By Tammy Bradly, VP Clinical Product Development, Coventry Workers’ Comp Services
Humans can be complex beings with a number of health-related issues that can affect recovery from a work-related injury or illness. When one is injured on the job, the response too often calls to mind the six blind men who examined the elephant in the Indian folktale. One is sure the creature is like a rope. Another says it feels like a wall. Yet another is certain that it is a tree trunk, and so on. Each man defined the elephant based on the limits of his experience.
Achieving better outcomes in workers’ compensation claims requires the ability to see the whole picture (or the elephant). To do so takes trusting your managed care partner to see that the injured worker is more than just a workers compensation claimant. He or she is a whole person—who is more than just a diagnosis or an injury.
More going on than meets the eye.
A sprained ankle or lower back strain may seem fairly straightforward, but statistically speaking, it’s likely that more is going on than meets the eye. Nearly half of all American adults have chronic conditions such as heart disease, high blood pressure, diabetes, obesity or arthritis; many have two or more chronic health conditions.1 As a rule, we are not getting healthier. The rates of chronic disease are climbing.
We’re seeing similar trends in workers’ compensation. According to an NCCI study, between 2000 and 2009, the share of workers’ compensation claims with a comorbid diagnosis nearly tripled, from 2.4 percent to 6.6 percent.2 These claims usually received more medical services, and their medical costs were about twice as high as those for claims that were otherwise comparable. Most workers’ comp claims are medical only, but when a comorbid diagnosis is involved, the claim is more likely to involve lost time.
Why do comorbid conditions have such an impact on medical costs and lost time? Comorbid conditions make management more complicated. For example, carrying extra weight can make it more difficult for an injured knee to heal. If a worker who is taking blood thinners for a cardiovascular condition needs surgery for an injury, the provider must weigh the risk of stopping the medication against the risk of bleeding during surgery.
Drug interactions may be a problem, too. Workers’ comp injuries are often treated with muscle relaxants or narcotic pain medications, but providers need to be cautious about prescribing these if a patient is already taking sleeping pills, antihistamines, anticonvulsants for depression or other pain medication. Another problem is the potential for the medications used to treat the work-related injury to worsen existing conditions, particularly in older workers. Non-steroidal anti-inflammatories (NSAIDS) used for pain can stress the kidneys and can cause fluid retention. Acetominophen may not be the best choice for an individual with poor liver function. In some cases, dosages can be reduced. In others, doctors will prescribe narcotic pain medications as an alternative.
Narcotics come with their own set of problems, including the fact that they can cause sedation, which increases the risk of a fall for a worker who already has problems with balance or agility. For those who already have a history of substance abuse or even those who do not, long term narcotic dependence can be a concern. In the NCCI study cited above, the number of claims with comorbid drug abuse diagnoses, including alcohol and tobacco, quadrupled.
Engaging the whole person drives better outcomes
The issues are as complex as each injured worker’s case, and for many the answers won’t be easy. One thing is for sure: Focusing solely on the injury in cases with comorbidities is not likely to lead to the best clinical, medical or return to work outcomes. It is vitally important to look at the individual holistically.
With the right background and training, the case manager may be in the best position to engage the whole person in order to promote more successful outcomes. In order to be effective, the nurse must first establish trust – trust with the injured worker, the physician and the adjuster. When it comes to the injured worker it’s important for the case manager to ask relevant questions to identify what existing medical conditions the injured worker has that might impact recovery and return-to-work, and determine what treatments—including medications—the individual is receiving. She should be able to educate the injured worker about the potential impact of the comorbidity and stress the importance of documenting all medications to avoid potential problems due to contraindications or drug interactions. She should also encourage the injured worker to talk with the doctor about treatment options and make informed decisions in partnership with the provider.
The case manager must have advanced skills and expertise in looking beyond the diagnosis, evaluating the whole person to identify barriers to recovery and return-to-work. This requires training in cognitive behavioral coaching which is not something a nurse obtains in basic nursing courses or traditional case management training. If the case manager employs active listening and cognitive behavior coaching techniques, she can further support desirable outcomes by identifying and addressing psychological/social/emotional barriers to recovery that might arise when an individual is dealing with an acute injury as well as chronic illness. A case manager who has this type of training and access to online health coaching tools will be prepared to educate and engage the injured worker in their recovery and return to work. The case manager should leverage employer sponsored health and wellness programs (for weight loss, smoking cessation, healthier eating) that can be used to improve overall health as a way to support faster recovery from the work-related injury.
Ideally, every case manager associated with your program should have the same high level of education, extensive experience and advanced training. When the case management partner has strict hiring requirements, a structured training framework that leverages tools to educate the injured worker about their injury and comorbidities and a case management culture that focuses on engaging the whole person, you can be confident about achieving consistently better outcomes.
About Tammy Bradly
Tammy Bradly is vice president of clinical product development for Coventry Workers’ Comp Services. Bradly is a certified case manager with more than 25 years of comprehensive industry experience through service delivery, operations management and product development. She holds several national certifications, including certified case manager (CCM), certified rehabilitation counselor (CRC) and certified program disability manager (CPDM).
About Coventry Workers’ Comp Services
Coventry offers workers’ compensation cost and care management solutions for employers, insurance carriers and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 30 years of industry experience, knowledge and data analytics. The company offers an integrated suite of solutions, powered by technology to enhance network development, clinical integration and operational efficiencies at the client desktop, with a focus on total claims cost.
1Centers for Disease Control and Prevention. Chronic Diseases and Health Promotion. http://www.cdc.gov/chronicdisease/overview/index.htm. Accessed March 20, 2015.
2National Council on Compensation Insurance. NCCI Research Brief: Comorbidities in Workers Compensation. October 2012.
Coventry WCS is a WorkCompWire Ad Partner.
This is not a paid placement.