Back to Work Strategies & Solutions Following Illness Or Injury 9/5/2015 Contents are proprietary...

Back to Work Strategies & Solutions Following Illness Or Injury

04/19/23 Contents are proprietary and confidential. Copyright 2008 Benefits Advisor Network

Presented by:

Dr. David Rearick Strategic Benefit Solutions, Inc.

Michael Brown, ARMVoCare Services Incorporated, Inc.

Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCApril 19, 2023 2

15%85%85%

Employer Payroll Cost

Wages Paid forTime at Work

Wages Paid forTime-Off and Disability

Days(including workers’

compensation (WC) medical expense)

The Magnitude of Absence Benefit Costs

Equivalent to:27 scheduled days off +11 unscheduled days offper year

Watson Wyatt, “WBGH Staying@Work Survey 2000/2001.” US Census Bureau Projections, 1998.Note: Disability includes: sick leave, workers comp, and short term / long term disability.Watson Wyatt, “WBGH Staying@Work Survey 2000/2001.” US Census Bureau Projections, 1998.Note: Disability includes: sick leave, workers comp, and short term / long term disability.


Hidden Costs by Program

$767

$2,007

$943

$3,855

$1,374

$3,593

$1,688

$6,722

$1,980

$5,180

$2,433

$9,690

$0

$2,500

$5,000

$7,500

$10,000

Avera

ge

Excess Staffing Average Lost RevenuePotential

Workers' Comp

FMLA

Sick Leave

STD


Full Costs by Program – EE Costs

$0

$1,000

$2,000

$3,000

$4,000

Avera

ge

Est. EEgrouphealth

WC STD LTD Incid.Absn.

FMLA

Lost productivityPayments


The Problem: The Full Cost of Employee Illness

Medical & Pharmacy Costs

*$6,020 PEPY

Health-related Productivity Costs

$12,000 PEPY

33%

66%

Workers’ CompMedical CostsSalary Continuation

Personal Health CostsMedical CarePharmacyHospitalizationBehavioral Health

Productivity Costs

Presenteeism

Turnover

Replacement Training

Temporary Staffing

Administrative Costs

Variable Product Quality

Employee Dissatisfaction Customer Dissatisfaction

Overtime

Off-Site Travel for Care

STDLTD

Sources: Loeppke, et.al., JOEM, 2003; 45:349-359 and Brady, et.al., JOEM, 1997; 39:224-231

Total PEPY= $18,020

*2003 PEPY Avg.

Absenteeism


Disability costs > 12% of Payroll Costs are Projected to Rise

$260$350 $400

$364

$490

$560

$0

$200

$400

$600

$800

$1,000

$1,200

1997 2000 2002

Direct Costs Indirect Costs

Disability Costs as a Percentage of Payroll

Direct Costs of Disabilities in the US(in billions)

Direct Cost of Disability

5%Indirect Cost of Disability

7%

Other Payroll88%

Watson Wyatt, “WBGH Staying@Work Survey 2000/2001.” US Census Bureau Projections, 1998.Note: Disability includes: sick leave, workers comp, and short term / long term disability.


The Link Between Disability and Disease Management

Impact of Employee Absence

Source: Managing Health Care Costs in a New Era - 10th Annual National Business Group on Health/Watson Wyatt Survey Report 2005

Note: Survey only includes employers with >1,000 employees

21%

5%

0%

5%

10%

15%

20%

25%

2004 2005

Source: UnumProvident

Employers Interested in Integrating Health Care & Disability


When to Refer

Early Intervention – Workers Compensation

85% of all injured workers do not return to work after being off-duty one year.50% do not return to work after being off duty 12 weeks.

10 days = $13,142

30 days = $20,167 2005 Ohio Bureau of Workers Compensation


Early Intervention

Increased success

Bob MacBride, MD, The Prudential Insurance Company of AmericaBob MacBride, MD, The Prudential Insurance Company of America


What is Disability Management?

"a workplace prevention and remediation strategy that seeks to prevent disability from occurring or, lacking that, to intervene early following the onset of disability, using coordinated, cost-conscious, quality rehabilitation service that reflects an organizational commitment to continued employment of those experiencing functional work limitations. The remediation goal of disability management is successful job maintenance, or optimum timing for return-to-work ..."

Akabas et al. (1992)


STD

LTD

WC

FMLA

STD

LTD

FMLA

WC

STD STD

LTD LTD

FMLA FMLA

WC WC

PTO

PTO

STD

LTD

FMLA

WC

PTO

IncidentalAbsence

Presenteeism

STD

LTD

WC

FMLA

WC

Traditional Integrated Disability Management Absence

Benefit Management


Medical Treatment

Return to Life Activities

Vocational Rehabilitation

Medical Stability

Social Model

Changing Priorities

100%

0%

Medical Model

CapacityValidation

100%

Bob MacBride, MD, The Prudential Insurance Company of AmericaBob MacBride, MD, The Prudential Insurance Company of America


Back to Work Strategies

Intervene as early as possible after an actual or potentially disabling event. Identify and provide necessary return-to-work assistance effectively. TWPStructure cash and medical benefits to encourage return work.


Case Example

Large Employer with Call Centers 10% of Employees34% of all absence

Referral of all STD claims within 5 days of absence.Medical Case Management with EAP and Disease Management coordination

53% with Comorbid conditionsComorbid increase days by approx 50%

18 months outAbsence reduce by 43%


Case Example: Timeliness Saves Days Lost Opportunity Days

0 50 100 150 200 250 300

Jan-09Feb-09Mar-09Apr-09May-09Jun-09Jul-09Aug-09Sep-09Oct-09Nov-09Dec-09

Lost Opportunity Days: The number of days late in making a referral after the targeted 5 days.

Source: AdvoCare Incorporated 2009

Lost Opportunity Days: The number of days late in making a referral after the targeted 5 days.

Source: AdvoCare Incorporated 2009

0

5

10

15

20

25

30

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Referal TimeReferal Time

One day = $240 in direct pay. One day = $240 in direct pay.


Healthcare Costs by Age x Risk

Source: Musich, McDonald, Hirschland, Edington, Disease Managements & Health Outcomes 2002; 10(4): 251-258; University of Michigan Health Management Research Center.

Used with permission. Dee Edington, Ph.D. University of Michigan, Ann Arbor, Michigan


Benefits of Early Intervention

For the Employer • Productive work force • Reduced number of replacement workers• Employer can be more involved in a claim • Reserves FASB 112• ADAAA compliance • Cost Control


Benefits Cont.

For the Employee• Feelings of self-worth, purpose • Involvement in active program vs. passively sitting at home• Keeps them in the routine of work• Vocational Rehabilitation provides an additional support

structure for the injured worker during recovery• Assistance in finding alternative work when unable to return

to work with original employer• Reduce wage loss


Controlling Return to Work

Early Notification of AbsenceCase Management Claims ManagementJob Descriptions –

Physical demandsCognitive demandsTemperments

Communication with Physician

Communication with Employee

Transitional Work Program Occ. & Non Occ.

Functional Capacity EvaluationsOn-site TherapyVocational Rehabilitation

Notifies Manager

Employee Assessed by RTW NurseCoordinator

Injured /IllEmployee

Assessment complete

Initial Eval &F/U only.

Completes FROI And ROI

Industrial

Non-Industrial

Claim Denied

Claim AcceptedClaim Investigated

Occ. Med Clinic

Specialist

On-siteOccupational Therapist

Meets MCM Criteria

Medical Only.No F/U

-Ergo Evaluations-Brown Bag (Lunch) mini-seminars on Ergonomics

Refer to Personal MD

CaseMgr…………C

Mgt TeamJob Description

Adjusters

PT/OT/Voc/Diagnostics

HRLegal

Employee

Voc Rehab

Families

RTW-Reg Wk Activity

RTWModified duty

(QIW) Qualified Injured Worker

+ Accommodations

Can notAccommodate

BackHome

PERMANENTRESCRICTIONS

ADAAAMeeting(HR/Mgt/Ns/Legal

Can not Accom-modate_____

Physicians

Voc Rehab


Job Analysis

Help Wanted

KITCHEN ASSOCIATE Line Cook Needed. Unmotivated slob who has a nasty disposition, no worthwhile abilities, and bad at communication. Can't handle a spoon, spatula, or knife and wouldn't want to lead people if their life depended on it. Of course we don't want an experienced person, nor do we want to train you. Evening shift, maybe days, maybe part time, maybe full time.

Norwalk Reflector


EMPAQ®

Employer Measures of Productivity, Absence and QualitySM.

EMPAQ®: uniform, standardized metrics and reporting system for health, productivity and disability management for all employers.

useful comparison of benefit programs across major industry sectors

employer participation in this national metrics benchmarking project

creation of an industry-accepted set of standardized benchmarking metrics

DMEC, NBGH, IBI


Recommendations

Discuss with current providers their capacity to assist. Establish a model for the program that fits the organization and its needs.Develop a core set of RTW strategies (e.g., designating transitional RTW pathways).Create policies that support RTW.Develop linkages with local healthcare and rehabilitation providers.


Recommendations

Provide staff development and mentoring through research and education (Mitchell, 1998).Define indicators of effective RTW outcomes and milestones for evaluating progress.Evaluate and monitor progress.Provide supervisor and physician training.Provide usable program evaluation information.Keep the program up to date


Spectrum of Services

Litigation Support Services

Expert WitnessLife Care Plans

Vocational Opinions

Guardianship Assistance Services

Eldercare advocacyAssistance with daily living; medical needs;

organizing & implementing relocation

Prevention:Transitional Work

Safety Plan Development

Workplace SafetyOSHA ComplianceRisk Management

TAM24/7

Absence Management

Integrated BenefitsIntegrated

Information System

Group Health

Case ManagementDisability ManagementUtilization Management

STDLTD

Worker’s Compensation

MCO/QHPDisability ManagementUtilization ManagementBill Review/Processing

TPA:

Employer RepresentationGroup Rating

Rate DeterminationsClaim Administration

Vocational Rehabilitation

Employer Incentive ProgramsJSST

Job Placement AssistanceCareer Counseling

Labor Market AnalysisOn-Site Therapy

Case ManagementCatastrophic Case Mgmt

Client

Questions ?

04/19/23 Contents are proprietary and confidential. Copyright 2010 Benefits Advisor Network

Michael Brown, VoCare Services, [email protected]

888-840-1221 x 270

Back to Work Strategies & Solutions Following Illness Or Injury 9/5/2015 Contents are proprietary...

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