement for gym memberships. They have a leading safety program and management committeemen to safety.

In summary, comorbid conditions are creeping into claims. It is important to try and combat these conditions as early as possible. Being able to recognize and acknowledge these comorbid conditions can decrease claim costs and get the injured worker back to work sooner.