Column: Workers' Comp

The Engagement Factor

By: | August 31, 2015 • 3 min read
Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Employers face a crisis with recent studies showing that worker disengagement has reached 70 percent.

Fortunately, I’m an engaged worker, according to a predictive tool that helps employers learn more about job recruits and existing employees by measuring their “sense of good judgment” in more than 70 areas.

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I learned of the predictive tool called the Judgment Index while reporting on integrated disability management. Renee Mattaliano, VP and practice lead of workforce management at HUB International, told me how employers can apply the index to learn whether a certain job will engage a specific job recruit.

The more engaged a worker, the less likely they are to be injured. The more engaged, the sooner they will return to the job should they suffer an injury.

That’s valuable insight for an employer.

Predictive information about how people will behave is being applied across more areas. A non-traditional loan company, for example, now uses a judgment tool to lend money to recent college grads lacking credit histories.

That tool evaluates grade point averages, SAT scores and colleges attended, among other data. It then determines the value credit applicants will place on their obligation to repay debt.

“Who you are is going to drive what you do.” — Roger D. Wall, chief marketing officer, The Judgment Index

Such technology is opening up a world where employers and others will know much more about us, including what we value.

“Who you are is going to drive what you do,” said Roger D. Wall, chief marketing officer for the Judgment Index.

Interest in how worker engagement might be measured and its influence on disability management led me to accept an offer to learn firsthand how the Judgment Index works. That involved having to prioritize several, sometimes odd-seeming, statements according to how much I agreed with them.

From the lengthy results report, I learned that managing difficult people is not one of my strengths. No surprise there.

But I am very strong on absorbing information, processing it and solving problems. I’m an engaged employee, according to the index results, because I value work and have a high degree of reliability. I also am process- or task-oriented.

The outcome also showed I rank strongly for self-care by paying attention to my physical, mental and emotional health. Obviously, the index didn’t ask how many needless calories I nervously consume at my desk while writing.

Still, information about my attitude toward my overall health could prove valuable to an employer customizing a wellness program or building a return-to-work strategy for my specific needs.

It can provide a lot of information about how you might behave under certain circumstances, as well as advice when improvement or caution may be necessary.

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For example, the Judgment Index showed I am “moderately idealistic.” I might be good at helping team members see new possibilities for improving things, but I must make sure my ideas are backed by convincing evidence so people with a strong realist bent don’t write me off as naive.

No wonder I’m engaged by my work. The job allows the moderately idealistic in me to write about how the workplace might be made better.

Now, what to do about the 70 percent who don’t value their work as much as I?

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DMEC Conference

Demographics, Regulations Pose Challenge for Absence Management

Attendees of the 2015 DMEC Annual Conference reviewed both obstacles and progress in absence management.
By: | August 11, 2015 • 4 min read
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2015 DMEC panel discussion on Amazon’s leave policy. Photo courtesy of DMEC.

Discussions at last week’s meeting of the Disability Management Employer Coalition in San Francisco focused on the impact of shifting workforce demographics amid current challenges and potential innovative solutions to disability management.

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With people continuing to work later in life, four different generations now make up the American workforce, and each has different priorities when it comes to employer benefits and how they are delivered.

This, combined with changes in the regulatory and health care landscape, presents unique challenges for employers and absence management providers. Below are some of the major themes discussed at the annual conference:

Regulatory Challenges

The pace of regulatory change remains a constant hurdle for employers. Absences in accordance with the Family and Medical Leave Act, in particular, have left employers vulnerable to compliance risk.

Prior to June’s Supreme Court decision to legalize same-sex marriage nationwide, employers had to cope with a definition of “spouse” that fluctuated among the growing number of states that had legalized gay marriage.

Initially, couples that lived in states where same-sex marriages were recognized were viewed as spouses under FMLA. Now, there are no location restrictions on the definition of “spouse.”

That is just one example of how quickly regulations can change, challenging employers to keep their policies up-to-date and ensure there is no infringement of employees’ rights.

Employers also consistently struggle with FMLA compliance by miscategorizing leave under regular sick time, or by punishing employees for FMLA-protected absence by discontinuing health insurance coverage or failing to restore him or her to their former position when the leave ends. Some simply fail to educate employees about their rights under the FMLA.

Federal investigations are also intensifying, with the Department of Labor increasingly requesting information on leave use and conducting more on-site visits, according to Jeff Nowak, a partner at Franczek Radelet, PC, and author of the blog “FMLA Insights.”

Companies can strengthen FMLA compliance and reduce their exposure by conducting more self-audits of their policies and implementing internal protocols to make sure requests for leave are properly designated.

While the Department of Labor is working on an FMLA guide for employers, companies can strengthen compliance and reduce their exposure by conducting more self-audits of their FMLA policies and implementing internal protocols to make sure requests for leave are properly designated.

One upcoming regulatory changes to watch is an update to the Genetic Information Non-Discrimination Act and Section 501 of the Rehabilitation Act.

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New legislation is also pending concerning accommodations for pregnant workers, following clashes between the Equal Employment Opportunity Commission and several companies over the treatment of pregnancy and related conditions as disabilities.

Managing Chronic Conditions

Addressing chronic conditions was a topic touched upon in several sessions. Studies from Liberty Mutual’s Research Institute for Safety show that chronic conditions affect 40 percent of the U.S. workforce.

An aging workforce and high rates of obesity and diabetes will only make chronic conditions more prevalent.

Chronic conditions pose problems because few surefire methods have emerged to manage them. Pre-placement exams can’t predict how a condition will develop over time, and the provision of wellness programs and behavioral therapy has shown no real impact in decreasing absence related to chronic conditions.

Sutter Health was able to cut lost days down by 8,632 in one year using a system that integrated leave management and return-to-work accommodations. The estimated savings impact was $2.75 million.

Training supervisors to facilitate return-to-work and oversee ergonomics improvements was one method that did make a material difference in decreasing lost time days due to chronic issues.

Research from Liberty Mutual showed that a supervisor training program resulted in a 27 percent decrease in lost time.

Providing on-site peer support to arrange care and accommodations for minor complaints also led to a 25 percent decrease in lost time.

Several speakers advocated seeking out methods of care that would address a worker’s injury or condition within the scope of their work environment.

Overall, hastening employees’ return-to-work by focusing more on “whole person care” emerged as a big shift for employers.

Zoning in on a specific injury without considering a worker as a whole ignores the unique interactions between the worker’s personal and occupational health risks, and his or her relationship with the workplace in general.

PG&E presented results from a new health plan built around the concept of treating the whole person, and found that focusing on preventive and primary care over specialty care reduced the number of ER visits and lost work days — saving about $1,918 in medical costs per employee in 2014.

Integrated Disability and Absence Management

While integrating disability and absence management, health and safety initiatives, and return-to-work programs remains a hot topic, most experts concede that widespread integration of those programs remains far off.

The complexity of the different pieces — FMLA, the Americans with Disabilities Act and workers’ comp — make coordination difficult.

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Those who succeed at streamlining these resources, though, stand to significantly reduce absences and reap savings.

Sutter Health, a nonprofit health system in Northern California, for example, was able to cut lost days down by 8,632 in one year using a system that integrated leave management and return-to-work accommodations. Over the course of that year, the savings impact was estimated at $2.75 million.

Future DMEC conferences will surely feature more employer success stories and pave the way for best practices for marshaling the data, resources and executive support to create integrated programs.

Katie Siegel is a staff writer at Risk & Insurance®. She can be reached at [email protected]
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Sponsored: Healthcare Solutions

Specialty Drugs Show No Signs of Slowing Down

The emergence of specialty drugs in the workers' comp market comes with a new set of complexities and a hefty price tag.
By: | August 31, 2015 • 4 min read
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A decade ago, high-cost specialty drugs were commonly referred to as “injectable drugs” and were used to treat conditions not typically covered in workers’ compensation, such as cancer, rheumatoid arthritis and multiple sclerosis.

“Today, however, new specialty drugs are emerging that will be used to treat other chronic and inflammatory conditions,” said Joe Boures, president and CEO of Healthcare Solutions, an Optum company providing specialized pharmacy benefit management services to the workers’ compensation market.

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Joe Boures, President and CEO, Healthcare Solutions

“Payers in the workers’ comp market are just beginning to feel the cost impact of greater utilization of these drugs, which come with expensive price tags.”

Specialty drugs are often manufactured using biologic rather than chemical methods, and they are no longer just administered by injections. New specialty drugs can also be inhaled or taken orally, likely contributing to the rise in their utilization.

“There isn’t a standard definition of specialty drugs, but they are generally defined as being complex to manufacture, costly, require specialty handling and distribution, and they difficult for patients to take without ongoing clinical support or may require administration by a health care provider,” said Boures.

In 2014, more than a quarter of all new therapies that the FDA approved were through its biologics division. Biologics, and similar therapies, are representative of a future trend in prescription drug spend.

“As the fastest growing costs in health care today, specialty drugs have the potential to change the way prescription benefits are provided in the future,” said Jim Andrews, executive vice president of pharmacy for Healthcare Solutions.

Workers’ Compensation payers may not recognize how specialty drugs are affecting their drug spend.

Specialty drugs like Enbrel®, Humira® and Synvisc® can be processed in conjunction with other medical procedures and, therefore, not recognized by payers as a pharmacy expense.

This leaves payers with little visibility into the costs of these medications within their book of business and a lack of tools to control these costs.

Due to the high costs of specialty medications, special due diligence should be utilized when claimants receive these medications, up to and including utilization review, said Andrews.

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Jim Andrews, Executive Vice President of Pharmacy, Healthcare Solutions

“Healthcare Solutions recommends that claimants using specialty drugs are monitored for proper medication handling and that the medication is administered appropriately, as well as monitoring the claimant to determine whether the medication is having its desired results and if there are any side effects,” he said.

“At $1,000 per pill for some of these specialty medications, making sure a claimant can tolerate the side effects becomes vital to making sure the claimant achieves the desired outcomes.”

Hepatitis C drugs have made their way to the workers’ compensation market, largely through coverage of healthcare workers, who have exposure to the disease.

“Traditional drug treatments that began in the 1990’s had a success rate of 6% and costs ranging from $1,800 to over $88,000,” said Andrews.

“The new Hepatitis C specialty medications have a treatment success rate of 94-100%, but cost between $90,000 and $226,000.”

Although the new treatments include higher drug costs, the payer’s overall medical costs may actually decrease if the Hep C patient would have required a liver transplant as part of the course of treatment without the drugs.

While the release of new Hepatitis C medications in 2014 demonstrated the potential impact specialty medications can have on workers’ compensation payers, there are some specialty medications under development that target more common conditions in workers’ compensation.

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Pfizer Inc. and Eli Lilly and Company are currently developing tanezumab, a new, non-narcotic medication to treat chronic pain, which is common in workers’ compensation claims.

Tanezumab has demonstrated benefits of reducing pain in clinical trials and may provide non-addictive pain relief to claimants in the future.  This may change how pain management is treated in the future.

Healthcare Solutions has a specialty medication program that provides payers discounted rates and management oversight of claimants receiving specialty medications.

Through the paper bill process, Healthcare Solutions aids payers in identifying specialty drugs and works with adjusters and physicians to move claimants into the specialty network.

A central feature of the program is that claimants are assigned to a clinical pharmacist or a registered nurse with specialty pharmacy training for consistent care with one-on-one consultations and ongoing case management.

The program provides patients with education and counseling, guidance on symptoms related to their medical conditions and drug side effects, proactive intervention for medication non-adherence, and prospective refill reminder and follow-up calls.

“The goal is to improve patient outcomes and reduce total costs of care,” said Boures.

This article was produced by Healthcare Solutions and not the Risk & Insurance® editorial team.



Healthcare Solutions serves as a health services company delivering integrated solutions to the property and casualty markets, specializing in workers’ compensation and auto liability/PIP.
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