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Studies from the National Council on Compensation Insurance and Coventry Workers' Comp Services show specific impacts of obesity on workplace injuries. In addition to wellness and prevention efforts, companies that identify and address obesity claims early might better protect their workers and save on the bottom line.

"Our data suggests it's fairly clear if a person is obese, especially morbidly obese, that has significant adverse implications for the outcome of a claim," said Harry Shuford, chief economist of NCCI. "It is much more likely to be expensive to treat, require a significant period to heal, and is much more likely to involve some sort of permanent problem."

Coventry's research was based on a review of medical billing data for nearly 2 million claims. The authors looked at comorbidities -- chronic diseases/conditions that were not part of the workers' comp injury but had the potential to influence and possibly complicate its treatment -- including obesity.

Increased costs. Both studies point to higher workers' comp costs for obese injured workers compared to their normal-weight counterparts. Part of that may stem from treatments not necessarily related to the primary diagnosis.

"It's fairly well understood that obesity tends to be associated with a range of medical issues, such as hypertension, high cholesterol, and diabetes. But there are a range of other things, including cardiovascular problems, joint problems, arthritis and so on," Shuford said. "One consequence when dealing with an injured worker is that you have to address the other medical problems that might be complicating the healing of the specific workers' comp injury."

The main cost drivers, according to NCCI's research, were physical therapy, complex surgery, and drugs and supplies.

"In the specific claims we looked at where both claims required surgery, the surgery for obese claimants was more expensive in part because the anesthesiologist had to do more things for problems related to anesthesia," Shuford said.

In addition to the costs of medical treatments is the duration of claims. The studies indicated recovery takes longer for obese injured workers.

"There's a lack of physical activity," said Dr. Melissa Bean, medical director of Coventry Workers' Comp Services. "Often times obesity results in delayed recovery because of physical inactivity, which leads to decreased function and deconditioning."

Getting exact costs for workers' comp claims involving obesity is tricky, though, because it is vastly underreported.

Mitigating the costs. Armed with the knowledge that obese workers' comp claims tend to cost more than those of other workers, insurers and employers can identify and address these claims early in the process.

"Knowing the condition is present can assist in efforts to set reserves, coordinate treatment, and engage the right resources to holistically manage the claim," according to the Coventry report. "An early intervention nurse triage service is a solution many payors have chosen to help mitigate the impact that comorbidity related factors can have on a claim."

Such triage services provide round-the-clock access to nurses who assess workplace injuries.

"At the onset of a claim, early predictors of complex or high dollar claims, such as comorbidities, may be discovered by the nurse during the standard triage process. These may serve as the catalyst for working with the claims adjuster or employer to coordinate other services such as focused case management programs designed to appropriately manage such complex claims," the report said.

"Part of the case manager's role is to help get the employee fully engaged in the treatment plan," said Mindy Hightower, director of telephonic case management operations for Coventry. "If they're invested in their treatment plan, they will be more likely and more successful in return to work."

Hightower says it's imperative for medical providers to take into account a claimant's total health profile. Case managers can assist.

"They'll ask the provider some questions that the worker forgets to ask or is reluctant to ask," she said. "It's basically being that support lifeline, so that an injured worker doesn't feel like they're in this alone."

An integrated offering can also help mitigate the costs of these claims. "They could include outcomes-based networks, including providers that have proven to demonstrate positive medical and disability outcomes; and pharmacy management services to help manage drug utilization and prevent medication abuse," Bean said. "The combination of outcomes-based networks, nurse triage, telephonic case management, and pharmacy management programs can really be of assistance in properly managing these complex cases."

Read more at the WorkersComp Forum homepage.

January 13, 2011

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