Opinion | Less CBD, More CBT: Exploring the Mind/Body Connection in Workers’ Compensation

By: | March 11, 2019 • 3 min read

Nina Luckman is a business journalist based in New Orleans, focusing primarily on the workers' compensation industry. Her credentials include a B.A. and M.A. from Tulane University, both in the study of English Literature. Over the last several years, Nina has served as Editor of Louisiana Comp Blog, a news site she started in 2014 under the auspices of a group self-insurance fund. Louisiana Comp Blog won the WorkersCompensation.com Best Blogs award in 2016, 2017, and 2018. She can be reached at [email protected]

With the ​news​ that Ohio is eliminating OxyContin and generic oxycodone from its drug formulary, the workers’ compensation community cheered.

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However, the decision was tempered by the fact that Ohio will replace it with Xtampza ER. Xtampza is an opioid medication ​approved in 2016​ for severe pain. The FDA says the drug is resistant to abuse.

And though this might seem like progress, if the workers’ compensation industry — and indeed the health industry at large — continues to insist opioid use for chronic pain must be curbed, then it’s time to start privileging alternative treatment modalities and not just preventing abuse of medication. In fact, workers’ comp is in a unique position to lead this effort through the biopsychosocial model of care.

The biopsychosocial model of care is a broad term that applies to all areas of treatment and is based on the ideas of the late George Engel, who authored an influential ​critique of biomedicine in 1977.  Engel’s biopsychosocial model was analyzed by researchers whose critique was published in the November 2004  ​Annals of Family Medicine.

Philosophically, biopsychosocial approaches take into account not just objective findings and biochemical alteration within the body, but also social dimensions of disease.

At the practical level, it means that physicians must make an effort to develop the relationship with the patient to encourage adherence to treatment. That relationship could manifest the need to address within a workers’ comp claim a psychological issue, a language barrier or nutrition.

The recent release of the federal government’s Pain Management Best Practices Inter-Agency Task Force mentioned the biopsychosocial approach by name in its recent ​draft guidance​, listing the following treatment modalities as central to balanced, individualized pain management:

  • Medications.​ Different classes depending on patient medical conditions and history.
  • Restorative​ ​movement therapies. ​Physical and occupational therapy, massage therapy, aqua therapy.
  • Interventional​ ​procedures.​ Different types of minimally invasive procedures can be important for both acute and chronic pain.
  • Complementary​ and ​integrative​ ​health. ​Acupuncture, yoga, tai chi, meditation.
  • Behavioral health/psychological interventions.​ Coping skills, cognitive behavioral therapy (CBT).

The first three on the list are likely familiar to workers’ compensation professionals, while the latter two may make us cringe. Why? Because the common understanding of mind/body medicine like yoga and cognitive behavioral therapy is that it doesn’t fall into the realm of work injuries.

On the contrary though, CBT is the “gold standard” of care and should be utilized at the first sign of catastrophizing or common mental health disorders like depression and anxiety.

A study​ published in ​The BMJ ​Occupational and Environmental Medicine edition bears this out, finding that “work-focused cognitive–behavioural therapy and individual job support” increased work participation in its population of 1,193 disabled persons by 7.8 percent versus the control after follow up at 18 months.

Meanwhile, yoga, an ancient mind/body practice, is touted in a 2015 Harvard Medical School ​review​ and countless studies as a powerful, modifiable pain relief tool for fibromyalgia and other conditions.

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The ability to try alternative treatment modalities, rather than mindlessly approving painkillers, creates an atmosphere of compassion around a claim that is likely to reduce litigation and encourage return-to-work. Indeed, World Health Organization data from a ​1994 study​ concluded that: “The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.”

Therefore, if functionality post-injury is the goal, addressing the mind/body connection is the solution.

Considering the unique interplay between the variety of providers and professionals that touch an individual comp claim — doctors, nurse case managers, vocational rehabilitation counselors, and adjusters alike — the workers’ compensation system’s ability to integrate the biopsychosocial model of care is obvious.

Let’s get to work. &

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]