By Tammy Bradly, VP Clinical Product Development, Coventry
At first it can seem like nothing. Maybe it’s a faint rattle or an occasional squeak under the hood. Yet savvy drivers know small anomalies can indicate larger trouble. It’s better to make repairs to a vehicle early on before the problem worsens. It’s much the same with injured workers. But too often we fail to do the preventative work that would increase the chance of a successful return-to-work outcome.
One area where we often fall short is with vocational case management (VOC) services. It’s time to reconsider how we think of “VOC.” Rather than a last-ditch effort made late in the process of helping injured workers, we should use VOC as an early intervention tool that can keep larger problems from developing.
For a long time, VOC has been seen as the end of the road. It’s been relegated to something we try only when the notion of a worker returning to the job appears to be fantasy. It’s akin to waiting until there is smoke pouring from the engine of a car before seeing a mechanic. In workers’ comp, how reasonable is it to expect success if we don’t turn to VOC until the very end? It’s easy to blame the case manager who is tasked with a monumental undertaking. But is that fair? What might we instead do to improve outcomes?
Vocational services deployed at the right time can be a powerful way to help injured workers. Ultimately, these efforts can and should align with our most modern return-to-work programs. Done right, VOC helps keep workers engaged, trusting, and focused. The research is clear on how important this is to getting someone back on the job as quickly as possible.
VOC hasn’t always been an 11th-hour intervention. Vocational rehabilitation was often defined as a state or federal program that helped people with physical or mental disabilities people get or keep a job. Part of the decline in use of vocational services in recent years came as states dropped their mandate for VOC services.
Taking a fresh look at VOC can be beneficial. As early as possible, case managers need to determine the feasibility of returning the employee to their regular job. This is a simple yet critical process. As a best practice, this should involve crafting a job analysis for the treating provider that outlines the essential functions of the worker’s role and the associated physical demands of these functions.
While the job analysis can be a relatively straightforward exercise, getting buy-in for its recommendations can be difficult. Perhaps a treating physician predicts the injured worker wouldn’t return to his or her regular job even after reaching medical stability. Or maybe an employer has said “no” in the past to the prospect of job modifications or other accommodations. This is when it’s time to dig in and work with treating providers and employers. Never assume that the employer won’t reverse course, for example. Case managers can work with the employer to alter the regular job or identify another job the worker would be able to perform based on their transferrable skills and anticipated physical capabilities upon reaching medical stability.
Even before that, there are important milestones that can help an injured worker plan for and envision an eventual return to work. Case managers can ask an employer whether they are willing to collaborate on a plan to create a transitional duty return-to-work opportunity for the employee while they recover. Never assume the employer will say no. Be prepared to help the employer find creative ways to construct transitional opportunities. As a best practice, transitional duty should be incremental and temporary. The physical demands of the work should grow alongside the employee’s condition and ability. Research indicates limiting transitional duty to between 60 and 120 days is ideal; 90 days is most common.
Of course, the challenges of helping someone re-enter the workplace aren’t limited to what he can do physically. Often the injured worker will be facing psycho-social barriers that need to be identified and broken down. From the employer, there could be negative feelings about the injured worker. It’s the job of the case manager to identify these issues that go beyond physical and medical ailments. The case manager should coach both the injured worker and the employer to overcome these challenges.
It’s impossible to separate recovery from return-to-work. Studies indicate that an employee who returns to work during his recovery generates lower overall medical costs. And, of course, a faster return to work translates to lower indemnity payments.
Yet getting an injured employee back to the workplace isn’t just good for the employer and isn’t just about saving money. The positive impact on workers of all kinds is enormous. An ongoing study (PDF) of injured veterans, by the Department of Veteran Affairs, reports that those who achieve rehabilitation have “substantially better” outcomes relating to employment and their standard of living than those veterans who stopped using support services. While the needs of veterans can differ from those of injured workers in the civilian labor force, the common thread is the need to help those who are injured re-engage with their work.
The mandate is clear: When case management focuses solely on treating a medical condition and leaves return-to-work prospects to chance, the likelihood of the employee getting back on the job goes down. It’s not sufficient to hope that the injured worker and the employer will on their own hammer out a successful plan for return to work.
Forging a successful return-to-work partnership requires expertise beyond medical management. A case manager must understand this process includes creating a thorough job analysis, identifying transitional duties and making permanent job accommodations that could include collaborating with the employer and worker to identify a new job. Naturally, a case manager should have a basic understanding of behavioral coaching. Granted, that might not be every case manager’s strength compared with, say, medical management. But it’s important to call on a resource that possesses the necessary expertise when it’s needed — and not wait until there is a smoking engine. For those who might not be comfortable with return-to-work planning, joining with someone who is trained in rehabilitation counseling can help usher in the needed cooperation with the employer and the injured employee to promote a faster return to work. In that scenario, the split role means the cost wouldn’t be greater than having a single case manager handle all of the return-to-work aspects.
The sooner case managers react to an indicator that something with a recovery is amiss, the better the chances for a successful intervention. Guiding an injured worker back to the job is a complex process that requires a unique set of skills. The most successful return-to-work efforts are those that begin early and are woven within the case-management plan. This is a collaborative process that involves several critical stakeholders. Of course, even the most polished plan won’t deliver success if the injured worker isn’t an active participant.
It’s time to stop thinking of VOC as the end of the road. It’s time to think of it as an early intervention productivity solution— the preventive maintenance of return-to-work.
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.