White Paper

Social Determinants of Health: The Missing Piece in Workers’ Compensation

Social and environmental factors can quietly derail recovery; integrating these insights into claims management is key to lowering costs, reducing litigation, and improving outcomes.
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White Paper Summary

Over the past 20 years, the workers’ compensation industry has worked to combat rising medical and claims costs through strategies such as early intervention and early engagement (24/7 nurse triage) and the advancement and acceptance of case management.

Now, we’re at an inflection point. Medical costs continue to rise, and complex cases, such as those involving mental health claims in addition to physical claims, are contributing to higher overall costs. Let’s take a step back from the individual injury or claim and examine cases from a program perspective. It becomes clear that outside factors are influencing the severity and complexity of claims today. These factors are the social determinants of health (SDOH).

The Centers for Disease Control and Prevention defines SDOH as the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, worship, and age. SDOH often include factors like income, education, housing, and access to nutritious food and safe environments. In workers’ compensation, these factors may include an individual’s residence, access to healthcare, their home support system, and financial situation.

SDOH aren’t new, but they’re the next most obvious factor contributing to higher costs and impacting the care, recovery, and return-to-work of injured workers. There’s an opportunity for the industry to reduce the overall cost of claims by first understanding how social factors influence recovery. Then it becomes a process: flag the more severe or complex claims, identify the social determinants at play, and manage them through a claim-centric and holistic approach.

To learn more about CorVel, please visit their website.

CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.

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