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Pushing for an Integrated Approach to Employee Health

Disability and medical programs that are integrated have been shown to result in shorter-duration leaves, quicker return-to-work rates and fewer employees on short-term disability moving to long-term disability.

January 9, 2009
Related Topics: Benefit Design and Communication, Health and Wellness, Compensation
More employers are looking to integrate their disability and leave programs with various health management efforts to reduce health care costs and create a healthier, more productive workforce, experts say.

    By closely connecting short- and long-term disability and family medical and other leave programs with medical, behavioral health, disease management and wellness programs, employers are better able to identify at-risk employees before they file a disability claim, advocates say. They also are better able to intervene with programs designed to assist employees in improving their health and returning to work.

    Disability and medical programs that are integrated have been shown to result in shorter-duration leaves, quicker return-to-work rates and fewer employees on short-term disability moving to long-term disability.

    The efforts are not merely about reducing health and disability costs. Employers also are looking to integration as a way to reel in lost productivity due to absenteeism and presenteeism, which studies show cost employers billions of dollars a year.

    "Employers have come to realize that having a healthy and productive workforce is part and parcel to their business strategy and business success, whereas for so long employers just saw benefits as a cost of doing business or an attraction and retention strategy," says Tom Parry, president of the Integrated Benefits Institute, a San Francisco-based nonprofit health and productivity research firm.

    "The mind-set has really become: If we invest in employee health, not only will employees be healthier, but they won’t be absent from work and they will be more productive while at work. That’s the magic of this whole thing," Parry says of integrated programs.

    For their part, health insurers have responded by offering employers single-source solutions for their disability and health management needs that also include valuable integrated data. Such data, experts say, give employers a better picture of where their health care and lost productivity costs are coming from in addition to the ability to evaluate various programs’ strengths and weaknesses.

    While such solutions have become available, many employers, especially larger ones, continue to use a multiple-vendor approach and outsource their data to integrated data warehouses, experts say.

    Several years ago, the focus of integrated disability management was on coordinating workers’ compensation with short- and long-term disability programs. But the difficulties of integrating a national disability program with a state-based workers’ comp program proved too difficult, experts say.

    Employers then realized that they had sick leave, family medical leave and disability programs that were consistent nationally and asked, "Why can’t we integrate that with a consistent national medical benefit and leave workers’ comp alone after once being burned there?" says Dr. Miles Snowden, executive vice president, clinical strategy, for UnitedHealth Group Inc. in Atlanta, referring to the prior integration difficulties.

    Integrating disability and health management, experts say, makes more sense and drives results.

    Having both a disability and health plan with one insurer allows the insurer "to proactively manage health and productivity issues that face an employer, because we address the employees’ needs holistically," says Adele Spallone, head of clinical services for disability and absence management at Aetna in Plantation, Florida.

    Such disability and health integration, which Aetna describes as a "process," starts with identifying and then proactively reaching out to members with medical conditions that could potentially lead to disability claims, Spallone says. "If the employee goes out on disability, we proactively engage the medical clinicians we have … to make sure that that employee is receiving the right care and identify potential disease management triggers," she says.

    Last year, Aetna launched a new Integrated Health Solution product, which combines medical, behavioral health, long- and short-term disability, disease management and wellness programs. By integrating clinical and system capabilities across products, health care management professionals can work together to provide health and wellness services tailored to specific conditions, Aetna says.

    "There’s a lot of value and obvious connection between integrating health care and disability, because every disability is a medical event," says Katie Dunnington, assistant vice president of Cigna Group’s wellness, absence and productivity program in Bloomfield, Connecticut.

    A 2007 internal analysis of Cigna’s medical and disability claims, for example, found that employees with disability claims made up only 5 percent of the employee population yet represented 37 percent of employee medical costs.

    "We’re not just focused on medical costs, but very much are looking at how to minimize unscheduled time away from work," Dunnington says.

    Employees who are on intermittent family leave, for example, are five times more likely to file a short-term disability claim than employees not on family leave, she says. So when an employee asks to take time off under the Family and Medical Leave Act, that employee is "waving a big white flag" that they may be having trouble, and that’s when he or she can be referred to the employee assistance plan, she says.

    Cigna began offering its single-source integrated solution, called Disability & HealthCare Connect, in 2003. Offerings differ depending on the additional programs an employer has with Cigna, such as an EAP, disease management and FMLA administration, but the program includes disability and medical leave at minimum.

    Technology systems are linked, enabling each program to share information, and data is pooled for further analysis, Dunnington says.

    In addition to linked technology, integration also can take the form of a common contact point and intake process for absences and disabilities, integrated claims data and integrated care management, experts say.

    There is not, however, a single integrated claims administration system for all of the programs offered today, says Tom Klett, senior consultant in Watson Wyatt Worldwide’s Stamford, Connecticut, office. "There’s a lot of toggling back and forth" between systems, he says.

    But to effectively manage a complex illness from the time an employee takes a leave until he returns to the job, "physical co-location" is needed, Snowden says. At UnitedHealth, "the nurses and physician leaders who manage medical illness are literally sitting beside the disability and sick leave management nurses."

    Such an approach not only allows for better corroboration among clinicians but also is a more effective way to get that employee back to work sooner, Snowden says.

    The health insurer, which is based in Minnetonka, Minnesota, teamed with Sedgwick CMS last year to launch an advanced integrated medical and disability program for large employers. Under the program, UnitedHealth provides medical, wellness and EAP services, while Sedgwick CMS provides administration of workers’ comp, disability and absence management services.

    The program offers employees a single point of contact for all absence-related needs in addition to integrated data reports so employers can better manage employee health and productivity.

    Coordinating disability, absence management and health management has caught the attention of Providence Health & Services, a Seattle-based nonprofit health care system. Over the past year, Providence’s Oregon region has attempted to reduce the number of unscheduled leaves of absence within its hospitals.

    "Ultimately when we look at disability management and the integration that we have to date, it’s really centered on what’s occurred. What we want to move to is a model that eases the way for our employees and helps prevent the progression of a medical issue from having an impact on the workplace and workforce," says Adrienne Paler, regional manager disability and ADA for Providence in Portland, Oregon.

    "There really are 30 different flavors of IDM, so we’re not looking for one to pull off the shelf and implement," says Judy Samples, regional director of human resources at Providence. "We’re in the early stages of developing what the new model will look like."

    "We do know … we want it to have a positive impact on the workplace with regards to outcomes," Paler noted. "And the outcome we want is for [employees] to be healthy and happy at work."

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