What is the Problem?

07 Dec, 2023 Douglas Amend


Douglas Amend, Partner, Optimized Outcome Solutions.

If you have responsibility for your company’s workers’ compensation budget, I think you will find value in this different perspective.  My experience speaking at numerous conventions suggests that “Employers/Payors want to reduce their workers’ compensation spend, they just don’t know how.” We look at the problem of rising Workers’ Comp costs and suggest, “Injured workers want to get better, they just don’t know how.” I believe Patient Education and Peer-to-Peer Coaching also serves the payors best interest with a better recovery experience and shorter back to work times.

When a worker is injured on the job their “Grand Bargain” voyage begins.  Most claims managers who are responsible for the money being spent believe there are opportunities to reduce their spend by improving efficiencies that may reduce medical costs and shorten the return-to-work timeframe. There are even a few managers who have demonstrated they can save money and improve outcomes by more focused spending in the early stages of a claim – think of the Ohio BWC study on Knee Injuries (https://myhealth.integerhealth.com/Images/Ohio%20Case%20Study%20(Journal%20of%20Total%20Rewards%20Q1%202023).pdf). 

What payors know about the recovery process is just as important as what you do about it.

Most surgeons have not suffered the injury they are fixing. While their expertise in repairing the physical damage is top shelf, the instructions for recovery they provide are learned from textbooks and other patient experiences passed along to them. Most surgeons are also limited on the amount of time they can spend with an injured worker to address all of their concerns and help the worker understand their role in the recovery process.

Pharmacists have not suffered every conceivable injury they are medicating. Likewise, Physical Therapists have not suffered every conceivable injury they are treating either.

Excellent skills, expertise and compassion are the hallmarks of these professionals.  But, if the questions being asked are anywhere outside of their core competency or expertise - like the important recovery strategies around mindset, nutrition, activity and rest - the injured worker may be left unaware that these key areas are also part of the optimized recovery process.

If your injured worker is seeking this kind of information, how comfortable are you as the payor knowing the injured worker is likely going to the internet to gather recovery information? That information comes from a wide variety of sources, much of it is biased marketing information. We have seen that homebound injured workers seeking guidance from an internet search can be a recipe for an extended claim.

The other readily available information source found on the internet or billboards are claims attorneys.   Having your injured worker retain an attorney is a surefire way to complicate what might otherwise be a straightforward claim.  If any readers have had the experience of attorneys helping to simplify and reduce claim costs, we would like to hear how that was done.

While there are strides being made to address optimizing the mindset of the injured worker and to engage them in their own recovery, the most effective way to achieve an optimal outcome is to encourage and direct your injured worker to speak to a peer-to-peer recovery guide.  Providing access to reliable information from a recovery guide who has been hurt and successfully recovered can be that extra “programming” that answers the question, “Employers/Payors want to reduce their workers’ compensation spend, they just don’t know how.”  Your injured worker is the wild card in their own recovery. Providing solid education on how to recover, coupled with peer-to-peer coaching, is a proven roadmap for success.

If you met me today, you would have no idea I fell down a 300-foot glacier fracturing my spine, hiked out solo over the next 8 hours, endured a 7-1/2 hour surgery to install a titanium vertebrae and spent 6 months recovering. Being able to speak with, compare notes and share experiences with someone who already suffered and recovered from a significant injury and/or surgery paved the way for my optimized recovery.  The most responsible choice a payor can make in Workers’ Comp is, like the injured worker, optimize your services to speed your employee’s recovery.

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