Officials at Cigna aren’t just assuming that earlier intervention can prevent disability. To validate the theory, the health and disability insurance company has launched an 18-month pilot study involving 26 employers and nearly 120,000 employees.
The goal: to reach employees who already are struggling to stay on the job but who may not know what help is available or may be reluctant to reach out, Cigna officials say.
“The real opportunity is to try to get ahead of that disability and use information strategically to help employees improve their health—to help them stay at work and not become disabled,” says Katie Dunnington, the company’s assistant vice president of wellness, absence and productivity.
The program, launched in October, is provided at no cost to employers who already offer Cigna’s health insurance and disability coverage. Employees are approached to enroll in the pilot study, called the Absence Prediction and Prevention Program, if they are assessed to be facing at least a three-times-higher risk than the typical employee of going on short-term disability within the next 12 months.
Once nurses start working with the employees, they frequently discover difficulties that extend beyond medical and behavioral health concerns, says Dr. Bob Anfield, chief medical officer for Cigna’s disability business. “Very frequently these accommodations that are identified are very simple and cheap to provide,” he says.
One employee with back trouble needed to lift heavy materials and transport them some distance, he says. A vocational counselor recommended a cart that could instead be loaded and pushed. In another example, an insulated mat was provided to ease foot pain for an employee standing on the production line.
While insurance plans typically offer some type of disease management program, Anfield believes that Cigna’s effort is rare in that it uses data analysis to first target at-risk employees and then to proactively intervene. Wolfgang Zimmermann, executive director of the National Institute of Disability Management and Research, agrees.
Intervening proactively has been tried by employers, but rarely by private insurance providers, says Zimmermann, who heads up the Canada-based international organization. “I’m a strong fan of anything we can do to prevent disability from the prevention point of view,” he says.
Staving off disability
Some conditions are more likely to end in a disability claim, including heart conditions, depression, cancer and lower back pain, according to a survey that Mercer and insurance broker Marsh conducted in 2007 with more than 600 U.S. employers.
Frequently, employees with these conditions are identified and assisted through case or disease management programs. Last year, about 2.5 million members participated in a disease management or case management program through Aetna, says Susan Kosman, Aetna’s chief nursing officer.
Through predictive modeling, Aetna officials strive to identify those enrollees who may face higher medical costs and, in the process, “hopefully allow them not to progress toward disability,” she says. For example, an employee with back pain may be identified for additional help after he consults with multiple doctors, including an orthopedic surgeon, along with getting imaging scans.
But Cigna officials believe their 18-month pilot will take early intervention to the next step: providing research evidence that an employee’s likelihood of going onto disability can be reduced.
Meanwhile, employee productivity can be improved in the here and now, they say, pointing to a large-scale study published last year in the Journal of Occupational and Environmental Medicine. In that study, researchers found that lost productivity associated with a medical condition cost twice as much as the actual medical and pharmacy bills.
So Cigna officials are dividing at-risk employees into a control group and a study group that receives individualized support, including working with a nurse case manager.
During the program’s first two months, nearly 2,100 at-risk employees were identified and divided into the two groups. Of those targeted for additional intervention, a Cigna representative reached 570 employees by phone. (Multiple efforts are made, including by letter and by phone.) Nearly half, 43 percent, agreed to begin the assessment process. The final results, including outcomes, won’t be available until 2011.
“Generally the employers have been very pleased,” Cigna’s Dunnington says. “They only benefit. They are probably increasing the employee’s productivity and there is less risk that they will be absent.”
For employees, there is a carrot. They receive an $80 incentive, paid by Cigna, if they complete a health assessment once contacted by a nurse. They also receive an additional $120 for participating in recommended programs. Anfield says that incentive will be re-evaluated after the pilot using a cost-benefit analysis.
To date, the vocational stay-at-work services and the employee help program are most frequently used, Dunnington says. But medical, pharmacy and other assistance may also be recommended. By working with a pharmacist, for example, employees can prevent potential drug interactions or over-prescribing.
Dunnington describes several employees in the pilot who drive trucks for a living and cope with lower back pain. Along with additional padding and adjustments for the trucks, the employees also are trying to lose weight and become more active.
“I think in today’s economy people desperately want to stay at work,” she says. “But they may be reticent or may not know where to go for help. I don’t think they always realize how many things we have that can help them.”
One hurdle in persuading employees to participate might be trust, says Zimmermann of the National Institute of Disability Management and Research. “Whenever you deal with an insurance company, there is a measure of distrust,” he says. “You wonder what they are going to do with your data.”
Cigna officials stress that stringent privacy protections are in place. Employers frequently don’t even know about an employee’s participation, unless a workplace accommodation is requested, they say.
As for the incentives, the $200 may entice employees to sign up, they acknowledge. But participants report that feeling better provides motivation enough to follow through.
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