1 kristin tugman, ms, crc, lpc september 2012 iarp new england fall conference how to effectively...
TRANSCRIPT
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Kristin Tugman, MS, CRC, LPC
September 2012
IARP New England Fall Conference
How to effectively implement a Transitional RTW program:
From the corporate office to the front lines
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Agenda
Health and Productivity Development
Transitional Return to Work Building the Business Case:● To the corporate office
● Corporate concerns
● To the locations
● Top concerns typically voiced by the locations
Transitional RTW program implementation● Development
● Manager training
Demonstrating Return on Investment – Case Studies
The impact of ADAAA
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A Health and Productivity Vision
Protect productivity Health Risk Appraisal/ Disease Management/EAP
Return to full productivity Collaborative solutions for all lost time events
Mitigate future health & productivity issuesAging work force /musculoskeletal disorders
Ambiguous impairments (depression/fibromyalgia)
Medicalization of common health problems
Medical costs, job performance and lost time are connected
Corporate cultureimpacts the H&P connections
The Corporate H&P information base guides the application of corporate and partner resources to:
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Health & Productivity Challenges In the Modern Workforce
The Aging Population From 2000 – 2020 the 55-64 year old age group will increase by 73% and the 65 and older
group will increase by 54% EEs over 40 are out of work on average 8-18 days longer than the younger worker 133 Million Americans live with Chronic disease and large portion of productivity, medical
costs and lost time are attributed to this growing population
Attracting and Retaining Younger Employees From 2000-2020 the 35-44 year old worker will decrease by 10% Do you live to work or work to live? The younger workforce demonstrates a higher utilization of intermittent FMLA
Ambiguous Impairments Depression claims have experienced double digit increases over the last 10 years Younger, less tenured, women are the most likely group to file a behavioral health claim The younger worker is 4xs more likely to RTW after a behavioral health claim There has been rise in other subjective disability claims Incidence related to the sandwich generation
There are Health and productivity program and integration solutions available to help address all of these areas of concern
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BUILDING THE BUSINESS CASESTEP 1.
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Company Research and Development - incidence and duration by division and diagnosis(2012 is through September 18)
Submitted in Average Submitted in Average Submitted in AveragePeriod (Paid) Duration Period (Paid) Duration Period (Paid) Duration
00133483-0001 4 2% 32.5 3 0% 74 1 0% 109PNNL bargaining 65 25% 51.4 83 13% 45 67 17% 53.800133483-0003 8 3% 55 6 1% 36.2 19PNNL non bargaining 176 69% 57.6 216 33% 64.2 137 36% 64.2BCO 3 1% 331 51% 48.7 175 46% 59.400133483-0006 14 2% 41.2 4 1% 43.4Totals 256 100% 55.4 653 100% 53.7 384 100% 60
Year2010 2011 2012
Policy-Division % column % column % column
Submitted in Average Submitted in Average Submitted in AveragePeriod (Paid) Duration Period (Paid) Duration Period (Paid) Duration
Circulatory 14 5% 59.5 36 6% 44.1 20 5% 64Digestive 19 7% 49.4 42 6% 34 27 7% 43.1Genitourinary 12 5% 53.9 39 6% 38.1 20 5% 44.4Infectious/ Parasitic 6 2% 31 11 2% 44.9 6 2% 39.4Injury/ Poisoning 34 13% 53.3 64 10% 54 54 14% 54.1Mental Disorder 15 6% 80.4 35 5% 92.6 14 4% 105.1Musculoskeletal/ Connective Tissue55 21% 67.2 134 21% 57.5 77 20% 65.6Nervous/ Sensory 11 4% 62 30 5% 54.4 18 5% 61.8Other 16 6% 37.2 34 5% 46.8 34 9% 63.9Pregnancy 37 14% 49.1 132 20% 52 80 21% 53.9Respiratory 16 6% 17.2 46 7% 24.4 11 3% 66Tumor 21 8% 79.9 50 8% 93.6 23 6% 66.1Totals 256 100% 55.4 653 100% 53.7 384 100% 60
Year2010 2011 2012
Diagnosis Group % column % column % column
Overall average duration has increased in 2012BCO has increased most significantlyMusculoskeletal and injury drive incidence and duration – those ICD-9s are primarily back, arthritis, sprains, fractures and dislocationsThe other category is primarily ill-defined symptoms that turn into more serious conditions such as heart. In addition there are about 5% vertigo and 2% ill-defined fatigue and pain
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Company Research and Development - bargaining and non-bargaining – age by top diagnosis
Submitted in AveragePeriod (Paid) Duration
Under 30 1 1% 6930 - 39 8 11% 6240 - 49 13 18% 86.450 - 59 30 41% 55.860 - 69 20 27% 69.370 Plus 1 1% 55Totals 73 100% 65.5
1/ 1/ 2011 - 9/ 18/ 2012
Age % column
Musculoskeletal non-bargaining
Submitted in AveragePeriod (Paid) Duration
Under 30 22 28% 6430 - 39 56 70% 50.740 - 49 2 3% 51.5Totals 80 100% 54.4
1/1/2011 - 9/18/2012
Age % column
Maternity non-bargaining
Submitted in AveragePeriod (Paid) Duration
Under 30 1 4% 8930 - 39 5 18% 17.340 - 49 11 39% 3750 - 59 9 32% 75.760 - 69 2 7% 122Totals 28 100% 55.8
1/ 1/ 2011 - 9/ 18/ 2012
Age % column
Musculoskeletal duration is driven by 40-49 age group with 50-59 age group being lower
Maternity duration hovers around 8 weeks driven by younger population longer claims
The union group duration by age is as expected – as age increases, duration increases
Injury - bargaining
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Current Cost and Potential Savings
Lost Work Day Impact
Current lost time 10% reduction
A. Total Lost Days (annualized per data analyzer) 34,152 30,000 1
Full Time Equivalent (FTE) ImpactB. F.T.E’s (A/260) 131 115 2
Indirect Productivity / Cost ImpactC. Average Salary $45,000
3$45,000
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D. Indirect Cost @ 100% (B x C) $5,910,9234
$5,192,3084
E. Direct Cost (B x C x 60% BenReplacement) $3,546,5545
$3,115,3855
Total $9,457,477 $8,307,692
Potential Savings
1.Manufacturing annualized STD lost time and 10% reduction.
2.FTEs out of work all year long as a result of STD
3. average salary.
4. Calculated by assuming 100% of direct costs. May include; hiring and training of replacement workers,
overtime, lower productivity from replacement workers, routine overstaffing
5. Direct costs at 60% of salary replacement.
$1,149,785
2012 Annualized
data
Expected TRTW impact
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WHAT ARE CORPORATE’S BIGGEST CONCERNS?
Question 1.
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Corporate’s biggest concerns/questions
How much time will this take? What are the commitments needed from my team and the locations?
Will it work… this is my reputation on the line!
What have you seen for ROI in the past?
What if we don’t do this?
How will we figure out payroll if employees are working part time?
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MAKING THE CASE TO THE LOCATIONSStep 2.
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The Pitch…
The Corporate Endorsement
Company ABC is experiencing over 131 full time equivalents out of work all year long as a result of short term disability
We spend over 9 million dollars a year from our bottom line in disability related costs
As result – we are piloting a Transitional RTW program and I have Consultant X on the line to walk through the specifics of that program and what it may mean to your organization
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Transitional Work
Transitional Return to Work Is:
•Based on the fact that employees do not regain 100% work capacity instantly. Recovery is incremental.•Time limited with a return to one’s own occupation •Successful through manager participation
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional Work
Absencefrom Work
Full work Capacity
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional WorkTransitional Work Transitional Work
Absencefrom work
Stay at work(preserve productivity)
Return to work(restore productivity)
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional Work
Absencefrom Work
Full work Capacity
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional WorkTransitional Work Transitional Work
Absencefrom work
Stay at work(preserve productivity)
Return to work(restore productivity)
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What are Transitional RTW Pathways?
A method of reducing lost time
A process to define functional capacity
What the employee is capable of doing within his or her own job
A strategy to reduce inconsistent and narrowly defined work site accommodations
A collection of agreed upon RTW pathways & options
A planning tool
A communication guide between employer, case manager/RTW Planner and physician
A method of documenting time limited accommodations offered and accepted
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Produce pathway options draft based on earlier discussions for testing out. Define impact on health and disability benefits, work status, and retirement status
What’s Possible?
Support
Apply
I ntroduction
Define readiness to develop pathways. I nitial Brainstorming session with: 1. Human
Resources 2. Employee 3. Physician To define options and secure buy-in.
Discuss with appropriate staff to identify likely adjustments, Challenges, barriers that may arise, as well as common restrictions, limitations, and discuss possible pathway options
Submit to HR & Conferences for review. Meet with conference managers to solicit feedback. Confirm with attending physician to determine medical readiness and include as part of treatment plan
Apply transitions Monitor on weekly basis Revise to reflect success and desired changes.
Theoretical to Actual
Apply
Establish Eligibility, as well as Entry/ Exit Criteria for Transitions (Prevent being stuck in permanent
light duty).
How to Build Pathways
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Transitional Work Example: Line Worker
Line worker who underwent back surgery and was out 6 weeks. It is recommended that the individual return to work incrementally return and time limit is 2 weeks to build up work capacity.
Return to
Work (restore productivity
)
Transitions Work
Absence from
Work
Full Work Capacity
Return to Work (restore
productivity )
Out of Work
Step 1:
20 hours/wkCross training
Step 2:
Work 40 hours per week On the line in a new rotation
Step 3:
Full time work capacity
Seek out assistance as needed
Full Work Transitions
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Sample Transitional RTW Pathways
Examples of Transitional return to work pathways for Manufacturing are below:
Restriction and
Limitations
Transitions – up to 1
week
Transitions up to 30 days
Reduce Lifting Assistance
Remove Tasks
Temporary Assignment
Alternate work assignment
ie, cycle counting,
inspections
Reduce Bend Twist Remove Tasks
Temporary Assignment
Alternate work assignment
ie, cycle counting,
inspections
Reduce
Stand/ Walk/ Climbing
Remove Tasks
Temporary Assignment
Alternate work assignment
ie, cycle counting,
inspections
Reduce Exposure to
targeted stressors
Remove Tasks
Temporary Assignment
Alternate work assignment
ie, cycle counting,
inspections
Reduced work hours Shift Change
Modify work hours
Shift Change
Modify work hours
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1/1/2011 – 12/21/2011 Sample - RTW Statistics 554 STD claims submitted and paid for 2011
182 claims went longer than 40 days in duration and for the review period (not including maternity)
212 reviews for RTW readiness during review period
48 RTW successes – RTW own occupation 32 Musculoskeletal/Injury 4 Nervous Sensory 3 Cancer 1 Other – (foot problem) 4 Digestive 1 Genitourinary 1 Infectious Disease 2 BH
2 RTW same ER, new occ – musculoskeletal, nervous/sensory
1 RTW plan not implemented, ER refused
2 RTW – release obtained
At least approximately 950 saved lost work days
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Dramatic Increase in Reviews & SLWDs quarter over quarter with increase in successes following… (Sample – Service Industry)
0
20
40
60
80
100120
140
160
180
200
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
TRTWReadinessReviews
TRTWSuccesses
Saved LostWork Days
Saved lost work days continue to rise – up to 185 for 4th quarter 1st qtr – 51, 2nd qtr – 70, 3rd qtr - 158
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SITE VISIT AND PROGRAM DEVELOPMENT
Step 3.
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Sample Site Visit Schedule
9:00 AM - 10:30 AM - Meet with HR Team to review critical issues and program guidelines
10:30 AM – 11:00 AM - Meet with SR. Operations to review program and ensure comfort level
11:00 AM - 12:00 PM - Meet with employees who have used the benefit within the last year (individual meetings – 15 minutes each)
12N – 12:30 PM – Lunch Break
12:30 – 2:00 PM - Tour of the facility
2:00 PM – 4:00 PM - Meet with representation of supervisors/managers in groups (1 hr sessions) 5-8 managers per hour is optimal.
4:00 PM - 4:30 PM - Question/Answer and review of visit. Discuss next steps with hosts
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WHAT ARE THE LOCATION’S BIGGEST CONCERNS?
Question 2.
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The location’s top concerns
I don’t want to buy a workers’ compensation claim! Prove it!
We don’t have “light duty”
How will we adjust productivity measures to ensure managers don’t get penalized for having a “light duty” worker
What if an employee is on heavy medication?
Now every employee is going to want to be on light duty!
I can’t have someone in my shop at less than 100% - the work is too physical, it is too dangerous!
Why wouldn’t I just pay OT or a temporary worker and get 100% output so that I ensure I meet my productivity goals!
What if patient care is negatively impacted because a less than 100% nurse couldn’t effectively respond in an emergency?
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MANAGER TRAINING Step 4/Question 3. Why?
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WITHOUT MANAGERS THERE IS NO PROGRAM!
Question 3. Answer
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Agenda
Transitional Return To Work (TRTW) Philosophy
Company’s TRTW Program
Location Statistics
What We Have Done so Far / Site Visits
Responsibilities
Process for the TRTW Program
Transitional Return to Work Pathways / Modification Options
Pay While on TRTW
RTW Tracking
Contacts / What’s Next
Questions
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Rationale for the Transitional Return to Work Program
Productivity & Staffing
Lost time disrupts operations and productivity leading to overtime or work not being completed. • Leads to a drain on operations and overall EE well being.
Operations already functions on a skeleton crew
Organizational Consistency
Ensure employees are offered the same opportunity for transitional return to work when appropriate
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Transitional Work
Employees do not regain 100% work capacity instantly. Recovery is incremental.
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional Work
Absencefrom Work
Full work Capacity
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional WorkTransitional Work Transitional Work
Absencefrom work
Stay at work(preserve productivity)
Return to work(restore productivity)
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional Work
Absencefrom Work
Full work Capacity
Stay at Work(preserve productivity)
Return to Work(restore productivity)
Transitional Work Transitional WorkTransitional Work Transitional Work
Absencefrom work
Stay at work(preserve productivity)
Return to work(restore productivity)
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Site Visits – Location 1 and Location 2
Purpose
Met with managers and supervisors to introduce the TRTW program and gain insight into potential barriers or issues with the program
Toured facilities to fully understand job requirements
Findings
Order builders and night shift workers have the most lost time issues
Two to four week transition plans are optimal
Part-time to full-time transitional work preferred
Job modifications possible to a degree – preferable that TRTW plans do not include “light duty” assignments typically given following occupational injuries
Some managers not aware that STD costs are currently paid for through payroll budgets TRTW will increase employee productivity
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Company RTW Coordinator Responsibilities
Discuss the RTW plan with the Return to Work Liaison (Vocational Consultant)
Discuss the RTW plan with the Employee’s Manager
Follow up with the Unum RTW Liaison with regard to the feasibility of the plan
Be available to discuss progress with the Employee’s manager
Contact the RTW Liaison if questions with the plan arise
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Company Manager/Supervisor Responsibilities
Discuss the RTW plan with and give feedback to Company RTW Coordinator
Verify the employee is scheduled to work the number of hours agreed upon in the TRTW plan
Meet with the Employee to discuss the plan upon the first day of transitional work
Meet with the Employee daily or weekly to discuss progress and ability to move on to the next step in the RTW plan
Follow up with company RTW Coordinator for your location if progress is not moving as expected
HR is only involved in the initial set up of the program or when escalated issues arise
HR is only involved in the initial set up of the program or when escalated issues arise
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Sample TRTW Plan
Transitional Return to Work Plan
Employee Name_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Manager Name_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date of Disability_ _ 4/ 1/ 2010_ Transitional RTW Date 7/ 1/ 2010 Expected Full Time RTW Date 7/ 24/ 2010 Department: Warehouse – Order Builder Actual FT RTW Date_ _ _ _ _ _ _ _ _ _ Restrictions and Limitations: part to full hours for 2 weeks, no lifting greater than 30lbs for 1 weeks with gradual increase to full lifting duties over the next week, and limited bending for first week back in warehouse
Sign off Initials
Timeframe Accommodation Expectations Results MGR EE
Week 1
Reduced work hours Alternate work
assignment
Work 4 hour shift Work in POS
Week 2
Reduced work hours Temporary Assignment
Works 4 hours Work Tygard Pallets
Week 3
Reduced work hours Temporary Assignment
Work 6 hours Work Tygard 4 hours of the
shift
Week 4 Full Capacity
Resume use of screw gun Seek out assistance as needed
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RETURN ON INVESTMENT CASE STUDIES
Step 5.
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Hospital – Case Study
The Challenge
1200 life hospital group with high STD and LTD incidence and longer than expected STD durations
Action steps
Performed Lost Analysis to determine areas of opportunity
Implemented structured TRTW program with TRTW pathways
Enhanced partnership through program solutions with claims teams
Outcomes
7 day reduction in STD durations 6 months over 6 months
79% reduction in flow through rate year over year
450 saved lost work days saved in less than one year
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RTW Development – Hospital A Duration comparison
55.8
53.7
50.6
48.5
20 30 40 50 60 70
2/1/08 -8/31/08
8/1/2007-1/31/2008
2/1/2007-7/31/2007
8/1/2006-1/31/2007
*All duration experience above includes the STD elimination period and expected is based on plan design, industry, and demographics
Expected Duration = 55 Days
Consistent improvement during review period
* Pilot TRTW program began 2/1/2007
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The Call Center Challenge
Call center environment with high incidence of Behavioral Health claims with higher than average durations
High level of frustration among management due to high incidental absence and the subjective nature of behavioral health claims
No structured return to work program
Increased employee anxiety around return to work
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Transitional Return to Work ProgramImplemented May 2009
Length of Transition Plans are more than 2 weeks and up to 30 days
o Reduce Work Hours Shift change Modify Work Schedule Increase Breaks
o Reduce Exposure to Targeted Stressors Training Project work Coaching
o Alternate sit/stand sit and stand as is necessary at their desks Training Project work Coaching
o Reduce Keying Training Coaching
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Sample Transitional RTW Plan – Major Depression
Prescribed Restrictions and Limitations: Reduced phone time for first day and then part time to full time hours over 2 week period Length of Transitional Work: 2 weeks Sign off I nitials
Timeframe Strategy Application Outcome MGR EE
Day 1
Training Modified Work Schedule
Catch up on emails Catch up on product updates Listen in with another EE Work 4 hours
Day 2-5
Modified Work Schedule
Resume regular position 4 hours per shift
Day 6-10
Modified Work Schedule
Work 6 hours per shift – regular position
Day 11
Modified Work Schedule
Return to full capacity
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Transitional Return to Work (TRTW)and Behavioral Health (BH) Case Management
Call Center Data Pre Implementation(10/1/08 – 9/30/09)
Post Implementation(10/1/09 – 9/30/10)
BH STD Claims 27 18
Average Duration of BH STD Claims
88 days 86 days
STD BH Claims Transitioning to LTD
6 2
BH TRTW Successes 0 7
FTEs out of work all year due to BH STD
7 4
Lost Time (Cost)/Savingsfor BH STD
($341,000) $119,000
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THE AMENDMENT TO THE ADA
A New Reason for Employer’s to Consider Transitional RTW
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Top 5 ADAAA Mistakes
1. Failure to identify essential functions
2. Failure to engage in the interactive process
3. Failure to accommodate
4. Adopting inflexible leave policies
5. Disregarding privacy rights
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Recent ADA violations
Sears
September 2009: EEOC reached a $6.2 million settlement with Sears, Roebuck & Co. based on an alleged policy of failing to accommodate employees after leave
Supervalu
January 2011: EEOC reached $3.2M settlement with Supervalu Inc. based on alleged policy of terminating employees at the end of medical leaves of absence instead of bringing them back to work with reasonable accommodations and failure to allow employees to participate in light duty programs if they were not injured on the job.
JP Morgan
November 2009: EEOC reached a $2.2M settlement with JPMorgan Chase to settle a class action suit alleging that employees were terminated after they exhausted six-month medical leaves without any analysis of whether it was possible to accommodate their limitations so that they could return to work.
