Jacksonville, FL – With the aging of the workforce, comorbidities may become a complicating factor on most workers’ compensation claims. To help industry professionals understand comorbidities and the effects they have on program costs and outcomes, Eric Patten, RN, senior director of clinical services at One Call Care Management (One Call), delivered the presentation, “Managing Workers’ Compensation Claims with Comorbid Conditions,” at the SEAK National Workers’ Compensation and Occupational Medicine Conference in Hyannis, Mass.
“A comorbidity exists when at least one other medical condition or disease is present at the same time as a workers’ compensation injury,” said Patten. “According to a 2012 NCCI report, the number of claims with a comorbid condition nearly tripled over nine years, and on average, claims with a comorbidity experienced twice the medical costs of otherwise comparable claims.”
In his session, Eric outlined the comorbid conditions that are most dramatically affecting workers’ compensation claims, including obesity, diabetes, hypertension, mental illness, tobacco use and substance abuse. These conditions inhibit an injured worker’s ability to heal and recover in a timely manner. As a result, early identification gives employers, providers, injured workers and payers a more realistic expectation of recovery and return-to-work timeframes.
“It’s important to employ proactive strategies—such as onsite comorbidity screening or telephonic case management—to identify conditions early in the injury management process,” said Patten. “Programs then have a holistic view of the patient’s overall health status and can ensure a more comprehensive approach to care.”
As employees remain in the workforce longer, past the typical retirement age, programs will also see a rise in claims with multiple comorbidities, such as obesity and diabetes. This trend poses an increased risk of complications and higher claims costs. In 2016, Harbor Health Systems, a One Call company, performed a study on comorbidities and reported that claims with multiple comorbid conditions experienced adverse development when compared to a control group, including the following results:
- 76% increase in claims duration
- 341% increase in total incurred costs
- 285% increase in temporary total disability (TTD) days
- 147% increase in litigation rates
- 123% increase in surgery rates
Employers must determine what comorbidities are specifically affecting their claims so they can take action to reduce the incidence and impact of these conditions. According to a 2015 report by the Society for Human Resources Management, more than two-thirds of U.S. employers offer some type of wellness program, which has a positive impact on healthcare, workers’ compensation and absenteeism.
“There’s no one-size-fits-all design. Wellness initiatives should address the unique needs of a company’s workforce. Today, disease management programs targeting chronic conditions, such as diabetes, are particularly effective in delivering cost savings. In addition, financial incentives are helping to drive increased employee participation,” concluded Patten.
Source: One Call
One Call is a WorkCompWire ad partner.
This is not a paid placement.