Risk Insider: Carol Murphy

Compassion in the Age of Uncertainty

By: | November 20, 2015
Carol Murphy has more than two decades of risk experience and currently leads U.S. Casualty sales and the Loss Portfolio Transactions practice at Aon. She can be reached at [email protected]

It is the political season, so we hear many different plans for fixing the economy, creating jobs and other aspirations.

Here is one we can’t forget about.

While we host some of the leading health research and medical facilities in the world, the decline of our population’s health is one of our most pressing issues.

Recently, we were saddened to learn of research by Drs. Meara and Case, reported in the New York Times, demonstrating  an increase in mortality among middle-aged (45-54) white Americans. The trend was most severe among those with just a high school education.

Economic uncertainty is strongly correlated to the increase in mortality rates.

This is a reversal of decades of improvement in American mortality rates. Thankfully, that improvement continues for all other population groups and ages.

Workers in this age group, at the height of their careers, could be considered the backbone of our American economy.

As employers and experts in risk and health, we’ve learned about co-morbidities such as diabetes and heart disease and how they dramatically add complexity, length of treatment, and cost to worker injuries.

Yet, the cause of the increased mortality in this group, according to the research, is a dramatic increase in substance abuse, including prescription drugs and heroin, in addition to alcoholic liver disease and suicides.

The linkage between prescription drug dependence and workers’ compensation injuries and treatment is well known, but what about those other causes?

In this segment of 45-54 year old whites with no more than a high school education, significantly more pain was reported than in the past.  Fully a third of this group reported chronic joint pain over the 3 year period, and those with the least education reported the most pain and the worst health generally.

Other research has demonstrated that the US has fallen behind other wealthy nations in life expectancy, which brings us back to the economy.

Economic uncertainty is strongly correlated to the increase in mortality rates.  In fact, those individuals with the least education who reported the most pain and worst health also reported the greatest financial distress.

During this period of 2011 to 2013, household income for households headed by a high school graduate fell by 22 percent, when adjusted for inflation.  The explanation for the increase in mortality attributable to suicide and substance abuse is a combination of pain with mental distress!

What can we take from this to help us be more compassionate employers?  The most influence organizations can have on employee well being is through the work culture and environment.

Well being and engagement drive business results. Wellness is a combination of physical and emotional health, financial well being, and positive social connection.

Where once wellness initiatives were limited to the corporate offices, we’ve found that employers have expanded initiatives throughout their operations.  All around us, wellness programs and opportunities are being expanded to financial well being and employers have long encouraged positive social interactions at work.

Wellness is a critical and urgent imperative for our times, improving health while saving employers on costly worker injuries and health care and improving productivity and results.  This will go a long way toward making the overall economy healthier.

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Worker Well-Being

Contractors Grapple With Employee Suicide Risk

The construction industry is increasingly incorporating suicide prevention measures within health and safety programs.
By: | November 4, 2015 • 5 min read
Close-up of a construction worker touching his head and removing his hardhat

Though it may come as a surprise to some, the construction industry is among the top nine occupations with the highest risk for suicide, according to the Bureau of Labor Statistics.


“The construction industry tends employ a lot of what we call “double jeopardy men” — men with a number of suicide risk factors who are also the least likely to see help on their own,” said Sally Spencer-Thomas, co-founder and chief executive of the Carson J Spencer Foundation in Denver.

The foundation, in partnership with Denver construction firm RK Mechanical Inc. and the National Action Alliance for Suicide Prevention, in September jointly released a suicide prevention guide, “A Construction Industry Blueprint: Suicide Prevention in the Workplace.”

“Employers are learning to make suicide prevention a priority within their health and safety initiatives,” Spencer-Thomas said. “In shifting from reaction to prevention, company leaders become far more proactive in providing skill-based training, linking distressed employees to helpful resources, are creating a culture of care.”

“It’s the quiet ones you have to worry about slipping through the cracks.” — Cal Beyer, director of risk management, Lakeside Industries Inc.

According to the guide, construction workers are also at higher risk for suicide because they have access to and familiarity with lethal means like firearms, pills and high places, and are often less afraid and more capable of self-inflicted harm by these means.

The construction workplace also tends to have 
a culture of recklessness, bravery and/or stoicism, in which people are rewarded for being tough and thus, are often less likely to reach out and ask for help.

Construction workers also have increased exposure to physical strain or psychological trauma; a culture of substance abuse; exposure to isolation if they work on temporary out-of-town projects; and increased exposure to humiliation if they fail on their job, among other risks.

The guide recommends that construction firms should instill a culture that promotes the importance of safety; emphasizes teamwork; increases employee engagement and connectedness; values mental health; provides access to insurance and mental health care, such as those through employee assistance programs; provides informational support systems, such as buddy systems; and provides leadership and supervisor training.

“It’s the quiet ones you have to worry about slipping through the cracks,” said Cal Beyer, director of risk management at Lakeside Industries Inc. in Issaquah, Wash. “At our firm, we’ve adopted a safety 24/7 culture, teaching safety at home, work and play. Safety is a core value for us, and mental health and suicide prevention 24/7 is just as important.”

The topic of suicide used to be taboo in the industry, Beyer said.

“We used to talk about mental health awareness, but construction managers and field supervisors said that was too amorphous of a term,” he said. “They feel they can’t do anything about mental health awareness, but if we call it suicide prevention, then they ask what can they do to help.”

With the aid of the Denver foundation in conjunction with the National Action Alliance for Suicide Prevention, Beyer has been leading a grassroots campaign among “enlightened” contractors to create awareness, advocacy and action for mental health and suicide prevention.

He has started a LinkedIn group along with colleagues in the Construction Financial Management Association, and they are now starting to schedule construction industry outreach presentations for 2016 via seminars, workshops and webinars.

For example, the Associated General Contractors of Washington will sponsor a presentation in February, and the AGC of Oregon has scheduled a presentation for June.

Understanding Red Flags

A number of construction executives explained how they are incorporating suicide prevention measures within their health and safety programs.


“First, acknowledge and embrace the fact that your work culture has the power to make a difference in the lives of your employees,” said Heather Gallien, RK’s director of marketing and communications.

“Accept that it’s an honor to take on the responsibility of looking out for the mental health and well-being of your workers. Decide to be a leader in affecting change in an industry that’s at high risk for suicide.”

Second, contractors should adopt guidelines, such as those from the foundation, and then take time with management to gain an understanding of work culture “red flags” and create an action plan to mitigate them, Gallien said.

“Furthermore, ask your management teams to start talking about mental health issues openly and transparently,” she said. “Ask them to make it okay for employees to do the same.”

There are tactical conversations and tools a company can adopt, but the most important factor is that those at the top talk about their own issues — when appropriate, added RK’s chief operations officer Jon Kinning. Managers should also model for their employees, especially men, that work is a safe environment to bring up personal concerns and to ask for help.

David James, chief financial officer at FNF Construction Inc. in Tempe, Az., said that, while the firm has an employee assistance program, the key is to make employees aware of services available and eliminate the stigma so often associated with mental health issues.

The EAP is a good starting point, but additional direction from management is critical to provide employee education and hands on support to at-risk employees.

“We used to talk about mental health awareness, but construction managers and field supervisors said that was too amorphous of a term. …  but if we call it suicide prevention, then they ask what can they do to help.” — Cal Beyer, director of risk management, Lakeside Industries Inc.

“One such group ‘at risk’ are those employees suffering through recovery from workers’ compensation injuries,” James said.

“FNF has had a long-standing philosophy to manage workers’ compensation cases with hands-on management, including regular communication, activities to support recovery and return-to-work programs. The caring attitude for such cases, and efforts to keep employees within the FNF family helps reduce the vulnerability of our workforce.”


Patrick Monea, vice president and chief financial officer at Granger Construction Co. in Lansing, Mich. said that suicide prevention is not an issue that his firm is currently focused on, but given the industry statistics, management now feels it is an issue “we have to strongly address.”

“Given the inherent stress of our industry and the associated culture, we feel the need to move toward education and prevention,” Monea said.

Granger’s human resources manager Matt Bozung added: “We must talk about mental health and suicide prevention openly and not ignore them as real issues. Further, recognition that specified training beyond basics, like stress management, is needed.”

Katie Kuehner-Hebert is a freelance writer based in California. She has more than two decades of journalism experience and expertise in financial writing. She can be reached at [email protected]
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Sponsored Content by CorVel

Telehealth: The Wait is Over

Telehealth delivers access to the work comp industry.
By: | November 2, 2015 • 5 min read


From Early Intervention To Immediate Intervention

Reducing medical lag times and initiating early intervention are some of the cornerstones to a successful claims management program. A key element in refining those metrics is improving access to appropriate care.

Telehealth is the use of electronic communications to facilitate interaction between a patient and a physician. With today’s technology and mass presence of mobile devices, injured workers can be connected to providers instantaneously via virtual visits. Early intervention offers time and cost saving benefits, and emerging technology presents the capability for immediate intervention.

Telehealth creates an opportunity to reduce overall claim duration by putting an injured worker in touch with a doctor including a prescription or referral to physical therapy when needed. On demand, secure and cost efficient, telehealth offers significant benefits to both payors and patients.

The Doctor Will See You Now

Major healthcare players like Aetna and Blue Cross Blue Shield are adding telehealth as part of their program standards. This comes as no surprise as multiple studies have found a correlation between improved outcomes and patients taking responsibility for their treatment with communications outside of the doctor’s office. CorVel has launched the new technology within the workers’ compensation industry as part of their service offering.

“Telehealth is an exciting enhancement for the Workers’ Compensation industry and our program. By piloting this new technology with CorVel, we hope to impact our program by streamlining communication and facilitating injured worker care more efficiently,” said one of CorVel’s clients.

SponsoredContent_Corvel“We expect to add convenience for the injured worker while significantly reducing lag times from the injury to initiating treatment. The goal is to continue to merge the ecosystems of providers, injured workers and payors.”

— David Lupinsky, Vice President, Medical Review Services, CorVel Corporation

As with all new solutions, there are some questions about telehealth. Regarding privacy concerns, telehealth is held to the same standards of HIPAA and all similar rules and regulations regarding health information technology and patients’ personal information. Telehealth offers secure, one on one interactions between the doctor and the injured worker, maintaining patient confidentiality.

The integrity of the patient-physician relationship often fuels debates against technology in healthcare. Conversely, telehealth may facilitate the undivided attention patients seek. In office physicians’ actual facetime with patients is continually decreasing, citing an average of eight minutes per patient, according to a 2013 New York Times article. Telehealth may offer an alternative.

Virtual visits last about 10 to 15 minutes, offering more one on one time with physicians than a standard visit. Patients also can physically participate in the physician examination. When consulting with a telehealth physician, the patient can enter their vital signs like heart rate, blood pressure, and temperature and follow physical cues from the doctor to help determine the diagnosis. This gives patients an active role in their treatment.

Additionally, a 2010 BioMed Central Health Services Research Report is helping to dispel any questions regarding telehealth quality of care, stating “91% of health outcomes were as good or better via telehealth.”

Care: On Demand

By leveraging technology, claims professionals can enhance an already proactive claims model. Mobile phones and tablets provide access anywhere an injured worker may be and break previous barriers set by after hours injuries, incidents occurring in rural areas, or being out of a familiar place (i.e. employees in the transportation industry).

With telehealth, CorVel eliminates travel and wait times. The injured worker meets virtually with an in-network physician via his or her computer, smart phone or tablet device.

As most injuries reported in workers’ compensation are musculoskeletal injuries – soft tissue injuries that may not need escalation – the industry can benefit from telehealth since many times the initial physician visit ends with either a pharmacy or physical therapy script.

In CorVel’s model, because all communication is conducted electronically, the physician receives the patient’s information transmitted from the triage nurse via email and/or electronic data feeds. This saves time and eliminates the patient having to sit in a crowded waiting room trying to fill out a form with information they may not know.

Through electronic correspondence, the physician will also be alerted that the injured worker is a workers’ compensation patient with the goal of returning to work, helping to dictate treatment just as it would for an in office doctor.

In the scope of workers’ compensation, active participation in telehealth examinations, accompanied by convenience, is beneficial for payors. As the physician understands return to work goals, they can ensure follow up care like physical therapy is channeled within the network and can also help determine modified duty and other means to assist the patient to return to work quickly.


Convenience Costs Less

Today, convenience can often be synonymous with costly. While it may be believed that an on demand, physician’s visit would cost more than seeing your regular physician; perceptions can be deceiving. One of the goals of telehealth is to provide quality care with convenience and a fair cost.

Telehealth virtual visits cost on average 30% less than brick and mortar doctor’s office visits, according to California state fee schedule. In addition, “health plans and employers see telehealth as a significant cost savings since as many as 10% of virtual visits replace emergency room visits which cost hundreds, if not thousands, of dollars for relatively minor complaints” according to a study by American Well.

“Telehealth is an exciting enhancement for the Workers’ Compensation industry and our program. By piloting this new technology with CorVel, we hope to impact our program by streamlining communication and facilitating injured worker care more efficiently,” said one of CorVel’s clients.

Benefits For All

Substantial evidence supports that better outcomes are produced the sooner an injured worker seeks care. Layered into CorVel’s proactive claims and medical management model, telehealth can upgrade early intervention to immediate intervention and is crucial for program success.

“We expect to add convenience for the injured worker while significantly reducing lag times from the injury to initiating treatment,” said David Lupinsky, Vice President, Medical Review Services.

“The goal is to continue to merge the ecosystems of providers, injured workers and payors.”

With a people first philosophy and an emphasis on immediacy, CorVel’s telehealth services reduce lag time and connect patients to convenient, quality care. It’s a win-win.

This article was produced by CorVel Corporation and not the Risk & Insurance® editorial team.

CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.
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