The pandemic disrupted the operations and planning of many
workers’ compensation organizations (WCO).
Researching and planning had to shift from strategic initiatives to
tactical priorities of protecting staff and serving the workers and employers
reliant on workers’ compensation. As we
transition to the post-pandemic era, planning for the longer term must gain in
priority.
The international consulting firm, Deloitte, published a
study on the future of workers’ compensation organizations in 2020, just as the
COVID-19 crisis was impacting services across the sector. The timing of its release meant that many
policy makers, boards of directors, and planners may have missed the analysis. A link to the study at the end of this post.
The study is based on surveys of 18 workers compensation
organizations in the US, Canada, and Australia.
It identifies five “levers” that workers’ compensation organization can
use to shape the future of service delivery and outcomes. The five levers are:
- Risk-based segmentation
- Standardized plans
- Case management team structures
- Focus on prevention
- Leveraging behavioural economics
The study focuses the work and structure of WCOs on return
to work (RTW) and recovery. For many WCOs, this means a functional shift
from internal processes focus of claims inventory management to better outcomes
for workers in terms of health, safety, recover, and RTW.
Risk-based Segmentation:
The majority of workplace injuries result in little or no
time away from work. Workers are often
back on the job before a claim is fully established. Identifying these cases as low risk in terms
of difficulty in recovery, rehabilitation and return-to-work can streamline
operations, improve customer service and focus resources where they are most
needed.
Many organizations are adopting “auto-adjudication” methods
for more routine cases. What is often
missing from the system is segmentation based on the risk of failing to return
to work or the difficulty of returning to work.
The study suggests that up to 80% of cases may be handled fully or
mostly by automated systems. This meets
service expectations of injured workers wanting timely decision-making and
payment of claims. It also frees
resources to focus on more complex cases including, shoulder, back, traumatic
stress, occupational cancers, and fatalities. This is not just Pareto principle,
example, but a practical imperative.
Organizations that stream or triage cases into specialty
areas from the start of the claim are already well on their way towards fully
risk-based segmentation. I have seen
specialty units set up for hand injuries where treatments are arranged and
commenced before the claim is fully adjudicated and accepted. Some agencies have experimented with
sensitive and mental injury claims groups to adjudicate and case manage injuries
related to harassment, assault and stress—claims with a high risk of lengthy
recovery, recurrent disability, and difficulty in sustained, safe return to
work. Risk-based segmentation has the
potential to make workers’ compensation organizations more efficient and better
at optimizing worker outcomes.
Standardized plans:
The Deloitte study emphasizes the use of standardized plans. This strategy follows from segmentation and
takes different forms in different workers’ compensation organizations. Case managers, treating physicians, and
therapists can use standardized treatment, rehabilitation and recovery protocols
as the basis for planning, setting expectation, and more quickly identifying
cases issues that may jeopardize outcomes.
Standardized treatment plans are not cookie cutters but
starting points for taking those medium and higher complexity cases toward the
objective of RTW and recovery. These are
not the old medical yardstick tools of the past. Treatment and rehabilitation guidelines (See
as an example, WorkSafeBC, Ankle Ligament Reconstruction Post-op Rehabilitation
Guidelines, available at https://www.worksafebc.com/en/resources/health-care-providers/guides/ankle-ligament-reconstruction
) provide the worker, case manager, and treating professionals with common
understanding, expectations, and
roadmaps to RTW and recovery. This
standardization does not obviate the need for customization and active case
management but does lead to consistent treatment, fewer delays and ultimately
better outcomes. Besides the
transparency and predictability standardized plans offer, they also allow greater
time for providing support to workers and their families.
Case management team structures
Having effectively and accurately segmented cases and standardized
plans, WCO structures and systems need to be aligned to manage cases. Injured workers with medium to high
complexity injuries complain about case manager lack of understanding of their injury,
constant hand-offs, and “churn” in personnel.
Injured workers often ask me, “Should it be up to me to training my case
manager?” and “Why do I get someone new every time I call?. They hear about a “team” approach but are
never told what that means. Rarely is
the team members identified by name and responsibility.
It is not just about structure. It is about training and specialization that
can implement the best practices of RTW consistently. Mental health teams, for example, can be very
effective if the teams have the deep understanding that comes with training and
experience, often within a specific sector (particularly law enforcement,
paramedical services, and healthcare).
Structures need foundations.
The infrastructure to support case management in the future WCO will not
be the same as it was in the past. Analytics
and artificial intelligence will facilitate timely actions and flag cases where
interventions are necessary. This is not
just about following schedules but integrating information to overcome barriers
to RTW or impediments to recovery so they can be acted upon in a timely
way. Ontario’s WSIB, for example, offers
the following “Specialty Programs” to:
…provide timely access to expert specialists for people with work-related injuries or illnesses. These programs specialize in recovery and achieving a healthy and safe return to work by conducting an assessment and providing interdisciplinary treatment for more complex injuries and illnesses.
(see WSIB, Specialty Programs, available at https://www.wsib.ca/en/specialtyprograms)
Focus on prevention!
Some seek to limit the concept of “prevention” of injury but
a more inclusive definition that embraces the prevention of disability is
needed. This is not as clear in the Deloitte
study as it should be. While there is a
nod to changes in terminology away from “injury management” to language and practices consistent with recovery
and return to work.
As the Deloitte study points out, the prevention mandate
varies widely across WCOs. About half
the Canadian jurisdictions and a few jurisdictions in the US and Australia, the
legislative mandate for occupational
health and safety including prevention is embodied in the workers’ compensation
legislation or authority.
Regardless of mandate, the study asserts, “prevention efforts can support all WCOs in
realizing sustained reductions in claims volumes and costs, higher safety
literacy rates, and communal ownership of prevention.” [p.15]
WCOs can act directly within their mandates. According to the survey, WCOs are now leveraging
a focus on prevention to reduce injuries and prevent through”
- Periodic workplace safety audits are conducted (50%)
- Employer rating/pricing is tied into their implementation of health and safety programs (56%)
- Work with employers to create customized safety programs for them (61%)
- Employers are offered a menu of safety programs that they may implement and adopt as needed (61%)
The Deloitte study flags strategies that focus on cultural
change within the workforce, third party collaborations to enable safety and
prevention in the workplace and data analytics to support workers and employers
in preventing injuries before they occur.
A prime strategy is to focus on industry and partner with employers,
industry groups and labour organizations.
Dedicated departments focused on prevention initiatives with the
personnel and budgets to initiate, sustain and expand preventions efforts are
essential.
Examples such as the collaborative cultural change efforts include
- The Community Against Preventable Injuries in BC https://www.preventable.ca/join-the-community/,
- WorkWell initiatives in Victoria, Australia, https://www.worksafe.vic.gov.au/workwell and
- Premium Pricing features in Alberta https://www.wcb.ab.ca/assets/pdfs/employers/pricing_2023.pdfb .
Collaborative initiatives targeting segments of high risk,
high complexity at their route are essential to effectiveness of this
lever. WCOs through collaborations and
initiatives can bring predictive analytics, the latest research, retrospective
data analysis and resources to bear on issues to prevent injury and disability
as with BC First Responders’ Mental Health
(see http://conference.bcfirstrespondersmentalhealth.com/).
Leveraging behavioural economics
WCOs are learning to reach beyond the traditional disciplines
of insurance and enforcement in finding ways to achieve a future state. The Deloitte study highlights the power and
potential of behaviour economics to better understand and influence the way
people behave.
WCOs have employer performance data on injuries, fatalities,
inspections, and penalties that are too often hidden from the public, workers,
and other employers. Overcoming the organizational inertia or limits of the WCO
mandate is essential to bringing about this future state.
One of the “future” behavioural
economic approaches highlighted include publishing employer injury rates online. A great example of this already exists in
Alberta. With the entry of an employer
name, results covering up to five years of data are instantly available. The data are rich and include person year
estimates, disabling injuries, lost-time claims, workplace incident fatalities,
occupational disease fatalities and much more.
Injury rates for the firm and the overall industry add to the context. The database includes summaries of occupational
health and safety orders, administrative penalties, and even convictions. [See https://extern.labour.alberta.ca/ohs-employer-search/occupational-health-safety/employer-records-search.asp]
.
The study also highlights research out of New South Wales that used behavioural economics:
…to personalize support for workers and encourage them to actively participate in the recovery process. Practices included reducing the volume and detail of communications, reframing messaging to focus on recovery and RTW rather than on injuries, and having case managers provide more personalized support that was targeted to workers as individuals. [p 18]
For corporate planners in WCOs, the Deloitte study is a must
read. It is not about the distant future
but an emerging one where the ideas presented are actual, real world actions
underway that have the potential to further prevent injuries and achieve better
outcomes for workers and their families.
The study “The future of workers’ compensation - How
workers’ compensation organizations are improving return-to-work outcomes” is
available at: https://www2.deloitte.com/ca/en/pages/financial-services/articles/the-future-of-workers-compensation.html
