Technology Gives the Gift of Movement
The ability to stand and walk unassisted is something most of us take for granted, but many catastrophically injured workers face a lifetime either confined to a wheelchair or relying on a prosthetic to help them move.
Luckily, advancements in medical technology are making movement easier.
Mark Sidney, VP, claims, Midwest Employers Casualty Co., and Clare Hartigan, project manager, Virginia C. Crawford Research Institute, Shepherd Center, discussed these advancements at a Thursday afternoon NWCDC session titled “The Bionic Claimant: Emerging Medical Technology’s Impact on Care and Cost.”
“Psychologically, being able to stand and look someone in the eye is a big deal.” — Clare Hartigan, project manager, Virginia C. Crawford Research Institute, Shepherd Center
Technology like myoelectric prostheses and exoskeletons can drastically improve quality of life for catastrophically injured workers, restoring some functionality and a sense of independence.
But this high-tech equipment comes with a hefty price tag.
Myoelectric devices, which use sensors and bioelectric signals to move the limb, can cost as much as $100,000. Exoskeletons are in the same ballpark, and this doesn’t include maintenance or the cost of replacing a device every five years or so.
“The difference in cost between a standard prosthetic and a myoelectric can be $1 million over the lifetime of a claim,” Sidney said.
More long-term studies are needed to prove the medical necessity of this technology, but the benefits are already clear.
“Just being able to get up and move leads to muscle strengthening and improved blood cholesterol and glucose levels,” Hartigan said.
“Psychologically, being able to stand and look someone in the eye is a big deal.”
To determine when a myoelectric device or exoskeleton is appropriate, workers’ compensation professionals should look at the patient’s lifestyle. What type of activities do they do? Are they more happy indoors or out? How often will they use their device?
Ultimately, it comes down to whether or not this advanced machinery will enable them to do things that are impossible with standard devices.
Rehab Rx: Return to Work
“Injured workers are a rewarding group to take care of, but a challenging group,” said Robert Hall, corporate medical director, Helios.
He and Dr. Marcos Iglesias, vice president and medical director, The Hartford, outlined the barriers to returning injured workers to full functionality and how to overcome them at a Wednesday morning session at the National Workers’ Compensation and Disability Conference, titled “Medical Director’s Perspective: Restoring Function and Returning to Work.”
Comorbid conditions – both physical and psychosocial – present the greatest obstacle.
They not only set people up for injury but also delay recovery. If an injured worker has a physical condition like obesity, diabetes or older age, recovery time usually doubles, Iglesias said.
If that condition is coupled with a psychosocial factor like catastrophic thinking or perceived injustice, the recovery time quadruples. Add in a mental health issue like depression or anxiety, and that time increases by a factor of eight.
Psychosocial risk factors are increasingly gaining awareness from the workers’ comp provider and payer community.
“Self-predictions about return to work are often self-fulfilling prophecies,” Iglesias said. He said that claims managers can identify patients as high or low risk by asking them when they believe they can return to work.
“Any answer beyond 10 to 14 days means they are at high risk for delayed recovery,” he said.
The best way to manage comorbid conditions and speed up return to work is through open and frequent communication between patient, provider, payer and employer, Hall said.
Physicians should use simple language to address patients’ fears and provide reassurance, and payers should follow up with doctors to verify that their treatment plan follows evidence-based guidelines.
Non-pharmacological treatments like exercise and socialization should also pay a big role. As Hall said, “Opioids alone don’t bring about recovery.”
Because time away from work only increases the likelihood of developing depression and exacerbating existing comorbids, returning to work should also be considered part of the rehab process, Iglesias said, and not just the end goal.
Bringing Focus to Broad Challenges
Target’s roughly 341,000 employees perform a wide array of tasks. In its nearly 1,800 retail locations, they stock shelves, walk the aisles assisting customers and man the cash registers, sometimes staying on their feet for hours on end. In the company’s 38 distribution centers, they move large pallets and work side by side with heavy machinery.
Target also operates in 49 of the 50 United States. As any national company can attest to, this presents regulatory complexity, as no two states are the same when it comes to safety regulation, health care resources and workers’ compensation law.
The safety and workers’ comp challenges, to say the least, are broad.
Then, the retail giant underwent a companywide reorganization in March 2015, which left the risk management department with fewer team members, and just as much work to accomplish. The team is responsible for safety, claims, finance and insurance across the corporation.
“We had an opportunity to help team members learn new skills and expand their knowledge base,” said Jodi Neuses, safety director, Target. “From the safety team’s perspective, we had to do some cross-training so that everyone had a well-rounded understanding of our risks on both the retail and the distribution side. We no longer had specialized experts in just one part of the business.”
The same was true on the workers’ comp side of the equation.
“We were fortunate to have team members who were specialists in workers’ comp claims and have previously been adjusters,” said Amanda Lagatta, Target’s director of insurance and claims. “We had people with similar skill-sets work together to apply those skills in new ways.”
The team also began re-evaluating whether it was utilizing its third-party vendors in the most efficient way.
“We made several changes with our claims vendors and managed-care vendors, so that we were fully leveraging all the services they provide,” Lagatta said.
Neuses and her team turned to professional associations like the American Society of Safety Engineers and the Minnesota Safety Council to stay updated on the latest guidelines and training. Vendors and professional groups have become a regular source of expert advice for the safety team.
Rebuilding the expertise of the safety and workers’ comp team offered an opportunity to view the company’s challenges with a fresh perspective. It opened their eyes to new ways to improve their programs.
The workers’ comp claims team, for example, made greater use of predictive analytics to streamline and expedite its processes.
“This is a service that we think is unique to us, and has really evolved to become a central part of our advocacy program.” — Amanda Lagatta, director of insurance and claims, Target
Originally, the analytical tool was used to determine at the outset the level of adjuster that should be assigned to a case. It was meant to direct the right level of expertise to a claim. The problem with that model, however, is that it touches a claim only once and does not account for how the claimant’s experience changes over time.
“We subsequently updated the model so that it looks at a claim at different points throughout its lifecycle, not just at the start,” Lagatta said. “As things change, we’ll evaluate the use of a return-to-work coordinator, and when we should call a roundtable to discuss a claim’s progress to develop a new strategy or get different people involved.”
Diving deeper into claims data also helps the safety team pinpoint where injuries are happening, so they can focus prevention efforts where they’re needed most.
Stronger Safety Culture
A culture of safety devoted to keeping team members and guests safe is a critical goal for Target. Efforts are focused on creating a top-down culture of safety throughout the company, including leading off meetings at distribution centers with safety messages, and leveraging an ergonomic specialist to consult on workstation design and merchandise presentation to minimize injury risk. The team also engages the “assets protection” leader at every retail location to take on the role of “safety captain” to reinforce a culture of safety in their stores.
Huddles — how the Target store teams refer to their twice-daily gatherings — and Start Up Messages, in which managers communicate the company’s safety message before the day begins and lead their teams in stretching and other warm-up exercises, are another key feature of the safety program.
Signage in stores and distribution centers remind employees of hazards and safety practices they should follow to mitigate them. Training programs for powered equipment were simplified and adjusted to allow trainers and supervisors to control when an employee is ready to be certified and move on to independent work.
“Safety is mission-critical,” Neuses said. “We try to be proactive and continually reinforce that message.”
Unfortunately, even the most thorough safety program can’t prevent all accidents. When an injury does occur, Lagatta and her team ensure that the worker is treated with respect and care — and treated quickly.
When a team member is injured on the job, they often don’t know how to navigate the workers’ comp system or how exactly the claims process works. Confusion and frustration can add to the employee’s stress and lead them to delay seeking care.
As part of an initiative to build a more formal, advocacy-based claims model, Target instituted a Workers’ Comp Assistance Center with the help of its TPA, Sedgwick Claims Management Services.
“This is a service that we think is unique to us, and has really evolved to become a central part of our advocacy program,” Lagatta said. “Someone from the assistance center — not the claims adjuster — will reach out to the team member and make the first contact with them. Their job is to reassure the team member that we care and we’re there for them, to familiarize them with the workers’ comp process and answer any questions.”
Those initial calls are also an opportunity to collect additional information about the claimant and the injury. That data is entered into the predictive modeling system and used to direct the right resources to the case.
Return-to-work coordinators are another critical component of the advocacy approach, and the retailer’s return-to-work program is a differentiator in the industry.
The risk management team has identified suitable light-duty positions for injured workers, and provides 12 weeks of modified duty payroll to support the stores using this program. But sometimes follow-up surgeries are necessary, and recovery can be a difficult road. Post-surgery, injured employees may receive another 12 weeks to accommodate the additional treatment.
Third-party service providers again play an important role in this process. Nurse case managers liaise with physicians and human resource departments to gather the information they need, and keep all parties on the same page. For example, they can analyze an injured team member’s abilities and investigate worksites to determine what is safe and suitable.
“We really rely on our vendors to help navigate that process and make informed decisions,” Lagatta said. “We’re fortunate to have partners we can trust, so we can maximize the impact of our department.”
Since implementing these changes in safety, claims management and return-to-work, Target has seen reductions in claim frequency, length and cost, and has improved the experience for its injured workers. &
Read more about the 2016 Teddy Award winners:
Bringing Focus to Broad Challenges: Target brings home a 2016 Teddy Award for serving as an advocate for its workers, pre- and post-injury, across each of its many operations.
The Road to Success: Accountability and collaboration turned Hampton Roads Transit’s legacy workers’ compensation program into a triumph.
Improve the Well-Being of Every Life: Excela Health changed the way it treated injuries and took a proactive approach to safety, drastically reducing workers’ comp claims and costs.
The Family That’s Safe Together: An unwavering commitment to zero lost time is just one way that Harder Mechanical Contractors protects the lives and livelihoods of its workers.
More coverage of the 2016 Teddy Awards:
Recognizing Excellence: The judges of the 2016 Teddy Awards reflect on what they learned, and on the value of awards programs in the workers’ comp space.
Fit for Duty: 2013 Teddy Winner Miami-Dade County Public Schools is managing comorbid risk factors by getting employees excited about healthy living.
Saving Time and Money: Applying Lean Six Sigma to its workers’ comp processes earned Atlantic Health a Teddy Award Honorable Mention.
Caring for the Caregivers: Adventist Health Central Valley Network is achieving stellar results by targeting its toughest challenges.
Advocating for Injured Workers: By helping employees navigate through the workers’ comp system, Cottage Health decreased lost work days by 80 percent.
A Matter of Trust: St. Luke’s workers’ comp program is built upon relationships and a commitment to care for those who care for patients.
Keeping the Results Flowing: R&I recognizes the Metropolitan Water Reclamation District of Greater Chicago for a commonsense approach that’s netting continuous improvement.