One Call and SEPTA Experts Outline Strategies to Manage Claims with Comorbidities at the National Workers’ Compensation & Disability Conference
Early intervention, holistic care and wellness programs help identify and address today’s most common and costly comorbid conditions
JACKSONVILLE, Fla. (December 12, 2017) – It’s now become a common occurrence to have injured workers suffer from another condition or disease – such as obesity, diabetes or depression – while recovering from a workplace injury. If a comorbidity exists, the claim can quickly spiral out of control, as an added condition can complicate treatment, prolong recovery and delay return-to-work.
Richard Graham, RIMS-CRMP, director of workers’ compensation at the Southeastern Pennsylvania Transportation Authority (SEPTA), teamed up with Eric Patten, RN, BSN, senior director of clinical services at One Call, to review the magnitude and impact of this issue as well as potential solutions in the session, “Strategies for Managing the Pandora’s Box of Comorbidities,” at the National Workers’ Compensation & Disability Conference on December 7 in Las Vegas.
“We’re not alone in this comorbidity challenge,” said Graham. “Obesity is a national health crisis with far-reaching repercussions. In industry studies, as well as in our own claims data, we’ve seen how this and other conditions negatively impact medical costs and return-to-work, but more importantly, there’s a harmful human impact in terms of the quality of life for employees.”
In 2016, Harbor Health Systems, a One Call company, performed a study and reported that claims with a comorbid condition on average experienced longer duration and higher medical and indemnity costs, as well as increased litigation and surgery rates. And, on average, claims with more than one comorbid condition showed a 341 percent increase in total incurred costs.
“Our program is a microcosm of these trends,” said Graham. “One might expect employees in physically demanding positons – such as mechanics in our maintenance shops – to experience a higher rate of injury and lost time, but it’s actually the opposite, with employees in sedentary positions, such as bus operators, who may be less active and potentially obese, having a higher incidence rate.”
In 2016, SEPTA mechanics experienced a 2.92 lost-time injury rate, while bus operators experienced a rate of 7.50. In 2017, the rates improved to 2.33 for mechanics and 6.72 for bus operators, but still exhibiting a higher rate for sedentary workers.
“Diabetes is another comorbidity that results in significant clinical issues,” said Patten. “As someone who has coped with this condition for more than 35 years and helped manage claims with this comorbidity, I’ve seen first-hand how it can hamper the healing process, increase the risk of infection, extend disability and lead to other medical problems.”
In 2012, the Journal of the American Medical Association reported that more than half of American adults either have diabetes or pre-diabetes and many are unaware they have the condition.
“With today’s aging workforce and baby boomers set to turn 65 on the order of 10,000 a day until 2030, comorbidities may become a complicating factor on most claims. That’s because the occurrence of conditions – such as diabetes, arthritis and heart disease – increases with age,” said Patten.
“It’s important to take a holistic approach to care; find out if a claimant has other medical issues in the injury-intake process,” Patten added. “If we identify a condition early, the claims and medical team can work together to achieve the best possible outcome. The earlier a condition is identified, the earlier the right clinical resources can be applied to improve results.”
SEPTA uses early identification and early intervention through telephonic case management. “This strategy pays significant dividends in terms of improved savings and outcomes,” said Graham. “We also employ pre-loss, risk management strategies to eliminate and reduce hazards through safety and wellness initiatives. Employers may be reluctant to put wellness programs in place, fearing they won’t see a return on investment. We can’t prove a direct correlation, but we’ve seen a healthier, fitter workforce emerge as well as shorter duration and fewer loss-time claims overall. We believe in the value of these programs, and by obtaining buy-in from employees, we can have a lasting impact.”
About One Call
One Call is the nation’s leading provider of specialized solutions to the workers’ compensation industry and is headquartered in Jacksonville, Florida. One Call’s solutions enable more efficient and cost-effective claims resolution with a focus on injured workers’ needs across the continuum of care. For more information, visit www.onecallcm.com or follow One Call on Twitter @onecallcm.