By Jim Thompson
Sarasota, FL (WorkersCompensation.com) - Comorbidities — conditions like diabetes and obesity that can complicate the medical care of people injured on the job — are significant cost drivers in workers' comp claims, and many employers turn to “wellness” initiatives to preventatively address those adverse health conditions.
According to a recent whitepaper from Harbor Health Systems, unveiled at the December 2016 National Workers’ Compensation & Disability Conference in New Orleans, the presence of comorbidities in workers’ comp cases vastly increases claims duration, claims cost, surgery rates and litigation rates.
Harbor Health Systems’ analysis, which considered 7,000 claims involving addiction, diabetes, hypertension, mental health, obesity, tobacco use, and multiple comorbidities, according to a BusinessWire news release, found:
- Claim duration increased by 76 percent for multiple comorbidities; 67 percent for addiction and 55 percent for obesity.
- With multiple comorbidities, incurred total costs increased 341 percent.
- Litigation rates for claims with multiple comorbidities increased nearly 150 percent.
- Surgery rates increased 123 percent for claims involving multiple comorbidities.
As just one specific example of how comorbidity can influence workers’ comp claim costs, Eric Patten (RN, BSN), senior director of clinical care at One Call Care Management, a provider of specialized solutions to the workers’ comp industry (Harbor Health Systems is part of One Call Care Management) addressed a hypothetical case of an injured worker with a broken bone also dealing with obesity.
In a case like that, Patten said, caregivers will have to utilize more durable equipment to physically support the injured worker, and will also have to take care that a broken bone is healed sufficiently to support the extra weight of the injured worker.
More generally, Patten said, a comorbid condition like diabetes can lengthen the healing time for an injured worker.
Many employers offer wellness initiatives, employing various measures for monitoring employees’ physical conditions such as weight, or improving their diet, or equipping them with activity trackers, as a means of reducing comorbid conditions and their adverse fiscal impact on workers’ compensation claims.
According to a 2014 survey of member organizations by the Society for Human Resources Management (SHRM), 76 percent of respondents reported having “some type of a wellness program, resource or service to employees.”
There are questions about the efficacy of wellness programs in the workplace. Ninety percent of respondents to the SHRM survey “reported that their organization would increase its investment in its wellness efforts if it could better quantify their impact,” according to a summary on the SHRM website.
Among the harsher critics of wellness programs is Al Lewis, the founder, president and sole full-time employee of the Disease Management Purchasing Consortium International, Inc.
Lewis told WorkersCompensation.com that people with comorbid conditions such as obesity and diabetes are “way beyond” the reach of any wellness program.
“They need nurses helping them with a care plan, not coaches telling them to eat more broccoli,” Lewis said.
Lewis went on to temper his remark, saying that “not every program really, really sucks.”
Specifically, according to Lewis, who holds a law degree from Harvard and is a visiting scholar in health policy at Brandeis University, wellness programs aimed at helping employees improve their own health — equipping them with activity monitors, making fruits and other healthy snacks available in the workplace — can be effective, although the measurement of outcomes isn’t particularly good.
On the other hand, Lewis said, wellness programs that employ direct measurement of employees’ health, such as weight, and that focus on things like smoking cessation, don’t appear to be particularly effective.
“The idea that you should line up your employees every year” to assess their health — what Lewis calls the “pry, poke and prod” approach — is “misguided and can lead to over-diagnosis” of potentially problematic health issues, Lewis said.
In many instances, though, employers may not be particularly focused on outcomes, but simply want to be able to point to the fact that they have some wellness initiative in place, according to Lewis.
“They put them in place to say they’ve got something in place,” Lewis said. “I think there’s a lot of ‘check-off’ stuff involved.”
“In some cases, they [employers] are being duped,” Lewis added.
The U.S. Chamber of Commerce, which supports wellness initiatives, nonetheless noted in a 2016 report titled "Winning With Wellness" that “there is no one-size-fits-all wellness program.”
Patten, who is supportive of wellness programs’ ability to positively affect employee health and workers’ compensation claims experience, amplified that point. Patten suggested that wellness programs should target specific issues affecting, or likely to affect, a given workforce. For instance, Patten noted, it’s likely that an employer whose workers sit at desks throughout the workday will need a wellness program focused on weight and related issues.
The Chamber report recommends that employers implementing wellness programs take four steps aimed at ensuring the effectiveness of those initiatives.
According to the report, wellness programs should have the clear support of senior business leadership; establish baseline data on employee health; evaluate that data to build a program targeted to employee needs, and ensure that the program includes some type of health risk assessment or biometric screening, education on healthy lifestyle choices, and some intervention initiatives, such as weight loss programs.
