2016 NWCDC

Risk Scenarios Live: Lessons in Managing Chronic Pain

Working through realistic scenarios, veteran workers' compensation experts pointed out flaws in claims management.
By: | November 30, 2016 • 2 min read

When a patient is in pain and in fear of pain, physicians face a dilemma. How to manage that pain in the best way without creating a dependency on pain medications?

When an injured worker is already floundering in a haze of prescription medications and denial, how best to intervene in a way that respects the worker’s rights, preserves the bottom line and most importantly, keeps that person productive?

These and other questions were on the table in the fourth installment of the Risk Scenarios Live presentation at the Ernest N. Morial Convention Center in New Orleans on Wednesday.

“Forget the money. Focus on the outcome.” — Michael Paladino, director, insurance services and claims, VCU Health System

As they watched filmed enactments of fictitious workers’ compensation claim scenarios, a veteran panel of workers’ compensation professionals had plenty to share.

“Forget the money. Focus on the outcome,” said Michael Paladino, director, insurance services and claims, VCU Health System.

The award-winning risk manager went on to say that an organization pays for an injured worker whether it is on the group health side or under workers’ compensation.

So, focusing on where that payment is coming from is less important than bringing the worker back to health, he said.

“We do have to treat the patient as a whole,” said Jill Leonard, assistant vice president of claims operations, Louisiana Workers’ Compensation Corp.

In three vignettes, the panel examined a chronic pain case, a case where a worker was ingesting a wide range of pharmaceuticals, and a scenario where a worker with an injured back failed to understand or comply with his return to work options.

Too often, according Dr. Robert Goldberg, chief medical officer, Healthesystems, there is a rush to surgery or a failure to fully educate an injured worker on their treatment and recovery options.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]