Lynch: The Psychosocial Buzz Is Getting Louder

Wednesday, April 5, 2017 | 0

“We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality, or even litigation. It is the negative impact of personal expectations, behaviors and predicaments that can come with the injured worker or can grow out of work injury.

"This suite of roadblocks is classified as 'psychosocial' issues — issues which claims leaders now rank as the number one barrier to successful claim outcomes according to the Workers’ Compensation Benchmarking Study’s 2016 survey — and they drive up claim costs far more than catastrophic injuries, mostly due to delayed recovery.”

That’s the beginning of a new white paper authored by friend and colleague Peter Rousmaniere and Rising Medical Solution’s Rachel Fikes. The paper, "How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity," reports on Rising’s 2016 benchmarking survey and describes how the workers’ compensation claims management community is ever so slowly coming to realize the leading cause of delayed recovery for America’s injured workers is psychosocial in nature, and that efforts to deal with this have, up to now, been woefully inadequate.

Rousmaniere and Fikes point to enlightened employers and insurers who are leading their companies to a greater acceptance of the need for competent, professional intervention to help injured workers overcome mental and emotional barriers delaying their return to employment.

They cite the work of Denise Algire, director of risk initiatives and national medical director for Albertsons Cos., a grocery chain with more than 285,000 employees. They also report on efforts by The Hartford, Nationwide Insurance and CNA.

All of the progressive actions undertaken by these organizations have one thing in common: the development of an empathic interview methodology devoted to understanding the “whole person” to discover which claims will need more intensive and specialized intervention.

At the Albertsons Cos., Algire espouses the advocacy-based model of claim management. This model emphasizes building a conversational and trust-based relationship with an injured worker through organic dialogue. She has introduced a modified Linton tool for screening injured workers for psychosocial comorbidities and has contracted with an external telephonic triage firm to conduct initial screenings.

At The Hartford, Medical Director Marco Iglesias reports 10% of claims fall into the psychosocial bucket with at least one psychosocial comorbidity, but they consume 60% of total incurred costs. He says adjusters now ask each injured worker an important question: “When do you expect to return to work?” The Hartford’s analytics indicate any answer longer than 10 days is a red flag for the future.

Nationwide Insurance, under the direction of Trecia Sigle, VP of workers’ compensation claims, is building a specialized team to address psychosocial roadblocks. Nationwide’s intake process will consist of a combination of manual scoring and predictive modeling, and then adjusters will refer red-flagged workers to specialists with the “right skill set.”

Pamela Highsmith-Johnson, national director of case management at CNA, says the insurer introduced a “Trusted Advisor” training program for all employees who come into contact with injured workers. CNA’s Knowledge and Learning Group helped develop the training with internal claims and nursing staff.

This white paper adds to the now undeniable research indicating the psychosocial problem is the biggest one facing the workers’ compensation claims community today. The leading experts agree that empathy, soft talk and the advocacy-based claims model is the method of choice for helping injured workers whose claims carry a psychosocial dimension. The experts cited in the white paper all agree that adjusters will require extensive and repetitive training to learn the new techniques.

However, all of this is a heavy lift for an adjuster community overburdened and overwhelmed with work, a group for which the average lost time claim load is often north of 150. Even with better training, they can’t do it alone. To really turn the psychosocial tide will require a well-rounded team of claims adjusters, nurses, case managers and external, well-trained clinicians working together with transparent, technologically advanced communication.

The missing links thus far are those well-trained clinicians and the advanced communication. Without these two components, the adjuster community will be hard pressed to achieve meaningful results.

Tom Lynch is a principal with Lynch Ryan & Associates, a Massachusetts-based employer consulting firm. This column was reprinted with his permission from his Workers' Comp Insider blog.