Rousmaniere: Stepping Up to Wellness?

Friday, May 16, 2014 | 0

Those who pay workers' compensation costs are giving more serious attention to the connection between personal health of the workforce and work injuries.  

This connection can smack you in the face.  Many trucking company executives know that the 34% smoking and 38% obesity rates among truck drivers, both close to double the rates for the total workforce, spell trouble for workers' compensation costs. (These figures are found in the Centers for Disease Control's January 2014 report of its Behavioral Risk Factor Surveillance System data from Washington State.)

When polled last week, over three quarters of a group of workers' comp professionals strongly agreed that healthy workers are less likely to be injured and more likely to recover from injury faster.

The National Institute of Occupational Safety and Health launched its Total Worker Health program in 2011 to formally recognize the connection between occupational and non-occupational health.  

And, the Reed Group and the Work Loss Data Institute have reported for many years how duration of disability increases when personal health factors are considered.  The Reed Group Disability Guidelines estimate that a 42-year-old man in a "light" job class in the central United States diagnosed with low back pain and no comorbids is predicted at 29 days of disability. If he's a smoker, expect 46 days of disability, a 58.6% increase.

Yet, the insurer community is just dipping its toe in the water.  

I have found two workers' compensation insurers who are several years into making worksite wellness a core competency.  They are Pinnacol Assurance, the Colorado state fund, and A.I.M. Mutual, a regional carrier with most of its business in Massachusetts.

After collecting and analyzing claimant data and actual outcomes, A.I.M. Mutual redesigned its traditional loss control model in 2013. It found that "traditional concepts of work injury risk reduction had become unable to grasp the most important emerging employee risks of today." It renamed its loss control function as the Injury Prevention and Worksite Wellness Department.

“The employer looks at wellness from both an altruistic and economic standpoint," says President Michael Standing.  Health insurers offer a premium credit for wellness programs.  Standing says that brokers generally look at wellness “as one way to differentiate their product offering from their competitors."

A.M. Best gave the insurer an Innovation Showcase award in late 2013 for its program.

Pinnacol Assurance introduced its Health Risk Management program in 2010 to its policyholders. The program includes an annual health risk assessment, telephonic health coaching, and assistance in setting up worksite programs and incentives. It retained researchers from the University of Colorado and the Integrated Benefits Institute to measure the program's impact on health risk factors, productivity, and workers' compensation.  Some positive data have been released so far.

Karen Curren, director of Health Risk Management at Pinnacol Assurance, says “there is a learning curve for wellness in the P & C industry. The brokers have had a challenge to understand it." Dealing with organizational silos within employers, which isolate workers' compensation from other management concerns, has also been a challenge for Pinnacol.

Indeed, for workers' compensation insurers to adopt wellness strategies demands a disciplined learning approach that extends over years.  

One challenge is the questionable impact of generalized wellness programs on employee health.  Critics assert that the voluntary nature of these programs, plus a natural tendency of a segment of high-risk individuals to migrate toward lower risk, means that glowing successes often reported may be overblown.

And, a worksite wellness initiative that links itself to injury prevention and early return to work could create problems in optics and in the law.  Employees might view the initiative as a crass way for the employer to save money, subtly suppress workers' compensation claims, and intrude into their personal health privacy.

A workers' compensation insurer has the option of recognizing wellness programs in its underwriting assessment but not invest in assisting policyholders.  Standing says an employer that is committed to wellness is probably more likely to work to control its workers' compensation claims.

Workers' comp insurers might elect to introduce nuances into wellness programs.  In last week's informal poll of workers' compensation professionals, concern about smoking, obesity and other oft-cited personal health issues was high, but the concern was highest about anxiety, a condition that is often underplayed in wellness promotion.  The respondents see a strong link of anxiety to claimant desire for opioids, surgery, and attorney representation.

What industry participants think about personal health

(poll conducted May 13 - 15, 2014)

Wellness promotion works might succeed when carefully introduced to a freshly injured worker.  Al Lewis, widely known as a fierce critic of wellness programs, speculated that an injured worker might positively respond to wellness coaching if done in a way that shows the worker, not the insurer or employer, comes first.

And, for the adept workers' compensation insurer, the Affordable Care Act includes a gift hiding in plain sight. The ACA authorizes employers to use wellness programs with big financial incentives to employees.  

The Disability Management Employer's Coalition's two decades-old advocacy of a holistic approach to employee health and disability has been largely ignored by workers' compensation insurers, even as evidence of the work injury impact has mounted.  If Pinnacol Assurance, A.I.M. Mutual and a few other carriers show that wellness pays off in better underwriting and marketing results, that might grab the attention of the insurer community.

Further reading on the personal health/occupational risk connection (thanks to Robert K. McLellan MD, Dartmouth Hitchcock Medical Center, and Jeffrey Kahn MD, WorkPsych Associates):

Burton, W. et. al. The Association of Health Risks With On-the-Job Productivity. JOEM. Volume 47, Number 8, August 2005, pp 769-777.

O stbye T, et al. Obesity and Workers' Compensation: Results From the Duke Health and Safety Surveillance System. Arch Intern Med. 2007;167(8):766-773.

Kuhnen, A et al. Employee Health and Frequency of Workers' Compensation and Disability Claims. JOEM. September 2009 - Volume 51 - Issue 9 - pp 1041-1048.

Hymel, P. Workplace Health Protection and Promotion: A New Pathway for a Healthier—and Safer—Workforce.  JOEM.  June 2011 - Volume 53 - Issue 6 - pp. 695–702.

Langlieb A et al. How much does Quality Mental Health Care Profit Employers? JOEM. November 2005 – Volume 47 – Issue 11 p.1099-1109.