Keys to Improving RTW Programs
Saturday, March 26, 2005 | 0
This article is the last in a series on Early Return to Work (RTW) and Stay-At-Work (SAW) programs. It will discuss how internet-based technology can make these programs easier to administer and more effective. The case management software of AtWork Resources, Inc. (AWR) is discussed.
THE LIMITATIONS OF EXISTING RTW STRATEGIES
Despite the varied and obvious benefits derived from Early RTW/SAW, significant challenges still exist that limit the potential of Early RTW programs. Existing solutions have several limitations that serve as barriers to effective management of work absence and disability. These limitations include:
* Disconnected Partners: Although sharing data amongst partners is important, a lack of team structure, focus, and collaboration among the responsible parties (insurance carrier, TPA, physician, supervisor, HR, claims examiner, medical case manager, vocational consultant etc.) leads to a fractured approach to managing work absence and productivity issues.
* Information Itself Does Not Solve The Problem: Although vital, transactional supports for benefit payments and data tracking do not directly impact the process, behavioral, and communication issues typically causing workplace absence and disability;
* The Employee and Key Personnel Lack Support: The employee and key personnel and other decision makers often do not know what information to seek nor do they have critical information (medical, vocational, safety, regulatory) available when they need it to make good decisions. It is prohibitively time consuming for them to locate the needed information, even when they do know what to ask for. As a result, decisions are often made (e.g. can we accommodate this worker or not?) with little information and in an inconsistent and/or arbitrary manner, leading to poor outcomes and further risk exposures, i.e. litigation, worker re-injury, etc.
* Communication Delays: In the vast majority of cases, it is not unusual for an excessive amount of time to lapse between the need for effective medical, vocational, or human resource information and the actual receipt of this information for decision-making purposes.
* Lack of Trained Personnel: Key personnel, including front-line managers, are often poorly trained and supported in managing workplace absence and disability, leading to inconsistent and/or ineffective decisions and poor outcomes.
* Inconsistent Response: Managing workplace disability is complex. Delivering consistent, yet individualized responses to these events is difficult. Unnecessary litigation and poor outcomes result from the failure to follow a consistent set of policies and procedures in the return-to-work effort.
As a result of the above limitations and other factors, Employers often lose influence over those variables that they can best control. These key variables are as follows:
* RTW policy and practice;
* Job duties and productivity standards;
* Employee - Supervisor interactions;
* The attitudinal and cultural behavior of the workplace.
EARLY RTW / SAW LOGJAMS
Insurance, medical, and/or other providers have many capabilities, but have rarely focused on the "disconnects" or what I call "RTW Logjams" that often occur in RTW/SAW programs. These "logjams" are as follows:
1. Effectively separating & managing Job Performance and Disability-related issues;
2. Efficiently and accurately determining meaningful employee Functional Work Capacities;
3. Developing and maintaining a usable Transitional Task Bank that reflects the work mangers/supervisors need done, matching workers to job tasks, and managing multiple workers in their work assignments;
4. Transitioning workers into Permanent Job Accommodations while complying with Federal/State requirements regarding the "Interactive Process".
Often these logjams are compounded by the conflict that often exists between the services and responsibilities of the insurer/provider i.e. "what they are paid to do" and the employers broader human resource needs. These conflicts are often significant and costly. Effectively managing these RTW / SAW Logjam issues can lead to significant cost savings and improved program outcomes. Focusing on achieving a timely and effective match of a workers abilities to their job demands is at the core of the transitional and permanent accommodation process.
AtWork Resources software and services deal with these challenges by assisting employers with program design, ongoing consultation, and software supports. Through experience, AWR has determined that the logjams in these above four areas inhibit or prevent Early RTW efforts from maximizing their value and return-on-investment. The chart below summarizes the problems, impact and AWR solutions to these four "logjam" challenges:
| Table 3 | Performance vs. Disability | Determining Functional Abilities | Developing and Managing Transitional RTW (TRTW) | Achieving Successful Permanent Accommodation |
| Typical RTW / SAW Logjam: | Problem: Slow or incorrect assessment of whether issue is HR or disability-based RTW issue. Impact: loss of control and unnecessary or extended benefits paid. | Problem: Slow determination of Functional Capacities: 1) Relying on Insurer/TPA to obtain medical restrictions; 2) Waiting for standard doctors report. 3) Vague work restrictions that need clarification. Impact: 30 to 90 days of lost time. | Problem: 1) Obtaining Supervisor involvement in developing and maintaining Transitional Task Bank. 2) Identifying appropriate transitional assignment. 3) Managing multiple workers in transitional assignments, moving them forward toward permanent assignments. Impact: Lost work days; failure of the TRTW assignment; poor transition to permanent work. |
Problem: 1) Wait for final disability determination by physician and then begin employee dialogue and interactive process. 2) Monitoring and updating the accommodation strategies as an employees medical condition changes. Impact: 1) Difficulty finding permanent assignment and poor retention of valued workers; 2) Exposure to long-term disability and claims for failure to accommodate. 3) Lost time of 30-90 days or longer. |
| Solutions | Strategy: Use collaborative communication tools, HR and disability forms/tools, and Decision- Support Process. Result: reduces inappropriate disability claims and lost time. | Strategy: Use online guidance and forms / tools for MD input, including Auto E-mail with embedded FCE forms. Result: reduction in lost time. | Strategy: Use transitional task matching with functional abilities MD form, as well as ongoing auto e-mail alerts to manage the transitional tasks. Result: Reduction of 30- 90 lost days per case | Strategy: Use of online Decision-Support Process ensures consistent, effective compliance with the "interactive process". Result: effective documentation of the case resulting in successful and defensible accommodation efforts. |
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