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Mandatory rehab benefits workers, employers

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NEW ORLEANS — Pairing mandatory rehabilitation participation policies with vocational rehab programs can have a significant impact in returning disabled employees to work.

Mandatory rehabilitation refers to policies requiring a disabled employee to participate in a rehab plan at the company's expense, with the failure to comply — absent good cause — potentially resulting in benefits being cut, Dr. Michael Lacroix, associate medical director for disability and absent management services at Aetna Inc. in Sarasota, Florida, told attendees of the Disability Management Employer Coalition conference in New Orleans on Tuesday.

“When you think about that, it sounds like it's a stick — if you don't participate there's going to be a penalty,” he said. “But if you think about it a little more, there's also a carrot piece, and the carrot piece is really important because what that says to the employee is … 'We want you back and we're willing to invest to get you back.'”

Aetna's 2014 short-term disability claims data showed that 40% of its health plans had mandatory policies, with these employees being out on disability for an average of eight fewer days than employees at companies that did not require employees to participate in rehab, he said.

In 2014, then-Kraft Food Group Inc. had 2,251 claims, and the decision to opt for a mandatory plan translated into almost $2 million in savings, Dr. Lacroix said.

“Mandatory plans: I'm a big fan; they save money,” he said.

Kraft merged with H.J. Heinz Co. to form the Kraft-Heinz Co., co-headquartered in Pittsburgh and Chicago, in 2015. The merger and corporate restructuring created a “high-stress environment” for its salaried employees, while its hourly staffers worked long hours at physically demanding jobs, said Kristen Wittenborn, manager of benefits.

The company recognized the challenges involved in addressing its high incidence of stress-related disabilities, including underutilization of its employee assistance programs, high-deductible health plans that could discourage the use of behavioral health care perceived as unnecessary, and the inability of hourly workers to take unpaid time off from work to seek care.

“We have a 24-month limit on our mental health disability claims, so it really does require somebody to address and utilize the benefits early to avoid long-term exposure and try to get them back to work,” she said.

Aetna's specialized behavioral health unit intervened to address Kraft's claims, and the percentage of short-term disability claims based on behavioral health dropped to about 4% in 2015 from nearly 8% in 2012. The unit gets involved from day one with disability claims receiving dedicated behavioral unit counselors, the use of vocational resources, employees receiving five free counseling sessions — a well-publicized benefit — and a plan that mandates participation of a mental health training provider, said Adele Spallone, vice president of business integration and strategy for disability and absence management with Aetna in Miami.

“Kraft makes health and wellness an organizational priority,” she said. “They want to know trends. They want to know outcomes so they can put the best programs in place.”

Vocational rehab is a critical part of this because Aetna data shows that every $1 invested generates an $11 return, Dr. Lacroix said.

“Voc(ational) rehab is boring,” he said. “But sometimes the boring stuff is really worthwhile.”

The results are even better when vocational rehab is tied to mandatory policies, as Aetna's data showed that cases involving employees at companies with mandatory policies closed earlier, had few transitions to long-term disability and had a higher percentage of return to work at modified duties.

“The vast majority of employees want to go back to work, so you're helping them,” he said.