Raising the Bar on
Integrated Disability
IDM programs target obesity and depression and utilize evidence-based medical guidelines to control costs
A special industry sponsored report published by
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Employee Benefit News • BenefitNews.com • July 2004
Raising the Bar on
C
By Bruce Shutan utting-edge integrated disability management (IDM) programs are waging war on costs on a number of new fronts, from control of obesity and depression to use of evidence-based treatment guidelines. A critical component in today’s integrated disability management (IDM) programs is a strategic plan of action that addresses two important drivers of lost time the nation’s obesity epidemic and undiagnosed depression. Obesity costs billions of dollars in medical and disability claims, lost productivity and unscheduled absences. During the past decade alone, there has been a tenfold increase in the incidence of disability claims attributed to obesity, according to research using UnumProvident’s integrated disability database. Another finding: Obesity-related disability costs now average $8,720 per claimant each year. The causes for and subsequent solutions to employee obesity are complex. Employers require options and opportunities to influence and support their employees’ efforts to lose weight. “We offer a tool kit with a set of tangible programs for companies to implement,” reports Kenneth Mitchell, Ph.D. vice president, corporate return to
A special industry-sponsored report published by Employee Benefit News
Integrated Disability
work development for UnumProvident, who describes it as a unique approach in creating an integrated solution to lost time. UnumProvident’s Employer Toolkit includes a body mass index (BMI) calculator. BMI has shown to be a good predictor of both lost time and injury rates. A recent report on lost time among nurses showed that those with the baseline BMI measurement for at-risk individuals (30 or higher) had the highest injury rate and the longest time off work. Other key elements in the tool kit include behavioral-modification protocols, transitionalwork options and supervisor training designed to help managers understand what drives obesity as a medical problem. It’s no surprise that the obesity piece of the IDM puzzle requires more precise focus, opines Tim Suchecki, national accounts practice leader for Reliance Standard Life Insurance. “Obesity can be either the primary or secondary contributor to a disability,” he says. Under this chicken-or-theegg scenario, there could be uncertainty about whether being overweight caused a claimant’s knee strain or extended the duration of disability. Because depression can be a contributing factor to obesity, the IDM program should aim to educate employees and medical providers alike about the availability of resources such as an employee assistance program (EAP), Suchecki notes. Another tack for employers is a wellness program that may involve a gym membership discount to compliment physical therapy. For disease management-type diagnoses, Reliance taps a broader database that clients with an integrated environment can use to modify plan design or safety and wellness programs, as well as enhance EAPs and add carveout plans as part of a larger injury-prevention strategy. Employers can use the information to target age, gender and diagnoses and marry this data with disability duration figures.
Depression connection
As with obesity, the key to managing depression is making available the right resources for both occupational and non-occupational behavioral health claims. Reliance, for example, offers clients a carve-out EAP in its disability product line. Suchecki says work-life initiatives also may prove invaluable in recognizing co-morbidity factors such as stress from child care or eldercare responsibilities, plus postpartum depression. “We want to make sure our claims staff recognizes the whole
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Employee Benefit News • BenefitNews.com • July 2004
Company: UnumProvident Corporation Headquarters: 1 Fountain Square Chattanooga, TN 37402 Contact Information: Keith Hickerson Vice President, Corporate Marketing Phone: 423.294.3258 Fax: 423.294.2270 E-mail: khickerson@ unumprovident.com URL: www.unumprovident.com Products/Services: Individual income protection, group short- and long-term income protection, individual and group long-term care, group life, voluntary workplace benefits, FMLA administration, integrated disability management, corporate return-to-work program development, comparative reporting and analysis. Scope of Business: $7.6 billion in premium income in 2002, $10 billion total revenue, 25 million employees protected, $5.7 billion paid in claims in 2003, 464,000 new disability claims received in 2003. Approach to Disability Management: The leader in income protection with more than a century of experience, UnumProvident offers comprehensive benefits solutions for employers, including employee insurance programs, benefit communication and enrollment support, claim management and return-to-work planning support.
person and triggers associated with how co-morbidities can extend the disability,” he says. Employers are said to lose an estimated $52 billion each year from depression-related absenteeism and reduced productivity. Moreover, depression often is under-diagnosed by as much as 50%, according to the President’s New Freedom Commission on Mental Health. The research literature suggests about 10% of the work force has symptoms that affect their job performance, according to Mitchell. “They key is to provide support Kenneth Mitchell for the person as they work through the right type of treatment and work site accommodation.” he says. A critical first step is to define the impact of the corporate culture on the mental health of the employees including the way managers and employees interact, work loads and access to behavioral health services. Because multiple factors contribute to depression, experts suggest a combination of counseling, medication, exercise and creating a healthy work environment. UnumProvident recommends a transitional period for claimants when they return to work.
Evidence-based guides
Obesity and depression, of course, aren’t the only hot topics on the radar screens of IDM program managers. A recent
Integrated Benefits Institute (IBI) study suggesting the importance of evidence-based medical guidelines found that the short-term disability rate for those receiving unnecessary surgery is nearly nine times higher than other treatment options. “Employers are looking at evidence-based medical guidelines to reduce unnecessary treatment, which represents a positive direction for disability decision making,” Mitchell observed. For example, the sports medicine model has adopted and applied an evidence-based medicine approach to help athletes return to competition in a safer and more timely manner. And although the competitive athlete may be more motivated than the average worker, Mitchell says several employers have applied the sports medicine concept when treating socalled “industrial athletes,” enhancing a return to productivity. “We strongly believe in industry-established treatment guidelines,” Suchecki says, noting that standardization generates the best return-to-work and stay-atwork outcomes. That’s why the first claims management entry at Reliance is an automated triage system with built-in protocols for disability duration and prescribed treatment. He says the approach helps direct the right clinical resources at the right time to complex claims. To help manage the process, Reliance nurses educate claimants in the early stages about treatment protocol options. Other key elements include a multitude of external-review services, network of locally based physician advisors in disciplined specialties and partnership with the health care vendors of corporate clients to assess
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Employee Benefit News • BenefitNews.com • July 2004
Company: Reliance Standard Life Insurance Company (A Delphi Company) Headquarters: 2001 Market Street, Suite 1500 Philadelphia, PA 19103 Contact Information: Timothy W. Suchecki National Accounts Practice Leader Phone: 1-800-351-7500 Fax: 267/256-3531 E-mail: marketing@rsli.com URL: www.rsli.com Products/Services: Group LTD, STD, life and AD&D, voluntary benefits, and integrated absence management services, including income replacement design, benchmarking, event reporting, nurse case management/return-to-work, leave tracking including FMLA, Family Rights Act, maternity, etc., tracking and reporting services (provided by Matrix Absence Management, Inc., A Delphi Company). Workers’ compensation (underwritten by Safety National Casualty Corp., a Delphi Company). Product availability and features may vary by state. Scope of Business: More than 500,000 lives covered. Approach to Disability Management: Absence Solutions is a comprehensive suite of products and services designed to give employers more control over every aspect of managing employee absence. The reason for the absence - illness, injury or personal leave - is not important. The solution is. We offer a single process for everything associated with absence management.
employers ask: “When are you coming back to work?” A more Marketplace innovation important question is: “How?” Apart from paying attention to Sixteen UnumProvident corpothe management of major co-mor- rate clients are using a unique bidity factors such as obesity and Web-enabled absence-managedepression or folment tool called lowing evidenceAccommodation based medical Matrix. This manguidelines, IDM agement tool is service and benefit designed to align managers continue worksite job to blaze a path to demands in accorinnovation through dance with physikey client initiatives cian recommendaand research. tions for the The IDM marketemployee during a place is evolving to transitional work include what period. The work Suchecki calls “daysite accommodation one” absence manis now achieved in a agement. Employers timely and consisare becoming more Tim Suchecki tent manner. The aware of the hidden strategies offer costs of casual absences. “We’re guidelines on adapting the working with one of our national employee’s restrictions that may clients to help address these include the avoidance of heavy issues and integrate them with lifting, standing, walking or high other forms of paid leave,” he levels of emotional upset or reports, noting Reliance’s unique stress. position to advance this contemPreliminary results are promisporary idea. ing: 30% of the firms have demonIndeed, unscheduled absence is strated that with the application a mounting problem, according to of the tapped the Accommodation a survey of 200 human resource Matrix they are achieving a 20% and operations managers conto 30% reduction in lost time. ducted by the Disability “We help them build a safe and Management Employers Coalition. timely pathway back to work,” While clinical management of Mitchell explains, “The matrix one to three-day absences hasn’t appears to work best with compahistorically reduced lost time, nies with a widely dispersed work Suchecki says employers can use force. We think it will make a difbroad data to realign benefits or ference in terms of preventing a enhance paid-time-off policies and lost-time event from occurring, as safety and wellness programs. “If well as re-engaging an individual you create a central environment back to productivity.” for all absences regardless of Bruce Shutan, former managing editor of cause,” he adds, “you increase Employee Benefit News, is a freelance your opportunity to provide conwriter based in Los Angeles. sistency and get better information in on a more timely basis so that employers can better manage their business process.” Mitchell says that all too often surgery trends.