By Roberto Ceniceros
Nov. 3, 2011
Large, cutting-edge employers are introducing their workers’ compensation and nonoccupational disability claimants to wellness programs originally launched to reduce illnesses treated through their standard health care plans.
The trend represents a form of benefits integration aimed at reducing employers’ overall medical spending, reducing accidents, improving productivity, and improving return-to-work outcomes by engaging employees with wellness programs and chronic disease management offerings, several sources said.
Employers also want to optimize employee use of established wellness offerings, such as weight-loss or smoking-cessation programs that otherwise may be underutilized, said Kimberly Mashburn, vice president of Chicago-based Pacific Resources Special Risk Insurance Services Inc., a benefits consulting firm serving large employers.
The integration practice, however, requires employers to transcend traditional corporate silos that typically separate risk management and workers’ compensation departments from those administering health benefits and nonoccupational disability plans.
“We worked closely with our risk management team and made a concerted effort to combine our risks on the workers’ comp side and getting (disability and workers compensation claimants) engaged, and communicating to them about the resources available on the health care side,” said a benefits manager for a global manufacturing company who declined to be identified.
The global manufacturer implemented a health care wellness program in 2002. Then about two years ago, its disability claims administrators began referring claimants to the wellness offerings. Now, workers’ comp claimants also are referred to programs such as those to manage lower back pain and other chronic conditions, she said.
The integration approach requires coordinating providers that do not typically work together, such as health insurers, workers’ compensation third-party administrators and nonoccupational disability insurers, several sources said.
About 10 months ago, TPA Broadspire Services Inc. helped a large employer launch a program to refer its workers’ comp claimants to a wellness program originally established under the employer’s group health plan.
That required several meetings between the self-insured employer’s health plan administrator, Broadspire, and the employer’s short-term disability administrator so that STD and workers’ comp claimants also could be referred to the company’s wellness offerings, said Gary Anderberg, director of business development for the Atlanta-based TPA.
The providers had to coordinate how they would communicate, the protocols for determining when it would be appropriate for workers’ comp adjusters or nurse case managers to telephonically introduce claimants to a nurse on the group health side, who then would help them access the company’s wellness options, Anderberg said.
It also required training Broadspire’s employees about the questions they need to ask injured employees to learn whether they might benefit from the employer’s programs for chronic illnesses such as back pain, respiratory problems or diabetes.
“The concept is simple, but the mechanics are not as simple,” Anderberg said. “We had a lot of meetings together.”
While more large employers are undertaking the approach, only a relative few have already done so, said Dr. Teresa Bartlett, medical director and senior vice president in Troy, Michigan, for Sedgwick Claims Management Services Inc.
Employers that have undertaken the process typically rely on employees of their vendors, such as nurse case managers employed by their workers’ comp TPAs, who speak to injured workers on the telephone to question the workers about co-morbid conditions, excess weight concerns or mental health issues, several sources said.
“We ask about height and weight or about any co-morbids,” Anderberg said. The questions are asked during the TPA’s first contact with an injured employee “because you don’t want to find out about an important co-morbid (condition) two months after the claim has started.”
Then, if deemed appropriate, the nurse case manager, while still on the telephone with the employee, typically calls a nurse or health coach with the wellness program to make a “warm transfer” introduction.
Other arrangements are possible, however.
The benefits manager who asked not to be identified, for instance, said that while a warm transfer to a health care coach occurs for her company’s STD and long-term disability claimants, a more passive, educational approach is used to engage injured employees who have made a workers’ comp claim.
Her employer’s human resource personnel contact workers comp claimants to remind them of the wellness offerings that are available, she said.
But “I believe the warm transfer is much more effective,” Sedgwick’s Bartlett added.
Employers that have this integrated treatment approach see it as a means to reduce their overall medical expenses and productivity losses regardless of whether an employee needs assistance because of a workplace accident or a nonoccupational-related leave.
“For us, in getting people back to work and getting them feeling better about themselves and getting their condition solved, it doesn’t really matter if (they are helped) on the health care side or the workers’ comp side,” the benefits manager said. “We just want to make sure people realize the resources they have available to them.”
While relatively few employers have implemented the approach so far, the “tide is shifting,” Bartlett said. That is evident because some employers that do not already offer wellness assistance have asked Sedgwick to use its case management and managed care services to develop wellness programs just for workers’ comp and disability cases, she said.
Attracting employees to use health care wellness programs has proved a challenge for employers, several sources said. But employees are much more likely to be ready to make changes and use the programs when they have suffered an injury or are absent from work because of physical or mental health issues, they added.
“Trying to get an employee to engage in those programs usually takes an event such as filing (a Family and Medical Leave Act) leave claim … or a disability claim,” Pacific Resources’ Mashburn said.
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