Assigning nurses — not just adjusters — to manage all workers compensation claims helped one large employer cut costs and enable its employees to tap the company's full array of health and productivity benefits.
What started as an effort to improve the medical handling of Textron Inc.'s workers comp claims has evolved into the integrated coordination of programs available for workers whether they suffer a non-occupational disability, a work injury or an illness handled by the company's group health plan, said Dan Shaughnessy, Textron's director of disability and wellness programs.
Providence, R.I.-based Textron is a Fortune 500 company with about 25,000 U.S. employees and thousands more spread across 25 countries. Its businesses include Bell Helicopter and Cessna Aircraft Co.
Like Textron, other large employers with diverse workforces spread across many locations struggle to help employees access their health and productivity benefits, said Kimberly Mashburn-Lee, vice president of strategic client solutions at Pacific Resources Benefits Advisors L.L.C. in Chicago.
With so many benefits and services available, such as wellness coaching, employee assistance programs and disability management, it often is challenging for employees to know where to turn, especially during stressful events, Mr. Shaughnessy added.
“Not everyone remembers all the benefits they have” when under duress, he said.
Consequently, employers spend large sums for programs that employees don't use, experts said. That hurts worker productivity and the company's bottom line. It also diminishes the return on investment that companies derive from their health and productivity programs.
But Textron has increased worker use of its health and productivity programs by 50%.
That accomplishment evolved from a late 2005 effort when Textron evaluated its third-party administrator contract and decided it wanted nurses managing each workers comp case from inception.
TPA Broadspire Services Inc. agreed to create such a program despite several unknowns.
“Basically they built the system, and one of the issues was figuring out how to price it,” Mr. Shaughnessy said. “That was one of the roadblocks the other TPAs that bid on our business had a problem with: figuring out how to get the pricing of nurses in their claims fee and (keep the cost) reasonable.”
Now, nurses decide what actions to take on a claim, managing each case to conclusion. But an adjuster also must work each case due to state mandates, Mr. Shaughnessy said. So adjusters handle nonmedical issues, such as approving or denying a claim.
Textron's arrangement has had a “huge impact on bringing people back to work faster and cases closing faster” because the nurses' expertise helps in medical discussions with treating physicians and nurses are a trusted medical resource for employees, Mr. Shaughnessy said.
The company's workers comp medical costs decreased 14% a year per claim from 2005 to 2008, although they spiked after that due to layoffs. Since 2011, they have resumed a downward trend of about 12% a year, Mr. Shaughnessy added.
Under a more typical workers comp arrangement, employers pay an additional charge each time an adjuster calls in a nurse, said Gary Anderberg, practice leader for analytics and outcomes at Broadspire.
While it is still uncommon today for nurses to manage a workers comp claim from the outset, more large employers are discussing the strategy, Mr. Anderberg said.
Based on Textron's workers comp success, MetLife Inc., the employer's short- and long-term disability insurer and provider of family medical leave services, decided about two years ago that the claims it handles for Textron also could be better managed by nurses instead of adjusters.
Since disability plans are not state regulated like workers comp, Textron is free to use only nurses to manage its nonoccupational disability cases.
“So we have the nurses do everything,” Mr. Shaughnessy said. “They make approvals, denials and they manage the cases to conclusion, taking it a step further than we have on the workers comp side.”
Having nurses coordinate non-occupational disability claims also has improved outcomes, Mr. Shaughnessy said.
In addition, more than a year ago, Textron integrated the services provided by the workers comp and nonoccupational disability nurses with offerings from UnitedHealthcare, the employer's group health insurer that “also has a group of nurses dedicated to our employees,” Mr. Shaughnessy said.
Textron arranged for information on claims received by Broadspire and MetLife to also flow to UnitedHealthcare. The group health plan uses the information to conduct outreach to employees who can benefit from its services such as disease management, wellness or even catastrophic care services.
Delivering those services and others when employees need them most is a constant battle for employers, Mr. Shaughnessy said. But Textron's strategy helps ensure that employees receive services when they need them most because three different service providers are evaluating their health needs all under the oversight of a nurse, Mr. Shaughnessy said.
“A lot of these services we offer can't be triggered unless something happens,” he said. “So what we are doing is (watching for) those triggers, hopefully (reaching employees) sooner than later, when these services can have the biggest impact.”