By Tammy Bradly, VP Clinical Product Development, Coventry
It’s often said a picture paints a thousand words. But does it tell you everything you need to know about a person? Some might argue that it depends upon the artist. After all, each person is unique. As case managers, we need to see the whole person to render a true and complete picture. This is an art at which some are better than others. Yet it’s also a skill that can be honed using the right tools. We must understand that not one thing — but many things — drive a person down a particular path.
Predictive analytics have come a long way in helping us to identify claims that need clinical intervention. Many companies now use analytics to predict or tease out risk. Early on, we started by looking at basic demographic information such as body part, time with employer, age, perhaps distance to work, etc. From there the list has grown. The smarter our science, the more we can know about a person. However, we also now realize that even more robust analytics can’t paint a complete picture of the injured employee or how she will recover or whether she will return to work.
In 2014, WCRI released a study that reflected interviews with more than 3,000 injured employees across eight states. The researchers found that key drivers of whether a person had returned to work included:
- English-language proficiency
- Fear of being fired
These findings confirmed what we have long known: Many variables influence and affect recovery and return-to-work following an injury. So we must go beyond even the drivers outlined above. To truly understand what influences a person we must understand their schema.
The psychological definition of schema according Psychology Dictionary is:
[The] mental model of aspects of the world or of the self that is structured in such a way as to facilitate the processes of cognition and perception. General, basic knowledge regarding a concept or entity which serves to guide perception, interpretation, imagination, and problem solving skills. Mindset involving self, other individuals, or the world which persists in spite of objective reality. Also known as: cognitive schema…
That’s a lot to take in so let’s break it down. Whether conscious or unconscious:
- We are influenced by family, friends, attorneys, the media, the environment, our relationship with our employer or the adjuster, etc. AND…
- These influences lead to perceptions (sometimes positive, sometimes negative) that might or might not be rooted in truth or reality but are very real to the person experiencing them.
This idea supports the WCRI findings that trust is a predictor of worker outcomes. Whether real or perceived, if the injured worker doesn’t have trust that the employer will do the right thing or if the employee has a fear or being fired, this can result in a “schema” that becomes a barrier to recovery and return- to-work.
So how do we assist an injured employee in overcoming these schemas or barriers to recovery? We need good case managers who are skilled in:
- Motivational interviewing to uncover the barriers
- Using behavioral coaching and education to assist the injured employee in moving forward for any barriers that are identified
- Working hand-in-hand with the injured employee, employer, provider and having a day-one goal of setting expectations for returning to work
I was recently in a meeting in which attention turned to employer visits and job analysis or the lack thereof. Much of the discussion focused on the fact that the case manager was solely tasked with “managing medical” while not being allowed contact with the employer and not having a job analysis available for the provider. That scenario raises the question of whether we should separate recovery (medical treatment) from return-to-work. When a person has recovered fully he tends to return-to-work. When an employee returns to working during the recovery (i.e., transitional duty) his medical costs tend to be less than those who do not.
According to the Labor Department, return-to-work programs can do more than simply reduce workers’ comp costs. They can boost productivity and overall morale in the workplace. These programs also can protect against the loss of talented workers. The agency says effective return-to-work strategies include:
- Working part-time
- Modifying work duties
- Modifying schedules
- Implementing reasonable accommodations
The Labor Department notes these steps can help workers return to the job even before their recovery is complete. This is important, in part, because employees can maintain their earnings and employers can save money. More broadly, it’s also important because getting back into work can facilitate a worker’s recovery.
At an average rate of approximately $22 per hour, the cost of an employer visit will pay for itself if we can reduce time away from work by two to three days. Further, doesn’t it become a guessing game when the provider needs to comment on the injured employee’s ability to return to work in some capacity?
Research from the National Council on Compensation Insurance indicates that an employee with one or more comorbid conditions has work-related medical costs twice that of a healthy employee with the same primary diagnosis. Conditions such as high blood pressure, diabetes and even obesity may prevent treatment from occurring or may complicate recovery. Medications taken for non-work-related medical conditions may be contraindicated with medications prescribed for the work-related diagnosis. These findings show us why case managers must take a holistic view. Case managers can use their coaching skills to educate the employee not only on the primary diagnosis but also on how overall health and wellness might affect recovery. It is imperative that we engage the injured employee in taking ownership of their recovery. Behavioral coaching and other cognitive techniques can improve employee engagement.
How do we enable our case managers to see the big picture and be the artist who captures the intrinsic and extrinsic variables that influence recovery and return to work?
Tools of engagement certainly help. When case managers have access to medical and pharmacy utilization data as well as ODG risk-scoring, we can not only identify the right claims for clinical intervention but also have a clear view into the areas that most need our focus. Access to data is critical yet oftentimes a payor uses multiple vendors for various services. This can lead to situations in which pieces of the medical/pharmacy puzzle aren’t visible to the case manager. The aggregation of information is critical to not only improving outcomes but proving we are improving outcomes year over year.
Delivery of health education, decision aids and tracking tools to drive injured employee engagement support the behavioral model. Case managers should have access to consistent and accurate health information to educate the injured employee on his diagnosis, treatment plans, potential alternatives and consequences so that informed decisions can be made. The interaction goes beyond just providing information; it’s about making sure that the education provided is understood and applied appropriately. There is no “one and done” between the case manager and the injured employee. It requires regular follow-up to provide encouragement and continued coaching. It also requires active listening to keep the injured employee moving forward toward recovery.
According to Gallup, lack of employee engagement costs U.S. companies $440 billion to $550 billion each year in lost productivity and performance. Research also shows, however, that if companies don’t work to engage employees properly, their efforts can backfire. Gallup also found only one-third of U.S. employees are engaged. That means being involved in, enthusiastic about and committed to their work and workplace.
So many of the clinical interactions case managers have today are task-oriented. This can allow for little to no education and coaching. Oftentimes, even claims assigned for full case management are so restrictive, they leave no time for the things that matter and move the needle. These include motivational interviewing, education, coaching, coordination of care, and return-to-work opportunities. Covering physician appointments but limiting contact with an injured employee might save a few claim dollars but isn’t that shortsighted? Case managers need time to establish trust. This is the foundation of behavioral coaching, employee engagement and improved clinical outcomes. Careful case selection with risk-modeling, combined with the expertise of a case manager skilled in establishing trust, negotiation, motivational interviewing and in the use of health education and coaching tools can deliver improved claim outcomes.
About Tammy Bradly
Tammy Bradly is vice president of clinical product development for Coventry. 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).
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.
Coventry is a WorkCompWire ad partner.
This is not a paid placement.