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

Accidents happen. No matter how much safety training and risk mitigation you do, no company is immune from the possibility of a worker becoming injured on the job. What you can control is how prepared your organization is to respond to a work-related incident, because when it happens, timing is everything.

 

Early intervention programs focus on the immediate and accurate assessment of an injury as soon as it happens. These programs ensure that workers get put on the best course of treatment from Day One all the way through their return to work. Taking action from the onset of an accident can help prevent injuries from becoming chronic and reduce the number of medical claims that become indemnity or litigated claims.

 

Early intervention programs are becoming widely recognized for their efficacy in improving outcomes for injured workers. Here are the top five reasons why you should consider implementing an early intervention program:

 

1.) Employees Are Our Biggest Assets. It’s important to take care of your employees. They are your competitive advantage, your intellectual capital and the engine that drives your business. Attracting and retaining talent typically comes at a high price and word quickly gets around if you don’t take care of your workforce from every angle. This includes when they are hurt, and especially when they’ve been hurt on the job.

 

2.) Right Place, Right Time. When an injury does occur, getting the injured person to the best possible clinician and facility as quickly as possible is imperative. Using certified nurse triage specialists immediately after an injury significantly increases the chances that your employee will be directed to the best facility possible for their injury. It also mitigates costs and reduces exposure. When shift supervisors and managers make medical care decisions for injured employees, the chances of a lawsuit go up.

 

3.) An apple a day keeps ill will away. From the inception of an injury, it’s important to engage the employee and let them know you are there for them. Whether you engage your own employees to do this, contract with a firm that specializes in early intervention or some combination of the two, it’s important for the injured employee to know that they’re not alone. Assisting them throughout the process, and communicating frequently, goes a long way in building good will.

 

4.) Encouragement from All. Encouragement should come from all parts of your organization. You want your employee to feel wanted and needed. Your injured employee needs to know their teammates are rooting for them and want them back. Find ways to encourage supervisors and others to reach out while a teammate is away from work during their recovery period. The more they feel needed, the harder they will work to come back and re-engage as part of the team.

 

5.) Guiding the Employee. Navigating the insurance and medical process simultaneously can be frightening for employees who have been injured on the job. Giving them a professional advocate who can explain processes and interpret medical speak can completely change an employee’s perception of their injury, their recovery. and their employer.

 

Early Intervention Programs should include:
• 24/7 Nurse Triage
• Empathetic Care Coordination and Concierge Services
• Integrated Dynamic Psychosocial Risk Profiling

 

Continuous monitoring of these programs and their return on investment are also just as important. ChronWell provides these services along with a full array of tools to help in the monitoring process.

 

Author: Matt Schreiber