WCRI
(Workers’ Compensation Research Institute) recently released a report identifying
predictors of injured worker outcomes.[1] While the report reflects
only a few states, the information can logically be extrapolated to other
areas. When seeking answers in medical management, the issues remain fundamentally
constant regardless of location because they are medical, not jurisdictional.
“Better
information about the predictors of poorer worker outcomes may allow payors and
doctors to better target health care and return-to-work interventions to those
at risk,” stated Dr. Richard Victor, WCRI executive director.
Moreover, data systems can search for the
predictors in claims so that appropriate attention is focused on them from the
beginning, thereby mitigating the damage.
Preventive communication
Having
said that, the first predictor of poor outcomes identified in the WCRI study will
not be found in the data. WCRI found when injured workers are strongly
concerned about being fired after the injury, outcomes will be poor. Managing
worker understanding is an employer risk management issue, one that can best be
prevented with good communication.
Contacting
injured workers early and continuously with reassurances of continued
employment will drive best results. Moreover, the approach is easy and costs
nothing. Yet, other risks identified in the study require a different approach.
Comorbidity risk
WCRI
research identified three comorbidities of concern: hypertension, heart
disease, and diabetes. When these comorbidities are combined with a workplace
injury, the result is poorer outcomes measured by longer disability durations.
Workers with heart disease had disability durations four weeks longer than
those without heart disease. Those with hypertension and diabetes exhibited 3%
and 4% higher rates of not working three years after their injury.
Comorbidity
risk such as that found in the study is a generally known truth, gained either logically
or through experience. I call it corporate wisdom.The study validates the theory.
Monitor ICD-9’s
Search
for these and other conditions in claims by monitoring the data continuously. Each
condition has a set of ICD-9’s (International Classification of Disease) for
the disease. ICD-9’s appear on medical bills so a continuous search for them in
the bill review or claims systems is reasonable. Moreover, the search can be
extended to other comorbidities.
Other risky comorbidities
Other
comorbidities have been identified through industry research as complicating
injury recovery and generating poorer outcomes. Search Google to find specific
diseases to find a myriad of studies that bear this out. Such studies are proof
of the notion that when certain diseases are coupled with work place injuries,
outcomes are poorer, disability durations are longer, and costs are higher.
Examples of search requests are, “Opioids in Workers’ Compensation” or “Obesity
in Workers’ Compensation”.
Use a
search engine to find industry studies regarding other comorbidities such as specific
mental health conditions like stress or depression. The research provides an
argument for proactively managing claims where the comorbidities exist.
Opportunity gain
Industry
research is invaluable. Leverage the work of serious researchers rather than
engaging in pricey statistical modeling. Statistical modeling uses advanced
mathematical methods to identify high risk claims. The value of statistical
modeling is it analyzes the data for the organization to identify the unique
risks in that organization. Still, an affordable alternative method is
available.
Customize for the organization
To
learn the comorbidities of most concern to an organization, do a query of the
highest cost claims in the data over the past few years. List the diagnoses in
those claims and identify the comorbidities most commonly associated with them.
Then look for industry research on those diagnoses to establish rationale for
implementing the monitoring and intervention procedures.
Coattail to predict
If statistical
modeling is not within practical reach, coattailing industry research is a
viable alternative. Determine the highest risk comorbidities within the
organization, search the research, and begin monitoring the data to find claims
where they occur.
Monitoring
the data allows for a proactive approach by tagging claims at risk soon after
injury, thereby modulating the damage.
Plan of Action
Establish
standard medical management processes for responding when identified
comorbidities or other high risk diagnoses appear in a claim. Identifying
claims that portend risk, whether from comorbidities or anything else, is a
cost savings measure only if an action plan is in place for responding to it. Gaining
the information is nice, but it must be tied to an intervention plan to make a
difference.
Since
these are medical situations, automatic referral to a medical case manager makes
the most sense. An organization should establish protocols and procedures for
approved intervention. Appropriate attention focused from the beginning, will abate
the damage, thereby improving outcomes.
Karen
Wolfe is the founder and President of MedMetrics®, LLC, a Workers’
Compensation analytics company. MedMetrics offers online apps that super-charge
medical management by linking analytics to operations to make them actionable. MedMetrics
provides data monitoring and automatic alerts for comorbidity diagnoses and
other risks. karenwolfe@medmetrics.org
