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A large employer and an insurer in separate efforts are taking the uncommon step of attempting to address workers compensation injuries with wellness programs.
Employers typically implement wellness and disease management programs to reduce health care and nonoccupational disability costs and, more recently, to reduce absences and drive productivity, experts say. Some have even directed workers comp claimants to employee assistance programs.
But corporate silos that typically separate risk management departments overseeing workers comp from group benefit management departments have been obstacles to directing workers comp claimants to wellness programs, several sources agreed. Employers also have been discouraged from linking the two areas because of fears that such a step could expand employers' liability for work-related injuries, they added.
A large, multistate manufacturing company is collaborating with its group health insurer, Family and Medical Leave Act administrator, third-party administrator and disability insurer in linking workers comp and wellness.
They are developing a plan to direct employees with complex workers comp claims to disease management programs originally established for the company's group health side, said Gary Anderberg, director of business development for Broadspire Services Inc., a unit of Atlanta-based Crawford & Co., and the employer's TPA.
“We are all at the table together trying to figure out how to make this work,” said Mr. Anderberg, who declined to name the employer.
In a separate effort, Denver-based Pinnacol Assurance hopes to involve 30,000 of its clients' employees by year-end in a study that began in May. The study aims to determine whether Pinnacol can reduce claim frequency and severity while improving worker productivity with wellness offerings, said Jeff Tetrick, Pinnacol's chief financial officer.
Pinnacol's effort is particularly unusual because the insurer is introducing wellness practices to small employers that may not even provide their workers with a health insurance plan, said Thomas Parry, president of the San Francisco-based Integrated Benefits Institute.
Typically, large employers, not small ones, have introduced wellness offerings for their employees, several observers agreed.
The IBI provided Pinnacol with a tool to measure how health improvements ultimately affect workers' productivity.
The IBI's tool consists of questions that Pinnacol integrated into a 75-question health risk assessment. The survey will help direct workers to health coaching, online health improvement programs and community health resources, Mr. Tetrick said. The survey also can help score employee health improvements.
“What we are trying to say is if you improve your score, there are fewer accidents; and if you do have an accident, you recover quicker,” Mr. Tetrick said. “People who have good health have lower (accident) frequency.”
Sheboygan, Wis.-based Trotter Wellness is providing Pinnacol with the health risk assessment and follow-up resources, Mr. Tetrick added.
Meanwhile, the employer that Broadspire is working with is undergoing a compliance review. It wants to determine whether various state laws will allow it to address employee health issues, such as obesity that exacerbates a work-related back injury, without making the company liable for the obesity as part of the workers comp claim.
“There may be a few states where we may not be able to do this,” Mr. Anderberg said. “A few states out there are notorious for, "You touch it, you buy it.'”
Fear of “buying” other health problems, such as obesity, as part of a workers comp claim has kept employers and insurers from moving forward with similar strategies, Mr. Anderberg said.
But the employer Broadspire is working with believes it ultimately can benefit by applying its existing nonoccupational EAP and disease management programs to complex occupational claims, Mr. Anderberg said.
About five years ago, the employer involved in the test combined oversight of occupational and nonoccupational disability claims and FMLA leave under one manager, which will help move the process forward, Mr. Anderberg said.
“It short-circuited the silo impact,” he added.
Most employers that have introduced wellness and disease management measures, such as smoking-cessation and weight-loss programs, have done so to prevent nonoccupational health care claims and not to help address existing occupational injury claims, said Marcia Carruthers, CEO for San Diego-based Disability Management Employer Coalition.
When the recession started, there was concern that constricted corporate budgets would kill benefit department wellness initiatives, Ms. Carruthers said. Instead, employers increasingly are interested in using health risk assessments and wellness programs to reduce all types of absences and maintain productivity as they operate with leaner staffs, she said.
“It's nice to see people are thinking a little outside the box for ways to approach comp,” Ms. Carruthers said.
The two efforts could provide models to help other employers bridge corporate silos with programs that reduce workers comp costs by addressing claimants' underlying health care issues, Mr. Parry said.
“So many organizations are so heavily siloed they never even think of this,” Mr. Parry said.