Early identification of injured workers at-risk for delayed recoveries saves an average $37,908 per claim. Combining those results with cognitive behavioral therapy (CBT) for those most at risk saves another $36,859.
A 50 percent reduction in total claims costs resulted from the program implemented at Albertson’s Safeway. The company’s Denise Gillen-Algire and I look forward to sharing this unique program and findings during RIMS in San Antonio.
Flagging Those at Risk
Identifying injured workers who may become ‘creeping catastrophic’ claims has been a difficult process for the workers’ compensation industry. A variety of solutions have evolved in recent years. One of the most effective to date is the IMCS Pain Screening Questionnaire (PSQ).
This screening tool was carefully developed and refined and has been proven to be extremely accurate in pinpointing the likelihood that an injured worker will recover quickly or have a delayed recovery. Psychosocial factors play a significant part in the recovery process so it is imperative to have a screening method to detect these issues as soon as possible after an injury.
The questionnaire consists of 21 questions on which the injured worker rates his pain experience. Depending on the score, the worker is placed into one of 5 risk categories from low risk to very high risk.
We used the PSQ to screen newly injured workers at Albertson’s Safeway. The results were, quite frankly, remarkable. This shows the number of workers in each risk category along with the average total pain and the average total incurred:
• Low risk: 1,031 workers, $2059 paid, $2683 incurred.
• Low-moderate: 307 workers, $10,759 paid, $15,305 paid.
• Moderate: 145 workers, $21m783 paid, $28,585 incurred.
• High: 192 workers, $26,212 paid, $36,765 incurred.
• Very high: 148 workers, $39,967 paid, $55,589 incurred.
The results clearly illustrate the cost differences to treat low risk vs. high risk injured workers.
Accurately identifying higher risk injured workers is the first step in the process to drive better outcomes. The next is providing the appropriate treatment.
Injured workers with delayed recoveries typically end up undergoing numerous medical procedures — including surgeries, and receiving a variety of medications. It is not uncommon to see many of these workers prescribed copious amounts of narcotics along with other pharmaceuticals meant to counteract the negative effects of these opioids. It is a story we see far too often in workers’ compensation, especially since we have the proven ability to reverse and prevent these occurrences.
CBT is considered the gold standard for treating patients with psychosocial factors and delayed recoveries. Research has borne this out over the past several decades. Our program at Albertson’s Safeway is the latest evidence.
For that program, we offered injured workers who scored in the ‘high’ or ‘very high’ risk categories the opportunity to participate in COPE with Pain, a CBT-based program. Approximately half those offered accepted.
To test the effectiveness of the program, we had three comparison groups of high risk scoring injured workers. Included were the company employees who opted for COPE with Pain and those who didn’t, along with a control group that were not involved and, therefore, were not offered participation in the COPE program.
Again, the results were extraordinary. Here was the breakdown in terms of the number of injured workers within each group, and the average paid and average incurred cost per claim:
• Cope with Pain participants: 78 workers, $36,629 paid, $51,317 incurred.
• Offered, but did not participate in COPE with Pain: 82 workers, $44,356 paid, $60,546 incurred.
• Not offered COPE program: 82 workers, $73,488 paid, $84,230 incurred.
This overwhelmingly shows the benefits of appropriate intervention for injured workers with psychosocial factors and delayed recoveries.
During the session, Denise and I will delve into the specifics of the program, both the screening and the intervention. Our presentation, Outcomes of a Workers’ Compensation Early Intervention for Delayed Recovery Program, takes place Tuesday, April 17, from 11 a.m. – 12 p.m. in the Hemisfair Ballroom C1.
We’ll also have a booth this year. It is #1656, which is right near the RIMS mail booth. Several of us will be on ‘booth duty’ and welcome the opportunity to meet you and discuss some of the challenges you are facing in your workers’ compensation program. We’ll be there from Monday April 16 –
Hope to see you there!