When employees can't work because of sickness or injury, both employers and employees suffer. By using a holistic approach to maintaining a healthy workforce, employees are more secure, productivity improves and the cost of running a business can dramatically decrease.
When employees can't work because of sickness or injury, both employers and employees suffer. By using a holistic approach to maintaining a healthy work force, employees are more secure, productivity improves and the cost of running a business can dramatically decrease.
The cost of injuries and illness to U.S. employers is staggering. The National Center for Health Statistics in 2004 reported that U.S. companies lost approximately 674 million workdays in 2001 because of employee illness and injury. In addition, an April 2003 analysis from Aetna shows 5% of members with PPO and disability coverage who have at least one disability claim have disproportionately high medical expenditures compared with members with no disability claims.
Aetna also looked at a variety of diagnoses such as irritable bowel syndrome (IBS), chronic fatigue, pregnancy, hypertension, back pain, morbid obesity and carpal tunnel syndrome. The analysis examined these diagnoses to determine which members also were diagnosed with depression and found that when depression is a comorbidity, the duration of the disability is longer. For example, depressed members diagnosed with IBS experienced an average of 63% longer disability durations than members with IBS who were not depressed. Additionally, back pain claims resulted in disability durations that were on average 25% longer for claimants with depression than for members with back pain who were not depressed.
With traditional case management, health and disability plans are viewed in isolation; the health side is focused on getting the patient back to health, while the disability side is focused on getting the person back to work. Each view provides only half the picture.
The result is: Separate record keeping, separate treatment plans, separate events; and duplication of contact with members and providers, duplication of effort and inefficient use of resources. It represents a lost opportunity.
A comprehensive approach links medical and disability data to help anticipate concerns, take action and get employees back to work sooner. Known as integrated health and disability (IHD), this approach allows health plan and disability case managers to see a whole view of the employee. Aetna studies have shown that when an employee who has filed a disability claim allows both case managers to share information, the employee may be able to reduce short term disability durations that result in savings of as much as $300 per claim.
An IHD program identifies individuals at risk for adverse medical and related disability events and tries to prevent disability events from occurring. The program looks for specific opportunities to implement services designed to foster increased wellness and productivity.
In addition, clinical and case management experts help influence outcomes through:
Providing clinical and case management experts a complete picture also depends on the ability to aggregate data from multiple sources and provide combined data reporting. By using information from an extensive data warehouse, Aetna can provide employers with a report showing a global view of how benefit dollars are being spent on non-occupational disabilities. According to the Social Security Bulletin in 2000, this information is particularly relevant given that the most common source of short-term disability claims for younger workers (aged 15-54) was nonoccupational injury.
Making a successful plan
A program that offers disability, leave management and integrated health services should offer superior resources and support and a level of intervention a company needs. If you choose to go that route, make sure the plan includes:
Through the integration of medical and disability data, insurers can assist employers in identifying issues that adversely impact the health and productivity of their workforce and offer solutions designed to address the issues specific to that employer. Ultimately, that will lead to a healthier and more productive workforce.
Peg Haennicke is head of Disability and Products Services for Aetna Disability and Leave Management Services.