Non-Occupational Injuries, Integrated Care and Misaligned Incentives

12.20.2017


By Bob Wilson

In his column on WorkersCompensation.com last week, Peter Rousmaniere discussed the fact that employers spend a great deal of money on non-occupational disability insurance and related costs. He indicated that they spend upwards of $10 billion in annual medical and wage replacement costs for these types of injuries and illnesses. He also made a case for the cost being much higher than the reported numbers.

Rousmaniere believes it is “in our interest” to expand the workers’ compensation industry view to include these employee risks, and “learn if we can help employers reduce employee disabilities that are not work related by cause.” The purpose of his column was to ask the question, “Can we apply the expertise we have in the workers' compensation industry?” 

I believe the simple answer to his question is “yes, but not now.”

Two of Peter’s assumptions are absolutely correct. First, non-occupational injury costs are far greater for employers than those they must contend with under workers’ compensation. A study done a number of years ago in the Canadian Province of Saskatchewan revealed that the costs for employers for non-occupational injuries was something in the order of ten times greater than their occupationally caused counterparts. These costs were absorbed through disability insurance, health plans (even in single payer systems, the money has to come from somewhere), absenteeism, training and replacement costs. This led the Saskatchewan WCB to develop their innovative “Mission Zero” program, which was a concentrated media campaign urging safety consciousness both at home and at work. Mission Zero was probably the best example to date of knowledge and expertise from the workers’ comp sector being employed to the greater field of non-occ injury prevention.

Secondly, Rousmaniere’s contention that we have the skill to deal with injuries and impairments of all kinds is absolutely correct. There is no doubt that the workers’ compensation industry’s sole mission of occupational injury management has given us a level of focused experience that would be difficult to match elsewhere. But skill is only half of the needed equation.

In my view, we have the skill to accomplish this, but in a world of conflicting need and misaligned incentives, we currently lack the vehicle to make the transition he suggests.

That vehicle, of course, would be called Integrated Care. There has been an increasing amount of discussion on that topic, and some believe that it can become a reality over time. There are many obstacles along the path. One of the biggest is the current regulatory environment that drives every fiber of the workers’ compensation industry. Legislative and regulatory entities within workers’ comp generally lack the flexibility and rapid response needed to quickly incorporate new ideas and practices. Federal oversight requirements like HIPAA also can easily hamper the process.

Many employers have, for the most part, heavily siloed their non-occ and occupational disability areas, almost to the point where they are treated as unrelated topics. That culture would need to change for integrated care and this skill transfer to take place.

And there is the problem of reimbursement for services rendered. In a world where telemedicine has been slow to evolve for lack of a simple payment code, integrating non-occupational care would present its own unique set of challenges. 

And finally, much of the debate will have to come down to the delineation between impairment and disability; and what we define as “disability reduction.” If, by that term, we mean to reduce disability that is the result of a physical or mental impairment, then we have a better chance of extending our talent to the non-occupational realm. If we are simply talking about preventing the impairment in the first place, I don’t think we will have as great an impact. 

The sad fact is that, overall, injury avoidance is not our forte. Much of the workers’ compensation industry simply does not get paid for prevention, and when it comes to safety and injury avoidance, that presents the biggest misaligned incentive of them all.

The answer, then, is yes, we can use our skills to address issues in the realm if non-occupational disabilities if we have the proper vehicle; we just need a smoother path to get there, and a method of compensation for the service.

After that, the rest should be easy.

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