Christian says it is possible to identify and help injured workers destined to become high-risk, high-cost cases to achieve better outcomes for their workers and their companies. Understanding that people go beyond their physical injuries is critical.
"We tend to treat the incoming stream of newly injured workers as if they are all vanilla when, in fact, they are already strawberry, chocolate and vanilla," Christian says. "Some are destined [to become high risk] unless we do something different."
That is what Christian will discuss during her session, New Ideas for Your Worst Claims: Addressing Hidden Issues That Cause Poor Outcomes.
Ten to 20 percent of cases account for 80 to 90 percent of costs in the workers' comp system, Christian explains. Most are what she calls creeping catastrophes.
These cases start out looking like common health problems. But recovery stalls, the case goes downhill, the person becomes an unemployable invalid and often qualifies for Social Security Disability Income.
Providers, she explains, believe such cases are not their responsibility because, other than the physical injury, it is not a medical issue. Employers, believing it is a medical issue, feel it is not incumbent on them to deal with such cases. The result is needless impairment, work disability, job loss, and worklessness.
"Worklessness should be considered a poor outcome and a sign that programs and/or services are inadequate," she says. "A multidimensional, person-centric, prevention-oriented, function-focused, evidence-based, and outcomes-focused approach is the best way to acknowledge, explore, and attempt to resolve obstacles to health and recovery in any aspect of human life."
Functional impairment and work disability often are preventable. Illness and disease, she says, can co-exist.
"A person's functional status after a health problem occurs is often best explained by factors in non-medical domains," Christian says. "Thus, the problem has shown up in the medical domain, but the solution lies elsewhere."
Viewing the whole person.
To prevent injured workers from becoming high-risk claims, practitioners must be able to identify them and take steps to intervene. It comes down to using the biopsychosocial model. "It's more than just a catch phrase," Christian says.
"A bio-psycho-socio-economic model of human illness, disease, and disability is the most accurate way to explain the variability in impact of health conditions on life. It takes into account the entire context in which the person lives and the health problem is occurring -- the dynamics in biological, psychological, social and economic domains. Another name might be the 'whole life' model."
There are some 10 to 15 percent of the population who, when faced with a trauma such as a work injury, are more prone to deteriorate than others. "Research shows the causes of poor functional outcomes often/primarily lie in personal, social, situational and psychological domains -- how human beings tick, rather than the medical domain," Christian says.
While poor outcomes often stem from issues experienced in childhood, interventions in adulthood can be effective. Talking to those identified as potentially high-risk claimants and being willing to listen is a start.
"Stop thinking more or better medical care is the answer," Christian says. "Provide resources so they can educate, develop and heal themselves."
Self healing is an effective way for high-risk injured workers to return to productivity, Christian says.
Appropriate communication is one of the first steps in mitigating high-risk claims. All stakeholders can affect the outcomes of such cases.
"For many problem issues, physician advice has been shown to affect outcome," Christian says. "For people with serious medical problems, these things may be even more important."
The words and body language medical providers, claims managers, and employers use when speaking with high-risk patients can make a tremendous difference in the outcome. Christian will offer detailed explanations and examples of the "right" and "wrong" ways to communicate with injured workers.
One tip she suggests, for example, is to develop and provide standardized information packets about the workers' comp system to injured workers. Most are confused about the complexities of the system.
"So rather than educating the injured worker by phone, why not send them an educational document," she says. "Then call them."
The session takes place Nov. 21 from 1:30-2:45 p.m.
The 22nd annual National Workers' Compensation and Disability ConferenceŽ
& Expo takes place Nov. 20-22 at the Mandalay Bay Resort and Casino in Las Vegas. The conference is produced by LRP Publications.
By Nancy Grover
Read more at the WorkersComp Forum homepage.
November 4, 2013
Copyright 2013© LRP Publications