High ROI on Publicly Funded Stay at Work Programs
Publicly funded stay-at-work/return-to-work programs could help employers that may face reduced productivity from injured workers returning before they are at 100 percent of functionality, suggests a new report.
State and/or federally funded SAW/RTW programs could also save the governments themselves unnecessary expenses for injured workers who are laid off or cannot return to their jobs. While the authors focus on employees not covered by workers’ comp programs, the case can also be made for covered workers who do not receive the help they should.
“Despite the clear benefits to workers and taxpayers, no federal agency is in charge of preventing job loss after injury or illness.”
“Millions of hard-working Americans leave the labor force every year, at least temporarily, because of injury or illness. Without steady earnings, these workers and their families often end up in public programs such as Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid. The resulting costs to state and federal governments are steep,” the report begins.
“But the public sector could help to reduce those costs by adopting strategies to help people stay at or return to work, rather than fall through the cracks of a fragmented system.”
The brief, The Case for Public Investment in Stay-at-Work/Return-to-Work Programs, was developed for the SAW/RTW Policy Collaborative, housed in the Department of Labor’s Office of Disability Employment Policy. The document is part of the collaborative’s efforts to promote positive SAW/RTW programs.
“Despite the clear benefits to workers and taxpayers, no federal agency is in charge of preventing job loss after injury or illness. And state workforce and vocational rehabilitation agencies have not traditionally focused on workers who are at risk of losing their jobs because of injury or illness,” the brief states.
“State-regulated workers’ compensation systems provide cash and medical benefits to workers who experience work-related injury or illness. But they do not help the millions of employees whose medical conditions are not work related, and they often fail to help even those who are covered.”
The authors looked at the costs and benefits of an early intervention SAW/RTW program at the state level. They compared the costs to state and federal governments, the injured worker, and employers for a worker returning after an injury in a state with a hypothetical SAW/RTW program to one with no such program.
“Under our baseline assumptions, the state government would save about $83,000 in net benefits for each worker who is retained rather than replaced, following the onset of long-term disability,” the report says. “About $71,000 (or 85 percent) of the net benefits to the state would come from higher tax revenues under the SAW/RTW scenario than under the no-SAW/RTW scenario. The rest would predominantly be a result of avoiding the costs of Medicaid and unemployment compensation.”
Such a program would save the federal government even more — an estimated $292,000 in net benefits until the worker’s retirement. Much of those costs would result from avoiding public assistance expenses with the rest from higher tax revenues. The injured worker under the scenario would gain about $422,000 in net benefits from keeping his job and the associated compensation.
“The state government would save about $83,000 in net benefits for each worker who is retained rather than replaced, following the onset of long-term disability.”
Retaining an injured worker would admittedly be an expense for the employer. While the costs of recruiting, hiring, and training a new employee would be eliminated, the anticipated loss of productivity for an injured worker at less than full capacity equates to an estimated $185,000 — mainly from the assumed 16.3 percent reduction in productivity. However, those costs could be lowered.
“States may need to make larger investments, including subsidizing the wages of those with greatly reduced productivity, to sharply increase the number of workers who stay in the labor force,” the report says. “But states may not be willing to make these investments unless the federal government or workers (possibly via a payroll tax) help pay for them.”
States already have a variety of ways in which to help foster SAW/RTW efforts. “The workers’ comp system can make regulatory, process or service changes to improve the SAW/RTW services for workers with job related conditions,” according to the collaborative. “Some states have reemployment subsidies until the workers return to 100 percent functional capacity.”
State governments can include aggressive SAW/RTW strategies in their Workforce Innovation and Opportunity Act plan. The act, implemented last summer, requires states to strategically align their workforce development programs.
Workforce agencies can help employees and employers identify and access SAW/RTW services, support development of, and state agency cooperation with, employment resource networks that facilitate SAW/RTW support, and leverage capabilities developed under the state’s Disability Employment Initiative.
Several states have tools in their short-term disability programs that allow wage subsidies or partial benefits for RTW. And state personnel agencies can help state workers by improving their access to evidence-based SAW/RTW services and improving incentives for workers and their managers to use SAW/RTW services effectively.
Washington State’s Model
A unique program in Washington State pays employers to help injured workers stay on the job. Stay at Work “is a financial incentive that encourages employers to bring their injured workers quickly and safely back to light duty or transitional work by reimbursing them for some of their costs,” the Washington State Department of Labor and Industries website states.
Employers may be reimbursed for 50 percent of the base wages paid to injured workers, as well as some of the costs of training, tools, or clothing the worker needs to undertake the transitional or light-duty work.
The program “has increased return to work and reduced workers’ compensation costs,” according to the SAW/RTW Policy Collaborative.
Bringing Workers’ Comp Management Into the 21st Century
A worker at a facility in Kansas is injured on the job. His company was recently acquired by a larger organization that has completely different policies and procedures for handling workplace accidents.
Add to that the fact that he’s in a rural area where few medical providers are available — especially any who understand the nuances of the workers’ comp system and its emphasis on returning injured employees to work.
Now imagine his supervisor goes onto a computer and immediately has access to all the information he needs in a way that adheres to the procedures of the new parent company. Add to that the ability for whatever physician is involved to look on his smartphone and immediately see the exact tasks the injured worker’s job entails, plus a proposed temporary light-duty solution, ultimately saving time and money for the organization.
Such a solution is being widely used in Canada and is making its way into the U.S.
“What this system does is it gives employers the best chance of turning indemnity claims into medical-only claims through the rapid use of data immediately and with more urgency,” said Richard Pimentel, veteran and well-known disability rights activist and associate with Milt Wright & Associates.
“It is a solution that “not only expedites your return-to-work process, it improves it by bringing together HR, safety, claims, the medical community, absence management, and occupational/nonoccupational RTW efforts into a seamless package.”
Pimentel, who has been espousing and consulting on effective disability and RTW solutions for several decades, has become one of its most vocal supporters. He’s hoping companies in the U.S. will soon embrace the system through his partnership with WorkSTEPS.
Based in Austin, Texas, WorkSTEPS provides functional employment testing throughout the U.S. With the goal of matching a worker’s functional capabilities with the needs of the job, its services include post-offer preemployment testing along with post-employment testing, which includes fit-for-duty testing, functional capacity evaluations, and sincerity of effort testing.
XILO, as the system is known in Canada, is called WorkSTEPS Enterprise Solution in the U.S. It was the brainchild of Grenville Lock, CEO and president of Canadian-based EARA Technologies. The former entrepreneur came from a software background and saw a need among his customers.
“Working within an organization here he was bombarded with questions as far as ‘how do we help sharing our data when it comes to health and safety,’” said Monica Kyveris, vice president of sales and customer relations for EARA. “He started to think about what it is that was lacking. A lot of organizations have this information, but nobody had thought about bringing it all together.”
“What this system does is it gives employers the best chance of turning indemnity claims into medical-only claims through the rapid use of data immediately and with more urgency,” — Richard Pimentel, Milt Wright & Associates
He started with a return-to-work system that included job demand analyses. The company’s research and development team looked at other areas of health and safety that required the same information and expanded the program. As Kyveris said, they saw a need.
“There was a lot of software out there that addressed specific areas in health and safety, but nobody really brought it all together,” she said. “Our app does everything. It crosses all silos.”
Described as a “one stop shop health safety information management system,” it allows users to store, search, retrieve, update, integrate, and share information with the click of a mouse from any computer, anytime, anywhere in the world. The company rolled out the finished product in 2005; however, it did not take off immediately.
“People were like ‘why do we need a health management system,’” Kyveris said. “We had to educate the Canadian market. You get early adopters, and then it takes off.”
With so many company acquisitions occurring in the U.S., organizations are increasingly finding it difficult to integrate their various legacy systems and ensure consistency, especially when there are multiple facilities located in different jurisdictions. Advocates see the system as a game changer here.
“As near as I can tell, there are systems [here] for data but they tend to be compartmentalized,” Pimentel said. “This is the only system I’ve seen where you can have job descriptions, policies and procedures, and reminders. It’s the only system I know of that integrates it all.”
As he explained it, the system allows for a supervisor to quickly identify and locate all jobs that meet the needs of an injured worker. For example, it can pinpoint jobs that require just eight pounds of lifting.
“The sense of it to me is that effective RTW needs to be done with a controlled urgency. So anytime you’re waiting for data, you’re losing money,” Pimentel said. “My theory is I don’t even want to wait for a physician to give someone a limited duty release. I want to hit the physician with a proposal to bring someone back to work, based on the limitations they see.”
Pimentel took his enthusiasm for the system to WorkSTEPS in the hopes the company could incorporate it into its existing framework. For the last three decades, WorkSTEPS has provided evaluations and assessments for new hires to determine whether a worker can safely perform the essential functions of a particular job. Additionally, the company provides an in-depth analysis of the worker’s physical capabilities at the moment the person begins the job.
“If there are preexisting conditions you haven’t identified, you own it,” said Pete Gallaher, president and managing director of WorkSTEPS. “Once there is an incident you can tell the physician what their condition was when they started and an exact picture of what that person does on the job, so the physician can make decisions based on real information.”
The company addresses privacy concerns by ensuring only specific people at a company can access certain information. “It’s shared access by all stakeholders depending on their level in the [company] hierarchy,” said Cindy Gallaher, WorkSTEPS’ vice president of business development.
“It’s information that’s so critical in goal setting for treatment of these injured workers. So you’re getting them back to work safely and as soon as possible, which we all know is critical in keeping them in the workforce.”
Advocacy: The Impact of Continuous Triage
In the world of workers’ compensation, timing is everything. Many studies have shown that the earlier a workplace incident or injury is acted upon, the more successful the results*. However, there is further evidence indicating there is even more of an impact seen when a claim is not only filed promptly, but also effective triage is conducted and management of the claim takes place consistently through closure.
Typically, every program incorporates a form of early intervention. But then what? While it is common knowledge that early claims reporting and medical treatment are the most critical parts of a claim, if left alone after management, an injured worker could – and often does – fall through the cracks.
All Claims Paths are Not Created Equal
Even with early intervention and the best intentions of the adjuster, things can still go wrong. What if we could follow one injury down two paths, resulting in two entirely different outcomes? This case study illustrates the difference between two claims management processes – one of proactive, continuous claims triage and one of inactivity after initial intervention – and the impact, or lack thereof, it can have on the outcome of a claim. By addressing all indicators, effective triage can drastically change the trajectory of a claim.
While working at a factory, David, a 40-year-old employee, experienced sudden shoulder pain while lifting a heavy box. He reported the incident to his supervisor, who contacted their 24/7 triage call center to report the incident. After speaking with a triage nurse, the nurse recommended he go to an occupational medicine clinic for further evaluation, based on his self-reported symptoms of significant swelling, a lack of range of motion and a pain level described as greater than “8.”
The physician diagnosed David with a shoulder sprain and prescribed two weeks of rest, ice and prescription strength ibuprofen. He restricted David from any lifting over his head.
By all accounts, early intervention was working. Utilizing 24/7 nurse triage, there was no lag time between the incident and care. David received timely medical attention and had a treatment plan in place within one day.
A critical factor in any program is a return to work date, yet David was not given a return to work date from the physician at the occupational medicine clinic; therefore, no date was entered in the system.
One small, crucial detail needs just as much attention as when an incident is initially reported. What happens the third week of a claim is just as important as what happens on the day the injury occurs. Involvement with a claim must take place through claim closure and not just at initial triage.
The Same Old Story
After three weeks of physical therapy, no further medical interventions and a lack of communication from his adjuster, David returned to his physician complaining of continued pain. The physician encouraged him to continue physical therapy to improve his mobility and added an opioid prescription to help with his pain.
At home, with no return to work in sight, David became depressed and continued to experience pain in his shoulder. He scheduled an appointment with the physician months later, stating physical therapy was not helping. Since David’s pain had not subsided, the physician ordered an MRI, which came back negative, and wrote David a prescription for medication to manage his depression. The physician referred him to an orthopedic specialist and wrote him a new prescription for additional opioids to address his pain…
Costly medical interventions continued to accrue for the employer and the surmounting risk of the claim continued to go unmanaged. His claim was much more severe than anyone knew.
What if his injury had been managed?
A Model Example
Using a claims system that incorporated a predictive modeling rules engine, the adjuster was immediately prompted to retrieve a return to work date from the physician. Therefore, David’s file was flagged and submitted for a further level of nurse triage intervention and validation. A nurse contacted the physician and verified that there was no return to work date listed on the medical file because the physician’s initial assessment restricted David to no lifting.
As a result of these triage validations, further interventions were needed and a telephonic case manager was assigned to help coordinate care and pursue a proactive return to work plan. Working with the physical therapist and treating physician resulted in a change in David’s medication and a modified physical therapy regimen.
After a few weeks, David reported an improvement in his mobility and his pain level was a “3,” thus prompting the case manager’s request for a re-evaluation. After his assessment, the physician lifted the restriction, allowing David to lift 10 pounds overhead. With this revision, David was able to return to work at modified duty right away. Within six weeks he returned to full duty.
With access to all of the David’s data and a rules engine to keep adjusters on top of the claim, the medical interventions that were needed for his recovery were validated, therefore effectively managing his recovery by continuing to triage his claim. By coordinating care plans with the physician and the physical therapist, and involving a case manager early on, the active management of David’s claim enabled him to remain engaged in his recovery. There was no lapse in communication, treatment or activity.
After 24/7 nurse triage is conducted and an injured worker receives initial care, CorVel’s claims system, CareMC, conducts continuous triage of all data points collected at claim inception and throughout the life of a claim utilizing its integrated rules engine. Predictive indicators send alerts to prompt the adjuster to take action when needed until the claim is closed – not just at the beginning of the claim.
This predictive modeling tool flags potentially complex claims with the risk for high exposure, marking claims that need intervention so that CorVel can assign appropriate resources to mitigate risk.
Claims triage is constant – that is the necessary model. Even on an adjuster’s best day, humans aren’t perfect. A rules engine helps flag things that people can miss. A combination of predictive systems and human intervention ensures claims management is never stagnant – that there is no lapse in communication, activity or treatment. With an advocacy team in the form of an adjuster empowered by a powerful rules engine and a case manager looking out for the best care, injured employees remain engaged in their recovery. By perpetuating patient advocacy, continuous triage reduces claim severity and improves claim outcomes, returning injured workers to the workforce and reducing payors’ risk.