Magazine article Risk Management

The Road to Comprehensive Health Care

Magazine article Risk Management

The Road to Comprehensive Health Care

Article excerpt

Today employers are faced with a tight labor market, higher wages and increasing health care costs, leaving productivity as one of the few remaining levers for maintaining or improving profit margins. So risk and benefits managers are challenged to find ways to return ill or injured employees to work quickly and safely, while still providing the best medical treatment. And with increasing frequency, their primary solution is to integrate occupational, non-occupational and health care benefits into one program.

What It Is

The theory of integrated benefits is simple: Rather than have four or more delivery systems (health care, short-term disability, long-term disability and workers' compensation)--each with its own disparate process, people and technology--combine them into one program. With such a program, there is one team managing medical treatment and the claims process, one effective return-to-work plan, one system to capture all pertinent information and one phone number to file a claim. In practice, an integrated benefits program combines medical and lost-time management into a seamless process that saves time and money, eliminates bureaucratic inefficiencies and improves service for employees (patients), employers and health care providers.

Why integrate? [Illegible Text] at today's [Illegible Text] starters, workers' [Illegible Text] aggressively managed [Illegible Text] in the United States [Illegible Text] disability is the least aggressively managed and can cover everything from a severe bout of the flu to major surgery. Long-term disability is costly and often not well managed. Health care has been well-managed, but costs are beginning to rise again.

The industry consensus is that the greatest opportunity for better lost-time outcomes is in better management of short- and long-term disabilities. Common sense tells us that we can significantly improve the outcome of any lost-time claim by identifying it as quickly as possible, and by promptly managing it using consistent clinical and lost-time guidelines For example, the proven success of workers' comp claims management has included intervention strategies for returning the injured employee to work as well as safety evaluations and ergonomic assessments to prevent injuries.

A successful integrated benefits program draws from all of these important lessons.


The various integration models can be confusing, but there are essentially four types:

Health care and disability--This model integrates non-occupational lost-time management with medical management. Features include early notice of disability, focus on return to work and the use of disability duration guidelines, all coupled with current practices for medical management. This model enables health care providers to advise their patients effectively about expected lost-time durations for their specific diagnoses and job types, based on data gathered from medical literature, consensus panels and disability claims. Links between medical and lost-time databases eliminate delays often seen with manual systems and result in extremely efficient processes.

Health care and workers' compensation--This model integrates occupational lost-time management with medical management. Features include integration of both occupational and non-occupational medical management best practices that enable early return to function and return to work, plus single provider access.

Health care, disability and workers' compensation--This model combines the benefits of both models above and fully integrates occupational and nonoccupational lost-time management with medical management. Features include a smooth transition of all traditional lost-time and health care benefits for employees and single provider access.

Disability and workers' compensation--This model integrates lost-time care management and claims services, including intake for lost-time claims. …

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