a new paradigm for workers’ compensation & disability benefits systems: the work disability...

A New Paradigm for Workers’ A New Paradigm for Workers’

Compensation & Disability Compensation & Disability

Benefits Systems: The Work Benefits Systems: The Work

Disability Prevention ModelDisability Prevention Model

Jennifer Christian, MD, MPHJennifer Christian, MD, MPH

The 60 Summits Project & Webility Corporation The 60 Summits Project & Webility Corporation

© 2007 60 Summits Project, Inc. © 2007 60 Summits Project, Inc.

Plan for This SessionPlan for This Session

Clarify terms / avoid confusionClarify terms / avoid confusion

Introduce another ACOEM GuidelineIntroduce another ACOEM Guideline

Create the possibility of “first class”Create the possibility of “first class”

Lay out its recommendationsLay out its recommendations

Compare the traditional vs. new Compare the traditional vs. new paradigmparadigm

Introduce the 60 Summits ProjectIntroduce the 60 Summits Project

ACOEM’s ACOEM’s New Guideline: Guideline:

“Preventing Needless “Preventing Needless Work Disability by Helping Work Disability by Helping People Stay Employed” People Stay Employed”


2 Different Guidelines2 Different Guidelines

Treatment guidelines:Treatment guidelines:

– ACOEM Occupational Medicine PRACTICE ACOEM Occupational Medicine PRACTICE Guidelines – >300 pp ($$ - books, online) Guidelines – >300 pp ($$ - books, online)

TODAY’S FOCUSTODAY’S FOCUS: :

– ACOEM Work Disability Guideline – 20 pp (free ACOEM Work Disability Guideline – 20 pp (free on website)on website)


Reactions to the Guideline Reactions to the Guideline

Embodies a new paradigm for Embodies a new paradigm for workers’ compensation and disability workers’ compensation and disability benefits systems. benefits systems.

An easy-to-read, clear blueprint for An easy-to-read, clear blueprint for process improvement. process improvement.

A framework for building a shared A framework for building a shared positive vision across traditional positive vision across traditional boundaries. boundaries.

Unofficial commentsUnofficial comments on on ACOEM’s Work Disability ACOEM’s Work Disability

Prevention GuidelinePrevention Guideline

(not speaking (not speaking on behalf of ACOEM)on behalf of ACOEM)


Result: Needless Work Disability, Job Loss, & Iatrogenic Invalidism

DelayDelayUncertaintyUncertainty

DelayUncertainty

Medical Offices Workplaces

“not mine: this IS medical”

“not mine: NOT a medical issue”

SAW / RTW Communications Gap


What is “Work Disability”What is “Work Disability”

““Medically-related” time away from work or on “light Medically-related” time away from work or on “light duty” with less than full productivity.duty” with less than full productivity.

May be temporary or permanent, and last hours, May be temporary or permanent, and last hours, days, weeks, months or years.days, weeks, months or years.

May be permanent withdrawal from the workforce.May be permanent withdrawal from the workforce.

NOT impairment, NOT handicap, NOT THE SAME NOT impairment, NOT handicap, NOT THE SAME as “disability” under the ADA or SSA. as “disability” under the ADA or SSA.


Needless Work DisabilityNeedless Work Disability

Employee:Employee: Is harmful. Disrupts daily life, Is harmful. Disrupts daily life, threatens career and self-esteem, leads to threatens career and self-esteem, leads to iatrogenic invalidism. iatrogenic invalidism.

Employer:Employer: Is disruptive and costly. Reduces Is disruptive and costly. Reduces productivity, creates unnecessary hassle and productivity, creates unnecessary hassle and expense.expense.

Economy:Economy: Is wasteful. Diverts dollars from Is wasteful. Diverts dollars from productive use, invites petty fraud and productive use, invites petty fraud and corruption, reduces economic efficiency.corruption, reduces economic efficiency.


What is Disability Prevention?What is Disability Prevention?

NOTNOT injury prevention / safety injury prevention / safety – Primary prevention (don’t let it happen)Primary prevention (don’t let it happen)

Work disability prevention: Work disability prevention: NOW MISSINGNOW MISSING

– Secondary prevention (keep little things little)Secondary prevention (keep little things little)– Avoid poor outcomes – “back in the saddle”Avoid poor outcomes – “back in the saddle”

NOTNOT traditional return to work programs traditional return to work programs – Tertiary prevention (mitigate the damages)Tertiary prevention (mitigate the damages)– Rescue and rehab Rescue and rehab

Shift the Focus: Shift the Focus:

Is This Work Disability Is This Work Disability Medically Required? Medically Required?

How Can It Be Averted? How Can It Be Averted?


Work Disability Prevention = Work Disability Prevention = Reduce Needless AbsenceReduce Needless Absence

Medically Medically REQUIREDREQUIREDDisabilityDisability

MedicallyMedicallyDISCRETIONARYDISCRETIONARY

DisabilityDisabilityMedically Medically

UNNECESSARY UNNECESSARY DisabilityDisability


Disability Prevention Disability Prevention VisionVision

Usual level of

function

Employeefacing a new

challenge

Employee & Supervisor have coped with the new

challenge

Employee & Supervisor feel supported by the web the parties weave.

TreatingTreating ProvidersProviders

HealthPlan

HR / BenefitsDisability Benefits Payer

Work Disability Prevention Team

Safety

Minimum Time

ManagementManagement

Occ HealthWellness

Workers Comp Payer

Operations

Claims and Case ManagersClaims and Case Managers


History of GuidelineHistory of Guideline

Developers are all ACOEM members: Developers are all ACOEM members:

– 7 specialties (OM, OS, IM, FP, PM&R, P, EM)7 specialties (OM, OS, IM, FP, PM&R, P, EM)– 15 US states and Canada15 US states and Canada– Private practice, government, academia, heavy Private practice, government, academia, heavy

industry, workers’ comp & disability insurersindustry, workers’ comp & disability insurers

Collaborative, consensus-seeking methodCollaborative, consensus-seeking method

Adopted by ACOEM in May 2006Adopted by ACOEM in May 2006

Frequently confused with practice guidelinesFrequently confused with practice guidelines


Why Was Guideline Developed?Why Was Guideline Developed?

Share our unique perspective Share our unique perspective – Trained to tell medical from non-medicalTrained to tell medical from non-medical– Play a role in all benefits systems Play a role in all benefits systems – See well- vs. poorly-managed situationsSee well- vs. poorly-managed situations

> $200 billion and growing in payouts > $200 billion and growing in payouts

Loss of people to the economy who could Loss of people to the economy who could otherwise remain productiveotherwise remain productive

Aging workforce: Aging workforce: – Doubling % of people on SSA Doubling % of people on SSA


Purpose of ACOEM GuidelinePurpose of ACOEM Guideline

To describe the Stay-at-Work and Return-To describe the Stay-at-Work and Return-to-Work (SAW/RTW) process for the first to-Work (SAW/RTW) process for the first time.time.

To point out opportunities for improvement To point out opportunities for improvement and provide examples of current best and provide examples of current best practices.practices.

To support on-going dialogue among all To support on-going dialogue among all the stakeholders.the stakeholders.


Format of the GuidelineFormat of the Guideline

Introductory MaterialIntroductory Material

Orientation to SAW / RTW ProcessOrientation to SAW / RTW Process– How the SAW / RTW process worksHow the SAW / RTW process works– Variability of medical conditions and their Variability of medical conditions and their

impact on workimpact on work– The relationship of SAW / RTW process to The relationship of SAW / RTW process to

other processesother processes

Findings and RecommendationsFindings and Recommendations– Observations, discussion, examples of best Observations, discussion, examples of best

practicespractices


Why This is UnusualWhy This is Unusual

Expert physicians speaking to all stakeholdersExpert physicians speaking to all stakeholders

Physicians are in best place to distinguish Physicians are in best place to distinguish medical from non-medicalmedical from non-medical

Focus is on “secondary prevention”Focus is on “secondary prevention”

Highlighting a “gap” Highlighting a “gap” – Doctors think it’s not their business – it’s not Doctors think it’s not their business – it’s not

medical. medical. – Employers think it’s not their business – it’s Employers think it’s not their business – it’s

medical. medical.

The SAW / RTW ProcessThe SAW / RTW Process



SStay tay AAt t WWork / ork / RReturn eturn TTo o WWork Processork Process

A sequence of questions, actions, and decisions A sequence of questions, actions, and decisions made separately by several parties that together made separately by several parties that together determines whether a worker stays at work despite determines whether a worker stays at work despite a medical condition or whether, when, and how a a medical condition or whether, when, and how a worker returns to work during or after recovery. worker returns to work during or after recovery.

Often stalls or becomes sidetracked because the Often stalls or becomes sidetracked because the focus is on corroborating, justifying, or evaluating focus is on corroborating, justifying, or evaluating disability rather than preventing it.disability rather than preventing it.



SStay tay AAt t WWork / ork / RReturn eturn TTo o WWork Processork Process

A A sequence of questions, actions, and sequence of questions, actions, and decisionsdecisions mademade separately by several partiesseparately by several parties that together determinesthat together determines whether a worker whether a worker stays at work despite a medical condition or stays at work despite a medical condition or whether, when, and how a worker returns to whether, when, and how a worker returns to work during or after recovery. work during or after recovery.


Five Parallel ProcessesFive Parallel Processes

1.1. SAW / RTWSAW / RTW

2.2. Personal adjustmentPersonal adjustment

3.3. Medical careMedical care

4.4. Benefits administrationBenefits administration

5.5. ADA reasonable accommodationADA reasonable accommodation


The employee has the most The employee has the most power to determine the eventual power to determine the eventual outcome of a work disability outcome of a work disability situation –situation –

. . . because he or she decides . . . because he or she decides how much discretionary effort to how much discretionary effort to make to get better and make to get better and

get life back to normal.get life back to normal.


The employer plays the The employer plays the second most powerful role in second most powerful role in determining the outcome –determining the outcome –

. . . by deciding whether to . . . by deciding whether to manage the employee’s situation manage the employee’s situation actively, passively, supportively, actively, passively, supportively, or hostilely, and whether to or hostilely, and whether to provide for on-the-job recovery.provide for on-the-job recovery.


The doctor has the next most The doctor has the next most powerful influence on the powerful influence on the situation by providing factual situation by providing factual information and advice that will information and advice that will either encourage / support or either encourage / support or discourage / obstruct efforts at discourage / obstruct efforts at SAW/RTW. SAW/RTW.


““Designated Guessers”Designated Guessers”

Why are doctors put in the middle? Why are doctors put in the middle? – Pressed into service by others Pressed into service by others – Neither trained nor rewarded to do it wellNeither trained nor rewarded to do it well– Often the best available choiceOften the best available choice

Doctors are uncomfortable with this work Doctors are uncomfortable with this work – Sworn to be patient advocatesSworn to be patient advocates– A guess is required; evidence is weakA guess is required; evidence is weak– The questions are often NOT answerable with The questions are often NOT answerable with

typical information provided typical information provided


Result: Needless Work Disability, Job Loss, & Iatrogenic Invalidism

DelayDelayUncertaintyUncertainty

little information sharingno workplace knowledge

low priority unpaid “paperwork”

DelayUncertainty

Medical Offices Workplaces

“not mine: this IS medical”“not mine: NOT a medical issue”

SAW / RTW Communications Gap

abandoned employeesunhelpful guidance

unaware of employer’s situation

lack of expertise lack of expertise

unaware of doctor’s situation

low priority “paperwork”

The 16 Recommendations The 16 Recommendations from from

ACOEM’s Work Disability ACOEM’s Work Disability Prevention GuidelinePrevention Guideline


Listen from a New AngleListen from a New Angle

What would “first class” look like in What would “first class” look like in Workers’ Compensation?Workers’ Compensation?

What would “premier quality” service What would “premier quality” service look like to ill, injured, and aging look like to ill, injured, and aging workers (and their supervisors)?workers (and their supervisors)?


Relative Earnings of PPD Claimants as a Relative Earnings of PPD Claimants as a Proportion of Comparison Workers EarningsProportion of Comparison Workers Earnings

SOURCE: Reville, et al. 2001a, p. 48.


BadBad

GoodGood

Good, unless . . . .

Bad, unless . . .

Focus On The “Swing” Groups


What Do The “Swing Groups” What Do The “Swing Groups” Want / Need?Want / Need?

Injured workersInjured workers– Surprised by injurySurprised by injury– Life and work disruptionLife and work disruption– Discomfort; uncertain about medical careDiscomfort; uncertain about medical care– Vulnerable; concerned for safety / comfortVulnerable; concerned for safety / comfort– Uncertainty about the futureUncertainty about the future

Their supervisorsTheir supervisors– Workplace disruptionWorkplace disruption– Personnel management issues Personnel management issues


4 General and 16 Specific 4 General and 16 Specific RecommendationsRecommendations

1.1. Adopt a disability prevention model.Adopt a disability prevention model.

2.2. Address behavioral and circumstantial Address behavioral and circumstantial realities that create or prolong disability.realities that create or prolong disability.

3.3. Acknowledge the powerful contribution that Acknowledge the powerful contribution that motivation makes to outcomes, and make motivation makes to outcomes, and make changes to improve incentive alignment.changes to improve incentive alignment.

4.4. Invest in system and infrastructure Invest in system and infrastructure improvements. improvements.


1. Adopt a Disability Prevention 1. Adopt a Disability Prevention ModelModel

Increase awareness of how rarely work Increase awareness of how rarely work disability is medically-REQUIRED.disability is medically-REQUIRED.

Urgency is required because prolonged Urgency is required because prolonged time away from work is harmful. time away from work is harmful.

Shift the Focus: Shift the Focus:

Is This Work Disability Is This Work Disability Really Necessary?Really Necessary?

How Can It Be Averted? How Can It Be Averted?

Shift the Focus:Shift the Focus:

Is This Work Disability Is This Work Disability Medically Required?Medically Required?

How Can We Prevent It?How Can We Prevent It?


Results of FirstResults of FirstPhysician SurveyPhysician Survey

THE KEY QUESTION: Based on your THE KEY QUESTION: Based on your

clinical experience, what fraction of clinical experience, what fraction of

workers with workers with work-related injuries and work-related injuries and

illnessesillnesses who seek medical care really who seek medical care really

needneed to be off work for more than a to be off work for more than a

couple of days for couple of days for strictly medical strictly medical

reasons? reasons?


Workers’ Compensation Cases Workers’ Compensation Cases Requiring More Than Requiring More Than

A Couple of Days A Couple of Days Lost From WorkLost From Work

MD OpinionMD Opinion90% of surveyed doctors 90% of surveyed doctors

said <10% of cases said <10% of cases

50% of surveyed doctors 50% of surveyed doctors said <5% of cases said <5% of cases

ActualActual

25% - 30% 25% - 30% of cases of cases


Results of Second Results of Second Physician SurveyPhysician Survey

THE KEY QUESTION: What fraction of THE KEY QUESTION: What fraction of

your patients with a condition that is your patients with a condition that is not not

work-relatedwork-related and who have and who have asked you asked you

to sign a form excusing them from workto sign a form excusing them from work

really really neededneeded to be off work for more to be off work for more

than a couple of days for than a couple of days for strictly medical strictly medical

reasonsreasons??


Non-Occupational Cases Non-Occupational Cases Requiring More Than Requiring More Than

A Couple of Days A Couple of Days Away From WorkAway From Work

MD OpinionMD Opinion80% of surveyed doctors 80% of surveyed doctors

said <10% of cases said <10% of cases

54% of surveyed doctors 54% of surveyed doctors said < 5% of cases said < 5% of cases

ActualActual

100% of cases100% of cases


Disability Is Medically-Disability Is Medically-REQUIRED When . . .REQUIRED When . . .

Attendance is required at place of careAttendance is required at place of care

Recovery requires confinement at home or in Recovery requires confinement at home or in bedbed – Acute response to injuryAcute response to injury– Risk of contagion - QuarantineRisk of contagion - Quarantine– Need for protected environmentNeed for protected environment

Work or commute is medically-contraindicatedWork or commute is medically-contraindicated– Will worsen medical condition or delay recoveryWill worsen medical condition or delay recovery


Disability Is Medically- Disability Is Medically- DISCRETIONARY When . . .DISCRETIONARY When . . .

Could do something useful but . . . .Could do something useful but . . . .

““No way to get worker to work” No way to get worker to work” ““Worker is incapable of any substantial work”Worker is incapable of any substantial work”““Effort required to support the worker is more Effort required to support the worker is more than makes sense”than makes sense”““Can’t figure out how to provide work within Can’t figure out how to provide work within these limitations”these limitations”““Company policy / labor contract prohibits light Company policy / labor contract prohibits light duty”duty”


Disability is Medically-Disability is Medically-UNNECESSARY When . . .UNNECESSARY When . . .

Medical care is inadequate or delayedMedical care is inadequate or delayed

““Medical” time lost from work is really due Medical” time lost from work is really due to:to:– Communications delay / poor information flowCommunications delay / poor information flow– Ignorance or resistance (patient, employer, Ignorance or resistance (patient, employer,

doctor)doctor)– Administrative / procedural delayAdministrative / procedural delay– Other problems masquerading as medicalOther problems masquerading as medical– Flabby management, poor accountabilityFlabby management, poor accountability


1 Minute RTW Screening 1 Minute RTW Screening TestTest

1.1. What impact is the problem What impact is the problem with your ________ going to with your ________ going to have on your ability to do your have on your ability to do your usual job the regular way?usual job the regular way?

2.2. Have you figured out a way to Have you figured out a way to work around it while you work around it while you recover?recover?

3.3. Are you going to have any Are you going to have any problems with your boss or co-problems with your boss or co-workers about that? workers about that?

No YESYES

Yes NONO

No YESYES

No/low risk Risk/referRisk/refer


Restrictions and LimitationsRestrictions and Limitations

RESTRICTIONSRESTRICTIONS

A MEDICAL issueA MEDICAL issueRISK - What the worker RISK - What the worker SHOULD NOT doSHOULD NOT doWhat the employer What the employer SHOULD doSHOULD doMay be modified only by May be modified only by the MDthe MDIf not followed, medical If not followed, medical harm may occur. harm may occur.

LIMITATIONSLIMITATIONS

An ABILITY issue An ABILITY issue CAPACITY - What the CAPACITY - What the worker CAN do todayworker CAN do todayMD is serving as an MD is serving as an objective assessor objective assessor May be modified by May be modified by agreementagreementLittle/no medical harm if Little/no medical harm if not followednot followed

Are chronic pain and fatigue Are chronic pain and fatigue really medical issues – really medical issues – or humanitarian ones? or humanitarian ones?

“Tolerance” “Tolerance”


The Grocery Store The Grocery Store TestTest

If s/he owned his/her own “mom ‘n pop” If s/he owned his/her own “mom ‘n pop” grocery store, would s/he be able to find grocery store, would s/he be able to find a way to work safely?a way to work safely?

If YES, then absence from work is If YES, then absence from work is probably not probably not medicallymedically required. required.

That means a NON-MEDICAL aspect of That means a NON-MEDICAL aspect of this situation, not the medical this situation, not the medical condition, is creating the disability.condition, is creating the disability.


Time Is Of The EssenceTime Is Of The Essence

0

20

40

60

80

100

0 4 8 12 16 20 24 28 32 36 40 44 48 52

Time away from work in weeks

% EVER RTWAt 12 weeks, employees have only a 50% chance of ever

returning to work.


Work Disability Prevention = Work Disability Prevention = Reduce Needless AbsenceReduce Needless Absence

Medically Medically REQUIREDREQUIREDDisabilityDisability

MedicallyMedicallyDISCRETIONARYDISCRETIONARY

DisabilityDisabilityMedically Medically

UNNECESSARY UNNECESSARY DisabilityDisability


2. Address Behavioral and 2. Address Behavioral and Circumstantial RealitiesCircumstantial Realities

People’s normal human reactions need People’s normal human reactions need to be acknowledged and dealt with.to be acknowledged and dealt with.

Investigate and address social and Investigate and address social and workplace realities.workplace realities.

Find a way to address psychiatric Find a way to address psychiatric conditions effectively.conditions effectively.


3. Acknowledge Motivation3. Acknowledge Motivation and Align Incentives and Align Incentives

Pay doctors for disability prevention work Pay doctors for disability prevention work to increase their commitment to it. to increase their commitment to it.

Support appropriate patient advocacy by Support appropriate patient advocacy by getting treating doctors out of a loyalties getting treating doctors out of a loyalties bind.bind.

Increase availability of on-the-job recovery Increase availability of on-the-job recovery and transitional work.and transitional work.


3. Acknowledge Motivation 3. Acknowledge Motivation and Align Incentives and Align Incentives (cont’d)(cont’d)

Reduce distortion of the medical treatment Reduce distortion of the medical treatment process by hidden financial agendas. process by hidden financial agendas.

Be rigorous, fair and kind to reduce minor Be rigorous, fair and kind to reduce minor abuses and cynicism.abuses and cynicism.

Devise better strategies to deal with bad Devise better strategies to deal with bad faith behavior. faith behavior.


4. Invest in System and 4. Invest in System and Infrastructure ImprovementsInfrastructure Improvements

Educate physicians on how to play their Educate physicians on how to play their role in preventing disability. role in preventing disability.

Disseminate evidence on the benefits Disseminate evidence on the benefits for recovery of staying active and at for recovery of staying active and at work.work.


4. Invest in System and 4. Invest in System and Infrastructure Improvements Infrastructure Improvements (cont’d)(cont’d)

Improve and standardize methods of Improve and standardize methods of information exchange between information exchange between employers / payers and medical offices.employers / payers and medical offices.

Improve and standardize the methods Improve and standardize the methods and tools that provide data for and tools that provide data for SAW/RTW decision-making.SAW/RTW decision-making.

Increase the study of and knowledge Increase the study of and knowledge about SAW/RTW. about SAW/RTW.

CompareCompareTraditional ParadigmTraditional Paradigm(Claims Processing)(Claims Processing)

vs. vs. New ParadigmNew Paradigm

(Work Disability Prevention) (Work Disability Prevention)


Traditional Assumptions Underlie Traditional Assumptions Underlie the Claims Processing Paradigm the Claims Processing Paradigm

1.1. When they are injured, people will receive When they are injured, people will receive appropriate medical care and will know how to appropriate medical care and will know how to manage the life and work disruption that goes manage the life and work disruption that goes along with it. along with it.

2.2. Since workers’ comp is a medically-driven Since workers’ comp is a medically-driven legal system, our main job is to observe and legal system, our main job is to observe and evaluate the situation, administer the law, and evaluate the situation, administer the law, and pay benefits when they are due.pay benefits when they are due.


Traditional Assumptions (cont’d)Traditional Assumptions (cont’d)

3.3. Work absence or disability is necessary after Work absence or disability is necessary after illness and injury. The duration of work illness and injury. The duration of work absence reflects the severity of the illness or absence reflects the severity of the illness or injury.injury.

4.4. Work avoidance assists in recovery from Work avoidance assists in recovery from illness or injury, so it is good. illness or injury, so it is good.

5.5. Tragic situations and “bad people” cause most Tragic situations and “bad people” cause most loss costs. loss costs.


New Assumptions Underlie the New Assumptions Underlie the Work Disability Prevention Work Disability Prevention

ParadigmParadigm

1.1. Much of today’s work disability could be Much of today’s work disability could be foreshortened or averted entirely because foreshortened or averted entirely because work absence is usually work absence is usually notnot medically required medically required for more than a few days after illness and for more than a few days after illness and injury. injury.

2.2. Being active during convalescence speeds Being active during convalescence speeds recovery, while extensive work avoidance and recovery, while extensive work avoidance and “rest” tend to delay it. “rest” tend to delay it.


New Assumptions (cont’d)New Assumptions (cont’d)

3.3. Prolonged absence or permanent withdrawal Prolonged absence or permanent withdrawal from work is usually bad for people’s well-from work is usually bad for people’s well-being -- mental, physical, social and being -- mental, physical, social and economic. economic.

4.4. Prolonged withdrawal from work is usually Prolonged withdrawal from work is usually being driven by non-medical factors instead of being driven by non-medical factors instead of medical ones, especially lack of suitable work.medical ones, especially lack of suitable work.


New Assumptions (cont’d)New Assumptions (cont’d)5.5. Today, many people may need instruction, Today, many people may need instruction,

advice, or even one-on-one assistance in:advice, or even one-on-one assistance in:– how to navigate the healthcare system; how to navigate the healthcare system; – how to select doctors who provide effective care; how to select doctors who provide effective care; – how to cope best with a health-related employment how to cope best with a health-related employment

situation.situation.

6.6. The majority of problematic high cost claims The majority of problematic high cost claims begin as innocuous appearing medical problems, begin as innocuous appearing medical problems, and "go south" because of the way non-medical and "go south" because of the way non-medical aspects of the situation have been handled.aspects of the situation have been handled.


Sad SamSad Sam Lucky LouLucky LouBad disc; surgeryBad disc; surgery

Mediocre work historyMediocre work history

Weak supervisorWeak supervisor

Supervisor never called:Supervisor never called:“They will handle it”“They will handle it”

Teasing by co-workersTeasing by co-workers

Disabling doctorDisabling doctor

““Stay home until you’re able Stay home until you’re able to do your job.”to do your job.”

PERMANENTPERMANENTDISABILITYDISABILITY

Bad disc; surgeryBad disc; surgery

Mediocre work historyMediocre work history

Good supervisorGood supervisor

Supervisor kept in touch: “We Supervisor kept in touch: “We need you”need you”

Support from co-workersSupport from co-workers

Function-oriented MDFunction-oriented MD

““Stay active; be useful”Stay active; be useful”

Transitional duty; adaptive Transitional duty; adaptive equipmentequipment

BACK TO WORK IN 6 BACK TO WORK IN 6 WEEKSWEEKS

About About The 60 Summits ProjectThe 60 Summits Project


HistoryHistory

ACOEM WDP Guideline approvedACOEM WDP Guideline approved

Now what?Now what?

Create a mechanism to get the Create a mechanism to get the recommendations ADOPTED and IN USErecommendations ADOPTED and IN USE

Not an ACOEM projectNot an ACOEM project

First an impulse, now a non-profitFirst an impulse, now a non-profit


The IdeaThe Idea

Goal: Propagate the new paradigm across Goal: Propagate the new paradigm across North America.North America.

Create a mechanism to get the guidelines Create a mechanism to get the guidelines off the paper and into action.off the paper and into action.

Convene meetings in 50 US states Convene meetings in 50 US states ++ 10 10 Canadian provinces Canadian provinces

At the Summits, get people inspired, At the Summits, get people inspired, collaborating, and then get them in action collaborating, and then get them in action creating positive changecreating positive change


How Does It Work? How Does It Work? Feasibility SessionFeasibility Session– Local team decides to hold a SummitLocal team decides to hold a Summit

Planning Phase Planning Phase – Local team plans event and invites stakeholdersLocal team plans event and invites stakeholders

The Summit MeetingThe Summit Meeting– Multi-stakeholder event; workshop format Multi-stakeholder event; workshop format – Use the Guideline as a discussion frameworkUse the Guideline as a discussion framework– Small groups consider each recommendationSmall groups consider each recommendation

Do we want to do this? How can we make it happen? Do we want to do this? How can we make it happen? What is a concrete first step? What starts tomorrow?What is a concrete first step? What starts tomorrow?

Follow-up groups – Make it happen!Follow-up groups – Make it happen!


Progress to DateProgress to Date

Summits already held (2006 -8) : Summits already held (2006 -8) : – OR (2), NM, Northern CA, ND (4), MNOR (2), NM, Northern CA, ND (4), MN

Summits scheduled (2008): Summits scheduled (2008): – OH, MT (3), AZ, FLOH, MT (3), AZ, FL

New Summit planning groups: New Summit planning groups: – BC, MA, MI BC, MA, MI

Next states: Next states: – TX, TN, ME, SC?TX, TN, ME, SC?


RecapRecap

ACOEM’s Work Disability Prevention ACOEM’s Work Disability Prevention GuidelineGuideline– A new (improved) paradigmA new (improved) paradigm– A blueprint for process improvementA blueprint for process improvement– A framework for building:A framework for building:

a shared positive visiona shared positive vision

a “first class” workers’ compensation systema “first class” workers’ compensation system

The 60 Summits ProjectThe 60 Summits Project– A mechanism to propagate the new paradigmA mechanism to propagate the new paradigm


How to Prevent Needless Work How to Prevent Needless Work Disability In ANY Kind of ClaimDisability In ANY Kind of Claim

1.1. Speed recovery from the medical Speed recovery from the medical condition itself by reducing delays and condition itself by reducing delays and increasing the quality of care. increasing the quality of care.

2.2. Restore or strengthen the worker’s Restore or strengthen the worker’s motivation and ability / willingness to cope.motivation and ability / willingness to cope.

3.3. Arrange workplace and logistical support Arrange workplace and logistical support to enable on-the-job recovery (stay-at-to enable on-the-job recovery (stay-at-work or return-to-work).work or return-to-work).


Disability Prevention Disability Prevention VisionVision

Usual level of

function

Employeefacing a new

challenge

Employee & Supervisor have coped with the new

challenge

Employee & Supervisor feel supported by the web the parties weave.

TreatingTreating ProvidersProviders

HealthPlan

HR / BenefitsDisability Benefits Payer

Work Disability Prevention Team

Safety

Minimum Time

ManagementManagement

Occ HealthWellness

Workers Comp Payer

Operations

Claims and Case ManagersClaims and Case Managers


Where To Learn MoreWhere To Learn More

ACOEM’s new guideline on ACOEM’s new guideline on Work Disability Prevention: Work Disability Prevention:

www.acoem.org www.acoem.org www.60summits.orgwww.60summits.org

The 60 Summits ProjectThe 60 Summits Projectwww.60Summits.orgwww.60Summits.org


1.1. Join a free e-mail discussion group Join a free e-mail discussion group – the Work Fitness & Disability– the Work Fitness & Disability Roundtable. Roundtable.

(G(Give me your business card)ive me your business card)

2. Talk about a possible2. Talk about a possible Summit for South Carolina? Summit for South Carolina?

((Meet me at lunch)Meet me at lunch)

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Thanks for Listening!Thanks for Listening!

a new paradigm for workers’ compensation & disability benefits systems: the work disability...

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