Reaping the Rewards of Benefits Integration
Discussions at this week’s Disability Management Employer Coalition conference held in New Orleans included measures for keeping employees healthy, injury free, and on the job.
Conference participants also reviewed risk reduction, ease of administration, and cost saving advantages obtained by integrating absence management and disability benefit programs such as workers’ compensation, the Family and Medical Leave Act, and short-term disability offerings.
Proponents say integration makes sense because of overlaps among the range of programs under which workers can be absent and the cost to organizations regardless of the reasons for missed work days.
They also point to potential compliance risks when the administration of programs is segregated and improperly aligned.
“There is hardly any situation where there is just one perfect claim going on,” said Karen English, a partner at Spring Consulting Group. “If someone is [out] on workers’ comp, they are probably on FMLA [and] STD. Then we have all our concurrent leaves going on. So keeping workers’ comp to the side can actually be viewed as a risk to your organization.”
Failing to integrate can lead to lost opportunities, such as the ability to appropriately minimize the amount of time employees spend away from the job by concurrently running FMLA leave with a workers’ compensation absence.
“Just as an example, if you have a workers’ comp claim and that person is out eight weeks for a surgery, if you don’t run it concurrently, you are allowing that employee to come back from that workers’ comp claim and then go out for 12 additional weeks of FMLA time,” said Trina Mouton, manager of disability management and wellness at CenterPoint Energy.
“So it is really advisable to run those concurrently,” Mouton continued. CenterPoint experiences a 2-to-1 return on investment from its efforts, she added.
Employers speaking at the conference cited their gains from integrating programs, although their results are also influenced by several efforts including implementing return-to-work programs.
“We compare ourselves to the hospital industry in terms of [employee restricted-duty days] and lost time,” said Jane Ryan, return to work recovery and claims services at Mayo Clinic. “Our lost time rates are actually lower than the national industry [average] and I think that speaks to the ability we have to keep people at work or return to work early.”
“There is not one silver bullet or only one way to integrate benefits delivery. Every company is so different.” — Karen English, partner, Spring Consulting Group
The paths that employers take to integration and the programs they integrate vary considerably depending on each company’s needs, speakers said.
“There is not one silver bullet or only one way” to integrate benefits delivery, English said. “Every company is so different.”
English will join DMEC’s CEO, Terri Rhodes, in a discussion on how to integrate workers’ comp, disability, and leave programs on Dec. 1, at the National Workers’ Compensation and Disability Conference® & Expo that will also take place in New Orleans.
At the DMEC conference held this week, meanwhile, other discussion topics focused on specific illnesses and corresponding wellness efforts for keeping employees healthy and productive.
Diabetes, for example, impacts employers’ profitability by driving medical costs that are 2.3 times greater than for people without the illness as well as by increasing employee absences and work disruptions.
“There is no question that diabetes affects the bottom line,” said Matthew Ceurvels, director of disability products at Sun Life Financial. “Productivity can be impacted by presenteeism, when an employee is working sub-optimally, by ad-hoc absences, and by long-term absences when employees go out on a disability claim.”
More employer disease management programs focus on diabetes than on other common illnesses like asthma or heart disease, Ceurvels said.
Diabetes care, for example, is a key component of a wellness program CNIC Health Solutions Inc. offers its workers, said Linda Benedict, human resources manager for the third party administrator of employee benefit plans.
CNIC Health Solutions’ employee wellness program’s overall offerings include a recreation center, free access to a CrossFit trainer, encouragement to engage in desk exercises, and online health assessments tied to biometric screenings that provide employees with private information about their individual risk factors.
As part of its health plan, the company also provides free monitoring and testing supplies for diabetes sufferers along with a third-party tracking service for the diabetes testing results.
“We also offer a discount on what the employee pays for their portion of health insurance premiums,” Benedict said. “That is one of the biggest components of our wellness program.”
The discount works as an incentive, providing employees with a 25 percent health care premium reduction, first for participating in the biometric screening, and then as they maintain a certain screening result level.
That led to a 23 percent improvement in employee health risk over one year, as measured by the biometric screenings.
The wellness efforts have improved employee engagement and morale, lowered workers’ comp losses and reduced absenteeism, she said.
“One key metric for us is that in the last year and a half, we have not had one FMLA leave,” Benedict said. “It has really limited FMLA leave for our employees because they are more engaged. They are taking care and looking at their metrics, and sharing them with their physicians. It is really starting to pay off.”
Grow Operations Coming to Terms With Risk
As the legal cannabis industry matures, its crop producers and retail shops are increasingly adopting risk management practices that include greater attention to worker safety.
The expanding size and sophistication of grow operations, greater scrutiny from regulatory agencies, crime, potential labor union involvement, and even workforce-retention concerns, are rapidly driving adoption of safety practices ignored when mom-and-pop size operations dominated.
“I see it happening very quickly,” said Justin S. Moriconi, an attorney at Segal McCambridge Singer & Mahoney who advises marijuana industry clients.
“I have seen a huge uptick in standard operating procedures to deal with issues, such as how much weight one [marijuana grow operation] worker can move at one time.”
The shift is driven in part by the industry’s rapid evolution, as more states allow recreational and medicinal marijuana production and sales.
In some East Coast states, for example, there are only a few legal grow operations, but they are very large, requiring millions of dollars in investment. It’s also a business model increasingly driven by players with multi-state operations.
While such operations don’t typically hire someone with a risk management title, like larger corporations might, they are paying greater attention to insurance purchasing and risk mitigation practices than the smaller operations that dominated the early years of legal cultivation limited to California, Moriconi said.
“When you are dealing with that level of money investment, certainly you are going to be much more attuned to risk management … and making sure everything is going as planned,” he said. “I am seeing a lot of that.”
On the West Coast, Moriconi is witnessing changes as he tours expanding cannabis operations.
A year ago, he toured a grow facility with the walls and floor painted white to boost light reflection that can improve plant yield and thus, the bottom line.
But the paint made for a slippery floor surface for workers tending plants.
“They had done that, not thinking about the production workers walking around this grow operation picking all the dead leaves off, watering the plants, and doing all the things that need to be done to cultivate this product and they were slipping occasionally,” Moriconi said.
During a more recent visit to the same facility Moiconi noticed a slip-resistant floor had been installed, although the slip resistant material remained white.
Jennifer Martin, a cultivation consultant at marijuanapropagation.com, said ergonomics are a key topic she speaks on before industry groups because at many commercial cultivation sites she sees plants on the ground. That forces workers to constantly bend down.
She advises raising the plants on stands to eliminate strained backs while increasing worker productivity.
“Even among younger workers I am seeing knee and back problems from them doing it that way,” Martin said. “So that is the first thing I say when I go in. Not only so the workers won’t be stressed, but so they can do a better job growing the plants because you can see them better when you are looking across [plants] instead of down at them.”
Other risks that grow operation workers face include exposure to chemicals and intense, hot lighting systems.
“Once the unions get involved in this you will have no shortage of claims.” — Justin S. Moriconi, attorney, Segal McCambridge Singer & Mahoney
One emerging workers’ comp risk involves the long hours workers spend hand-trimming leaf matter away from the valuable cannabis buds, several sources said. It is typically a manual job with a potential for repetitive-stress injuries and lacerations.
“I know we have had claims associated with that,” said Jim McMillen, director of safety services at Pinnacol Assurance, a Denver-based insurer of Colorado workers’ comp risks. “Probably the most severe claim we have had with that type operation was an amputation — a finger.”
Unions Stepping In
The spectrum of sophistication among operations means some growers remain primarily focused on the basic task of product production without considering worker safety.
But as more grow operations evolve from bachelor-pad like environments to sophisticated concerns, said Martin, she is seeing greater attention paid to ergonomics and worker comfort.
Risk-mitigation efforts she sees include helping workers with posture, enforcing rest breaks, and hiring masseuses to ease shoulder and wrist strains.
Greater scrutiny from OSHA, state agricultural agencies and state marijuana control boards are helping drive the improvements, Martin said. Like employers in other industries, cannabis operations also adopt safety measures to eliminate employee turnover and retain valuable workers, she added.
Labor union pressures could also drive worker safety improvements. Notably, the 33,000-member United Food and Commercial Workers International Union is recruiting medical marijuana workers under a “Cannabis Workers Rising” program.
Moriconi expects to see the union active in Eastern states, such as Pennsylvania, which are adopting medical marijuana laws and already have an extensive organized labor presence.
In smaller mom-and-pop operations, younger workers may have accepted cash or product as wages and are not likely to report an injury claim, Moriconi said. But that will change.
“Once the unions get involved in this you will have no shortage of claims,” Moriconi said. “They are not going to take product. You will be dealing with different checks and balances to make sure you have the safety and risk management built in.”
The recent murder of a security guard at a Colorado marijuana shop, meanwhile, added to criticisms that increasing retail outlet security measures often focus on protecting the cash-only businesses’ cannabis product and money rather than workers.
But overall, the risks faced by cannabis retail shops generally mirror those experienced at other retail stores with an elevated exposure profile, sources said.
McMillen at Pinnacol likened the risk level to other businesses interacting with the public and handling cash, like liquor stores or taxi cabs.
The approximately 200 marijuana retail dispensaries insured by California State Compensation Insurance Fund report injuries consistent with other businesses classified as retail operations, a SCIF spokeswoman said.
“It was primarily slips, trips and falls,” she said. “In terms of the injuries, it was strains and sprains.”
Bluegrass State Leads the Opioid Fight
Central Appalachia earned a distinction as the epicenter of the nation’s opioid-addiction epidemic for a number of reasons.
Two key factors are the complex injuries suffered by coal miners and the physical demands placed on workers toiling in other hazardous industries in that region such as logging and trucking.
Others include the region’s economic misfortunes, lax prescribing practices, access to pill mills, and pharmaceutical company marketing. All led to an ongoing drug-abuse scourge that surfaced there in the 1990s, studies and observers report.
“Central Appalachia, which for us is eastern Kentucky, was one of the first areas to see the opioid epidemic explode in the 1990s,” said former Bluegrass State attorney general Jack Conway.
“Because in Appalachia you had mining, you had a lot of heavy industry, trucking, and more workplace injuries on average than you would in other parts of the state. You saw an increase in the prescribing and utilization of opioids and it created an addiction epidemic.”
Now, as the rest of the nation experiences opioid abuse patterns seen early on across Central Appalachia, Kentucky provides examples for battling back against the epidemic.
In 2012, Kentucky became the first state among jurisdictions adopting stricter prescription-drug monitoring programs (PDMPs) with objective criteria mandating when prescribers must register and review a state database of patient prescription histories, Brandeis University’s PDMP Center of Excellence reports.
State PDMPs seek to change provider prescribing practices and prevent patients from doctor-shopping to obtain multiple prescriptions.
Kentucky’s latest PDMP was born from a 2012 comprehensive law adopted to combat opioid abuse.
“Kentucky has a great [PDMP] system,” said Tom Clark, research associate for the Brandeis Center of Excellence. “It is very well supported by the state. Of course, this is all a response to Kentucky being in the epicenter of the prescription drug abuse epidemic and it has been for a long time.”
While all states except Missouri have PDMP laws, participation in many states remains voluntary, said Brian Allen, VP of government affairs for Optum workers’ comp and auto no-fault. In the last three years or so, however, more jurisdictions are making their use mandatory.
“There has been a lot more renewed emphasis on [PDMPs] because everybody has been trying to get their heads around this opioid problem,” he said.
A May 2016 Center of Excellence report with data from Kentucky and the other states indicates that increased PDMP use immediately impacts controlled substance prescribing and doctor-shopping.
Reports linking Central Appalachia’s work injuries to drug abuse have persisted for years.
Yet only a few states have laws as strict as Kentucky’s, requiring all prescribers to register and check their PDMPs when initially prescribing opioids and benzodiazepines, and again every three months when continuing the prescriptions, the PDMP Center of Excellence reports.
Meanwhile, reports linking Central Appalachia’s work injuries to drug abuse have persisted for years.
A 2002 combined U.S. Justice Department and Kentucky State Police assessment described a growing threat from prescription painkillers. The threat was so specific to Appalachia that opioids and opiates became known disrespectfully as “hillbilly heroin.”
“In the eastern coal mining counties of Kentucky, the large-scale diversion and abuse of painkillers are particular problems,” the report warned.
“In the past, coal miners spent hours each day crouched in narrow mine shafts. Painkillers were dispensed by coal mine camp doctors in an attempt to keep the miners working.
“Self-medicating became a way of life for miners, and this practice often led to abuse and addiction among individuals who would have been disinclined to abuse traditional illicit drugs.”
Michelle Landers, VP and general counsel for Kentucky Employers Mutual Insurance, agreed that eastern Kentucky’s historical dependence on coal mines, and related service industries like trucking, helped link workplace injuries and chronic pain with opioid use.
KEMI, which issues policies to coal mines, is the Bluegrass State’s largest workers’ comp insurer.
Coal operations provide one of eastern Kentucky’s few employment opportunities. Mining also produces severe workplace injuries, caused by accidents such as accidents such as cave-ins or heavy machinery malfunctions, Landers said.
“It’s not an industry where you are going to have small injuries,” she elaborated.
“They are typically severe or the chronic type of injuries you expect from people being underground.”
Kentucky’s private-industry workers, in general, experience a high injury rate. U.S. Department of Labor statistics for 2014 ranked Kentucky among 19 states with a recordable injury rate significantly higher than the national average.
Centers for Disease Control and Prevention data for the same year, meanwhile, shows Kentucky among five states with the nation’s highest rate of overdose deaths.
KEMI first discovered a frequent use of the narcotic OxyContin to treat work injuries after contracting with a pharmacy benefit manager in 2001, Landers said. The PBM data revealed questionable practices, such as doctors prescribing high doses of the drugs early in the course of treatment for back strains.
“We were seeing things out there about the high levels of addiction and [overdose] deaths and we didn’t want to contribute to that,” Landers said.
A 2015 study prepared by the Institute of Pharmaceutical Outcomes and Policy at the University of Kentucky reported that since the law’s passage,prescriptions for controlled drugs decreased 4 percent to 8 percent during the same period.
So KEMI became an early adopter of measures like educating adjusters and nurse case managers about the dangers of opioids and teaching them to recognize red flags, such as doctors prescribing the drugs for longer periods than typically appropriate.
KEMI also used PBM data to identify frequently prescribing doctors.
“If you were treating with one of those [doctors] that might be a red flag,” Landers said.
KEMI’s concerted efforts included using its attorneys to engage in medical-fee disputes challenging claims before administrative judges when inappropriate prescribing occurred.
“We have, from early on, taken the approach that if we don’t feel it’s appropriate and we don’t get cooperation from the physician, we are going to challenge it,” Landers said.
Landers will speak at the 25th Annual National Workers’ Compensation and Disability Conference® & Expo on Dec. 1, during a presentation titled “Lessons Learned From Fighting Drug Abuse in the Opioid-Crisis Epicenter.”
The 2012 Kentucky law has limited prescription abuse. In addition to requiring prescribers to report to the state PDMP, it also regulated pain clinics.
A 2015 study prepared by the Institute of Pharmaceutical Outcomes and Policy at the University of Kentucky reported that since the law’s passage, prescribers registering with the PDMP increased by 262 percent, while annual prescriber queries into the PDMP rose 650 percent.
Prescriptions for controlled drugs decreased 4 percent to 8 percent during the same period.
Appalachia still has issues, but the situation is improving.
Yet there remain pockets of physicians in Appalachia who still overprescribe opioids, said Cindy Whitehouse, CEO and founder of Ascential Care, a Lexington, Ky.-based managed care company.
But she agrees the law has helped, and other states could benefit from similarly stringent measures.
“I think we have more tools in the states that have been battling this [opioid epidemic] for some time,” Whitehouse said. “That has made us stronger in the ability to control it.”