Teamwork is Key to Best WC Outcomes, Says Johns Hopkins Study

Sarasota, FL (WorkersCompensation.com) – “Occupational safety and medical personnel need to engage early and often with injured workers, supervisors and adjusters to better manage the medical care and return to work process with the aim of achieving superior disability and cost outcomes.” That statement, included in a new study, summarizes the ingredients that led to better workers’ compensation claims outcomes over a 32-year period.

The study of healthcare workers and academicians employed by Johns Hopkins Health System and University between 1988 to 2020 showed the following results:

• Lost-time claims: Decreased from 22.15 to 4.32 per 1,000 employees
• Total closed lost-time claim costs per $100 payroll: Decreased from $0.62 to $0.17 (1988-2017).
• Percent of claims resolved within 3 years of the accident increased from 10% to 89% (1988-2017).

Adjusting for medical inflation and wage increases:

• Total workers’ compensation benefits paid per claim: decreased $124 per year
• Medical benefits: Decreased $45 per year
• Indemnity benefits: Decreased $79 per year

The study, Prevention, Medical Management and Adjudication of Workplace Injuries; A Thirty-Two Year Follow-up of an Integrated Workers’ Compensation Program, was published in the Journal of Occupational and Environmental Medicine. It is the latest study analyzing the results of workers’ compensation claims management processes initiated in 1991/1992.

The Program

Thirty-two years ago, Johns Hopkins Health System and University introduced a number of changes in its workers’ compensation system. These included:

1. Prompt accident reporting, expedited medical assessment and treatment at a worksite occupational health clinic
2. Safety investigation of all OSHA recordable accidents and plan of correction to address unsafe environments initiated within one business day post-accident
3. Injured worker advocacy regarding medical care delivery and expedited integration into the workplace post injury
4. Specialty care provided by an expert panel of selected physicians skilled in the management of injuries funded under the workers’ compensation system
5. Frequent patient followup by the worksite clinic’s practitioners and specialty medical providers from time of injury through claim closure
6. Nurse case management services provided to all claimants requiring medical care by specialty physicians
7. Twice-a-month case management meetings involving all parties (safety professionals, medical providers, adjusters, etc.) to discuss and resolve medical treatment, claim adjudication and workplace accommodation issues impeding claim resolution

Claims management system software improvements, electronic medical record revisions, ergonomic assessment program improvements and other system mechanics were refined over the subsequent years. New healthcare safety programs were initiated in the late 1990s and early 2000s, especially safe lifting programs and needle-less intravenous systems.

“All stakeholders (e.g., safety professionals, employees, supervisors, human resource professionals, medical and nursing professionals, adjusters, and attorneys) became active participants in the claims process,” the authors wrote. “The program adopted a non-adversarial stance, encouraged early reporting, patient advocacy, facilitation of care, and preventative measures as primary strategies in managing claims. Occupational health clinic physicians and nurses were encouraged to recognize the psychological and emotional needs of injured workers. Claimants were continuously provided with information regarding the therapeutic process.”

After the first 10 years into the program, the researchers identified a number of outcome improvements. Frequency for lost time claims decreased by 73 percent, while the rate of medical-only claims was down by 61 percent and total workers’ compensation expenses decreased from $0.81 per $100 of payroll to $0.37 in 2002.  

“The principal take-away from these early studies was that similar results could be achieved at large employers with occupational health facilities on premises, if the individuals involved in occupational health and safety and claims management adopted best practices and closely coordinated their activities to prevent accidents, expedite medical care and return injured workers back to work as soon as possible,” the authors wrote. “The purpose of this investigation is to extend the period of observation of the program at the Johns Hopkins Health System’s and University’s Maryland campuses to assess the durability of the program and identify the major component (accident prevention, post-injury medical and claim management) most responsible for any continued cost changes.”

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Among the reasons for the updated study was to determine whether the medical and indemnity reductions seen in the first 10 years continued. It did, although the cost decreases improved at a slower rate in more recent years. “Perhaps this indicates that there is an inherent risk in certain types of employment that is more difficult to be mitigated in order to achieve further reductions?” the authors speculated.

Nevertheless, the overall results were positive.

“Our study indicates that medical-only and lost time workers’ compensation claims rates decreased five-fold over the 32-year study period,” according to the researchers. “The decrease in rates translated into large decreases in total claim costs as well as indemnity and medical costs for lost-time claims (serious injuries) as percentage of payroll.”

Expedited medical care and return to work were credited for quicker claim resolution, which translated to fewer temporary total days paid and reduced medical costs, the authors said. The result was a ‘profound’ improvement in medical and indemnity claim severity.

“The 3-year closure percentage increased from 10% in 1988 (3 years before the cost containment initiative began) to 89% in 2017,” the study said.

Also accounting for some of the positive results is the amount spent on medical vs. indemnity. The average proportion of indemnity spending to medical spending per workers’ compensation claim closed within 3-years, was about 20 percent higher than medical spending; whereas the percent of medical spending accounts for 60 percent of workers’ compensation benefit costs among most U.S. employers.

“As medical inflation has been the principal driver of increasing workers compensation claim costs in the U.S. over the majority of the study period, the favorable ratio of medical to indemnity spending obtained by the JHWCP is another factor accounting for its observed outcomes,” the study said. “The ability to improve the post injury management of medical care may be a significant factor in the program’s performance.”

The authors said improvements in safety practices and case management and adjudication procedures impacted claim costs. Also, declines in total, medical and indemnity severity were related to the program’s ability to increase the rate of claim closures.

The collaboration among all stakeholders involved was seen as “the most enduring and unique feature” of the program, the authors said. Meetings held twice each month by all participants discussing the cause of the injury and ways to mitigate future accidents was key.  

“This meeting permitted constant dialogue and planning for return to work, including determination of work-place accommodations that match the injured worker’s restrictions or temporary alternative job placement. The interaction was felt to be the key ingredient in preventing future accidents, expediting medical care and, decreasing disability,” the authors concluded. “We believe this teamwork also accounted for observed increases in the rate of annual claim resolutions (closures), significantly reducing the number of active claims thereby reducing the amount of current and future JHWCP liability.”

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