By Tammy Bradly, VP Clinical Product Development Coventry
Many of us are used to unlocking our phones using a scan of our face or a fingerprint. This not only makes the phones easier to use, it’s intended to make them more secure by granting access based on someone’s unique features rather than a passcode. In recent years we’ve been seeing a similar shift in treatment of injured workers: the individual characteristics make all the difference.
Last week, we looked at how in workers’ compensation we’ve witnessed increased use of terms including advocacy, engagement, coaching, and “whole-person approach.” Terms such as these point to a need to consider each injured worker as having needs as unique as a face or a fingerprint. No two are alike. Similarly, no two injured workers will require the exact same interventions to hasten recovery and return-to-work.
Here we’ll examine some of the driving factors that fall under what we call social determinants of health. As we discussed last week, these forces can have a tremendous effect on outcomes. We’re seeing evidence of that already with disparities in how different groups respond to COVID-19, the disease caused by the novel coronavirus.
Social determinants play an outsize role because, in many ways, they represent the rest of our story – the part that’s not always found in a medical record. It’s whether we have steady employment or what our home life is like or whether we can obtain healthy food.
Here are some of the major factors:
Given that nearly eight in 10 U.S. workers live paycheck to paycheck, a reduction in earnings can disrupt recoveries by causing stress over finances.
- Economic stability
More often than not, an injured worker’s income is reduced while off work. Given that nearly eight in 10 U.S. workers live paycheck to paycheck, a reduction in earnings can disrupt recoveries by causing stress over finances. A 2017 survey from the job website CareerBuilder revealed several startling statistics related to debt, budgeting, and making ends meet. Among the major findings:
- More than half of minimum-wage workers say they have to work more than one job to pay their bills.
- More than a quarter — 28 percent — of workers making $50,000–$99,999 usually or always live paycheck to paycheck and seven in 10 are in debt.
- Nearly one in 10 workers making $100,000 or more lives paycheck to paycheck.
- More than one in four workers does not put aside savings each month.
- Nearly three in four workers say they are in debt — and more than half think they always will be.
- Physical environment
It is important to assess housing, transportation, and safety needs of injured workers. Do
they have transportation to their medical appointments? Do they live in a clean and safe environment that promotes healing or is there risk of infection or re-injury?
In order to connect with injured workers, we need to understand their literacy level and ensure our communication and education about their condition is easily comprehensible.
- Access to Healthy Food
Having access to healthy food options is an important part of promoting strong recovery.
Unhealthy eating can lead to weight gain and myriad chronic conditions such as high blood pressure, diabetes, and heart disease. Beyond that, unhealthy food options might also lead to malnutrition on the other end of the spectrum. Both scenarios can lead to complications and prolonged recoveries.
- Community and Social Context
The role that other people play in promoting injured workers’ recoveries can be overlooked.
Do the injured workers have support systems? Can they care for themselves? Will they need outside support during their recovery to assist with activities of daily living? Are they socially isolated because their only means of socialization was work?
- Health Care
Do injured workers have access to quality medical treatment? Are they compliant with the recommended treatment plans? Is return-to-work incorporated into the treatment plan?
As case managers, we are always looking to help the people we serve achieve the best possible outcomes. We usually define such outcomes as return to function or return-to-work — and more broadly, return to pre-injury lives. We are in a unique position to listen to our patients and ask the right questions. Active listening has long been a core component of good case management though it is a skill that requires training and reinforcement.
Case managers can benefit from focused training on how to deploy active listening and other cognitive behavioral techniques when interacting with injured workers. These skills can help case managers dig beneath the surface to better understand what unseen issues might be presenting obstacles to recovery and return- to- work.
Employing active listening and other cognitive behavioral techniques is important though it’s not all we can do. Taking a holistic view of the patient means we also can offer supports such as health education and coaching. Most of us, it turns out, could use a little guidance: The U.S. Department of Health and Human Services reports only 12 percent of Americans are proficient in health literacy such that they are able to understand their health and health issues well enough to make decisions and take care of themselves without support.
We’ll need to communicate more as the work force changes
The challenges around health literacy and communicating important health information are only likely to grow as the nation’s labor force further diversifies. The U.S. population is seeing an increase in the percentage of people who are of Hispanic and Asian descent. In 2017, foreign-born workers made up 17.1% of the labor force. (Hispanics/Latinos represented about half that group while Asians comprised about a quarter.) By 2024, Hispanics/Latinos are projected to be nearly one-fifth of the work force as a result of being the fastest-growing ethnic group.
The diversification of the work force, and of the country over all, are likely to increase demand for coaching and education services in languages other than English and even Spanish. Offering languages beyond these would potentially broaden access to information for some injured workers. Understanding and speaking, where possible, workers’ languages is part of viewing them as whole people. By speaking their language, we can increase the likelihood that injured workers will make informed decisions and improve their health literacy.
Even speaking workers’ native languages, however, isn’t enough on its own. It is important to simultaneously work to reinforce clinical competencies. By continually looking to improve the services we wrap around injured workers, we can boost the likelihood of a timely and successful return-to-work.
We can get to know workers by knowing what’s affecting them
All of these efforts are designed around the idea that meeting workers where they are and understanding the challenges they face gives us the best chance at helping them achieve the best-possible outcomes.
If we have deeper knowledge of the circumstances that surround injured workers we can intervene in ways that are more impactful. Plus, we know how important trust is in workers’ recoveries.
Most injured workers will appreciate that we’re showing interest in their circumstances. Beyond knowing about the hurdles that might be present, it’s important for workers to simply know we want to know. Understanding the social determinants of health affecting workers is crucial to understanding workers and to seeing their path to recovery.
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), certified program disability manager (CPDM), and critical incident stress management (CISM).
Coventry offers workers’ compensation care-management and cost-containment solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 35 years of industry experience, knowledge, and data analytics. As a part of the specialty division of Aetna our mission is returning people to work, to play, and to life. And our care-management and cost-containment solutions do just that. Our networks, clinical solutions, specialty programs, and business tools will help you focus on total outcomes.
Coventry is a WorkCompWire ad partner.
This is not a paid placement.