3 Essential Components of a Worker Advocacy Program

There have been numerous studies that show how psychosocial factors contribute to disability duration. The data is consistent for all medical conditions, whether from a work injury or not. Break-out sessions, initiatives, RFIs and white papers carrying the word “advocacy” have had a consistent presence in the workers’ comp industry. Despite the buzz, organizations small and large struggle to find an economically sustainable model for delivering it, especially one that fits into all logistical and financial aspects of a traditionally claims-driven process.

 

Should adjuster teams be infused with claimant-centric groups for additional outreach? Is extending the standard nurse case management concept into an early intervention program the way to go? Must a trained nurse evaluate every single claim? Would triage, beginning with a patient interview, be the right approach? Does it actually take human interaction to evaluate psychosocial risk, or can AI perform the majority of it?

 

And when it comes down to it, would an advocacy initiative provide a consistent return on investment, or would it result in more psych ICD-10 codes on bills? A managed organization needs to balance optimal recovery outcomes, while controlling costs on the long run. There is a natural hesitance to touch anything psych related, since treatment for such a diagnosis can be costly. However, the costs of an underlying psycho-social condition shows itself in the non-psych costs of the medical claims.

 

The emotional appeal of doing what is right for the injured worker is always strong. Many industries have undergone transformation by reorganizing SOPs around the experience of the consumer, rather than the convenience of the corporation. For the most part, shifting to a consumer-centric approach has had a positive impact on bottom lines.

 

There’s an old adage that the most expensive words in business are: “But we’ve always done it this way!” That’s never been truer than it is today. And with better technology, new ideas for the practical application of advocacy continue to emerge.

 

At ChronWell, we take a proactive approach to advocacy, and lay out the following blueprint:

  1. A trained professional is required to ask the open-ended questions we all respond to when vulnerable. Motivational interviewing certification is a valuable training tool to this end.
  2. Technology is essential. It must be used to integrate an advocacy program seamlessly into the claims process and it should be used to gather and score psycho-social risk factors across claims.
  3. Advocacy programs should be designed to be nimble to meet the specific needs of each organization. Programs should fit the workflow and culture for employers, insurers and claims administrators.

 

As part of our presence in NWCDC this year, we are hosting a session with Trilogy Enterprises out of California called, “Leveraging Technology to Connect Pre- and Post-Loss Strategies. In it, ChronWell’s Chief Medical Advisor, David Deitz, M.D., and Trilogy CEO, Santiago Martin, will share anecdotal and factual results from our California Farm Management advocacy program that was rolled out across a 5,000-person workforce.

 

If you’re attending #NWCDC2019, be sure to visit our booth (#1109) and check out our session on Nov. 6. Click here for details.

 

To learn more about our advocacy programs, read our California Farm Management Case Study here.

 

Additional Resources

  1. The Social Determinants of Health.  http://lulab.be.washington.edu/omeka/exhibits/show/lake2bay–public-health/social-determinants
  2. Marini, I., Glover-Graf, N. M., & Millington, M. J. (2012). Psychosocial aspects of disability: Insider perspectives and counseling strategies. New York, NY, US: Springer Publishing Co.
  3. The impact of psychosocial factors on adapting to physical disability: a review of the research literature. Swanson BCronin-Stubbs DSheldon JA.. https://www.ncbi.nlm.nih.gov/pubmed/2522668
  4. https://www.ncbi.nlm.nih.gov/pubmed/147009
  5. https://www.archives-pmr.org/article/S0003-9993(10)00798-7/pdf

Author: Nev Terzieva

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