Sarasota, FL (WorkersCompensation.com) – “Behavioral health is going to reshape work comp.” That was among the key takeaways from a session during the virtual National Workers Compensation and Disability Conference this week.
In multiple sessions, workers’ compensation veterans said COVID-19 has highlighted how non-physical factors can take a toll on individuals. They believe that the issue will move the needle and, at least in some areas, lead to more of a biopsychosocial approach in the workers’ compensation system.
“I think what has happened with COVID is going to be another paradigm shift in that now it’s been highly personalized,” said Mark Pew, SVP, Product Development and Marketing for Preferred Medical. “We now understand what it’s like to have everything that you thought was normal taken away from you. And if you think about it from an injured worker’s standpoint, that’s exactly what happened. They don’t go to a job anymore, they don’t set the alarm clock, they don’t see the people, in some cases the people they used to hang out with don’t hang out with them anymore. It’s just been complete upheaval; i.e. 2020 COVID. I think it’s going to be a lot easier for the workers’ compensation industry to understand and engage and accept biopsychosocial.”
Rather than a biomedical approach, which looks solely at the person’s physical ailment, a biopsychosocial approach looks at the whole person. It engages the injured worker in his own care, equipping and empowering him to figure out the way forward. That may include such things as yoga, deep breathing, changing nutritional habits, or using a Fitbit to remind the person to get in the appropriate number of steps each day.
While many have downplayed the idea of a biopsychosocial approach, embracing the concept will lead to faster and better recoveries, says one expert.
“The #1 barrier to recovery is psychosocial,” said David Vittoria, SVP, Clinical Business & Product Development, Carisk. “A lot of folks in comp believe that the main factor that will drive a delay in a claim might be indemnity payments or legal issues, maybe employer engagement or other factors. It’s the mental health factors that are related to an injury that often lead to a delay in recovery and many times it’s the challenges that patients face dealing with anxiety after they got hurt or experiencing adjustment or depression challenges when they’re out of work; maybe PTSD or substance use.”
Getting the entire workers’ compensation industry to endorse — and pay for — a biopsychosocial approach to help injured workers may be dependent on several factors, especially geographical areas. Pew related that discussions of Cognitive Behavioral Therapy had very different reactions in certain parts of the country.
“I started talking about CBT in 2012 in California,” he said. “A lot of people got it.” Fast forward to 2017 where Pew presented a session on CBT in Georgia. A friend later told him that someone sitting at the friend’s table whispered, “why would we pay for that when drugs are so cheap.”
“We still have a long way to go from a biopsychosocial standpoint, but I think because of COVID it’s becoming a big talking point and I think it’s going to become more acceptable and easier to adopt as we go thru that,” Pew said.
There are, admittedly many administrative complexities associated with getting all stakeholders to support the idea.
“We are trying to, especially from the claim s administration side, understand it and make it feel less ‘squishy.’ said Don Lipsy, AVP of Managed Care Government Relations for Sedgwick. Where we’re trying to understand that is, how do we define what services are right for what people? Because we know that if nothing else is true, everyone’s brain is unique. And so how we start treating things that are related to how people actually think in a non-physical but more internal way is going to be very unique, is going to be very challenging.”
The workers’ compensation system was designed primarily to handle physiological conditions, not biopsychosocial. “So we haven’t yet gotten to the point where we’ve developed treatment guidelines that really address what the appropriate level of care and access to care really should be,” Lipsy said. “Nor do we know if there’s enough providers out there.”
One thing that has changed in recent years, especially during the pandemic is the increasing efforts to include biopsychosocial conditions as part of a claim. Legislation, for example that includes PTSD in the workers’ compensation system and COVID presumption measures that will mandate the system cover these issues. “Are we going to be ready for that?” Lipsy asked.
“There are huge, huge regional differences and differences of opinions within states, between states,” said Lisa Anne Bickford Lisa Anne Bickford, director of Government Relations, Coventry. “We’re still at different areas in terms of acceptance with, this being a thing and, if so, to what extent it needs to be a compensable thing. So we can all kind of nod our heads and agree we think it’s a thing, but is it something that is a compensable thing within the workers’ compensation realm? That’s anybody’s guess.”