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IS THE FUTURE GOING CRAZY?PSYCHOLOGICAL CLAIMS
MANAGEMENT
BYLIZ SCOTT &
MICHELLE MACINTOSH
AGENDA
The facts
The solution
The proof – case study
Manulife LTD Claims by Diagnosis 2001
0%
5%
10%
15%
20%
25%
30%
Psychiatric
Musculoskeletal
Accidents
Neoplasms
Cardiovascular
Nervous SytemDigestive
Respiratory
Sense Organs
Genit-urinary
Other
Increased Cost in STD
1997 2000
STD 2.0 % 4.2 %
LTD 1.2 % 1.3 %
WSIB 2.4% 1.6 %
Total 5.6% 7.1%
OH&S Canada March 2001
Facts and Figures
The facts…
Depression Cost the Canadian & US economies $60 Billion US
annually. Half in lost productivity. Incidence is growing and getting younger Depressive disorders account for 30-40% of mental
illness in Canada, 50% of mental health $ spent Fastest growing category of disability claims Economic cost of mental illness in Canada are 14%
of corporate Canada’s profits & 3% of our national debt.
The facts…
Depression Productivity Issues
Working longer but less productive There is direct link between depression and loss
of productivity The future is mental!
Information economy Human capital & the human mind are more
important than brawn Depression directly effects out human capital
Defeating depression must be a corporate priority!
How Much is It Costing Your Company?
Estimate number of days – present but not functioning
Estimate number of days – off work on “sick leave”
Estimate number of days – off work on “short term disability”
Multiply by the average daily wage?
The facts….
Research to Reality
Berger, ML, Howell, R, Nicholsen, S & Sharda, C. (2003) highlight importance of keeping the workplace healthy
Claxton, AJ, et al (1999) indicate that appropriate treatment improves outcomes
Kessler, RC, et al (1999) depressed workers had 1.5 and 3.2 more short term work disability days
Mintz, J, et al (1992) Ten studies analyzed show therapy combined with medication had the most effective outcomes.
The facts….
The Problem with Mental Health Claims
No lab, no physical, no objective tests Takes 1.7 times longer Not a fatal condition - don’t die soon,
higher salary Massive reserves - $250,000 Can be “physical” – pain, fatigue, chronic
fatigue syndrome, fibromyalgia
Bottom line “on the street”
Only 1 in 16…. or 6 in 100 good care rate
Over 40% of all Dr notes are inappropriate* Coyne, 1995** Katon, 1995*** Kessler, JAMA, April 2003
The facts….
Long hours.The employee puts in to demonstrate that the employee has a high level of commitment.
The Facts….
Illness.Employee going into work with sicknesses (migraine, colds, flu, allergies) and are unable to work at a normal output level
The Facts….
Presenteeism.At work but not working.
Time spent on other actions such as personal email, phone calls, internet surfing, “water cooler chitchat”, daydreaming.
The Facts….
The facts….
CAUSES: Mental and physical illness Work/Life challenges Corporate culture
Workplaces have little power to reduce actual illnesses, mental and physical, but have tremendous power in changing the sense of Work/Life Balance their employees experience and creating a Corporate Culture that supports and enhances its employee’s lives.
In managing Presenteeism and mutual health disability, companies can effect change in the cost of absenteeism and STD.
How the health of the organization will impact outcomes
Could you insure the quality of your service and products…….
If each employee spent 2 to 6 weeks at work not able to do the job well?
Can you be confident about safety….
If 30 – 40% of your employees are to tired or sedated with diminished cognitive function and dexterity?
Understanding Health at WorkPsychsocial
Work environment
Physical Work
environment
Individual Health
practices
Healthy work environment
Basic Mental Health Needsin the Workplace
Respect & appreciation
Being heard and listened to
Sense of self-worth
Sense of belonging to a meaningful and supportive work group
Learning and challenge
Role clarity
Shain, M. Best Advice on Stress Risk Management in the Workplace
Work Factors That Threaten Well-Being Work overload and time pressures
Lack of influence over day-to-day work
Lack of training
Poor communication - ambiguity
Too little or too much responsibility
Lack of status rewards
Discrimination/harassment
Role overloadShain,M. Best Advice on Stress Risk Management in the Workplace
Understanding Health at Work
High JobPressure
Low Job Control
HomeStress
Low SocialSupport
Increased Risk to Mental and Physical Health
=
Illness, injury, infection, anxiety, depression, substance abuse
Sociobiological Translation
A mechanism by which human beings receive messages about the social environment and convert these messages into biological signals that trigger the processes of disease development or health promotion.
Tarlov, 1996
High Effort/Low Reward
+
High Demand/Low Control
2x - 3x Conflicts
3x Heart Problems
3x Back Pains
5x Certain Cancers
2x -3x Infections
2x -3x Injuries
2x Substance Abuse
2x - 3x Mental Health Problems
Shain, M. (2000) NQI - A Healthy Workplace
Impact of The Organization on Employee Health
Important Learning's…
Work-life balance can be affected by workplace responses
How work is managed and how decisions are made within an organization is an important variable
Accountability and infrastructure support are essential
Real benefits accrue to organizations who make a commitment
Workplace Necessities
The Underlying Framework
Fairness
Purpose
Trust
Programs
Trust
An understanding attitude towards employees is much healthier than denying the existence of family and family obligation
Fairness
2 Components:
Distributive - who get what, and when
Procedural - the process through which decisions are made
Sense of Purpose
Understanding of the vision, mission and values
Understanding of how an individual contributes to the achievement of the vision, mission and values
Programs
Design programs to assist employees in making the right choices
Lunch and learns Newsletters Fitness
What Employees Can Do
ATTITUDE INTERVENTIONS
Learning to Dance with Life!
Commit to staying healthy!
Read the following
RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN
Read the following
RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN RED BLUE ORANGE GREEN
The Value of Early Intervention
The Solution
What is Disability Management ...
An integrated systematic process of returning people to functioning lifestyles following an event of disability
Organizational Solutions, 2002
Workplace Events
WorkAbsences
Presenteeism
Absence Management
Employee Events
WorkTrials
ReturnTo Work
PreventionPrograms
Treatment& Recovery
Time
Early Intervention Disability Management
Return to WorkInterventionsDisability toAbility Mgt.
Adjudication
The Solution…The Bigger Picture
Healthy
EmployeeHired (promises made)
The Solution…. Disability Management Early Intervention = Success
Disability Management as Part of the Business Plan
The Solution
Why Disability Management ?
0
20
40
60
80
100
Pro
bab
ility
of
RT
W (
in %
)
0 3 6 9 12 15 18 21 24 36
Duration of absence (in months)
Probability of Returning To Work
The Solutions….
CORPORATE CULTURE Policies and Procedures that support and
are usable for managers and supervisors Managers that have face to face
managerial time built into their job Clear role definition Managers have Clarity- they are able to
communicate, observe situations from a non-personal position
Build trust
The Solutions….
WORK/LIFE BALANCE Live it! Policies and procedures that are fairly created and
implemented Humour and sense of fun at work Flexibility when exceptions are presented Managers and supervisors that manage little
challenges before they become large issues Implementation and promotion of EFAP Workshops that are meaningful to the employees
The Solutions….
Claim Initiation Appropriate paperwork
Appropriate treatment
Focus on RTW / capability
Claims Management
Right care, right time, right outcome
Ensure employees have a “its my job to get better” attitude
Be in contact with the employee, Dr. and Manager
Disease / Care Management
Claims management consists of monitoring a claim from the time it occurs until its final resolution.
Communication with the disabled employee during
recovery should be frequent and should contain important messages, Convey genuine concern, Set expectation the employee will comply with
company policies Express a commitment to return them to work
within their capabilities.
Claims Management
Only 20% of diagnosed depressions get appropriate “guideline care”
Specialist more likely to provide appropriate care then the family doctor
What is guideline care – CPA website
Return to Work
What is the RTW expectation?
Establish a clear path
Is it based on functional objective information or opinion?
Ensure they progress once they RTW
Prevent recurrence
Cognitive Job Demands vs. Cognitive Capabilities
Do they have the cognitive capabilities to perform the cognitive demands of the job
Quantify – much like the PDA vs FAE approach
What can the employee do vs What they need to do
Positive work environment will be essential
Old Management Approach!
The New Approach
Right care, at the right time, for the right outcome
Q&A?
?&Answer
Question?
Q&A
Q&
A
Q&AQ&A
HRPAO Presentation - 2006Liz R. Scott PhD Organizational Solutions [email protected] MacIntosh Baylis & Associates [email protected]
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