IS THE FUTURE GOING CRAZY? PSYCHOLOGICAL CLAIMS MANAGEMENT

1. IS THE FUTURE GOING CRAZY?PSYCHOLOGICAL CLAIMS MANAGEMENT BY LIZ SCOTT & MICHELLE MACINTOSH

2. AGENDA • The facts • The solution • The proof – case study

3. Manulife LTD Claims by Diagnosis 2001

4. Increased Cost in STD OH&S Canada March 2001

5. Facts and Figures Disability Costs LTD STD WSIB Payroll

6. Depression Cost the Canadian & US economies $60 Billion US annually. Half in lost productivity. Incidence is growing and getting younger Depressive disorders account for 30-40% of mental illness in Canada, 50% of mental health $ spent Fastest growing category of disability claims Economic cost of mental illness in Canada are 14% of corporate Canada’s profits & 3% of our national debt. The facts…

7. Depression Productivity Issues Working longer but less productive There is direct link between depression and loss of productivity The future is mental! Information economy Human capital & the human mind are more important than brawn Depression directly effects out human capital Defeating depression must be a corporate priority! The facts…

8. How Much is It Costing Your Company? • Estimate number of days – present but not functioning • Estimate number of days – off work on “sick leave” • Estimate number of days – off work on “short term disability” • Multiply by the average daily wage?

9. The facts…. Research to Reality • Berger, ML, Howell, R, Nicholsen, S & Sharda, C. (2003) highlight importance of keeping the workplace healthy • Claxton, AJ, et al (1999) indicate that appropriate treatment improves outcomes • Kessler, RC, et al (1999) depressed workers had 1.5 and 3.2 more short term work disability days • Mintz, J, et al (1992) Ten studies analyzed show therapy combined with medication had the most effective outcomes.

10. The facts…. The Problem with Mental Health Claims • No lab, no physical, no objective tests • Takes 1.7 times longer • Not a fatal condition - don’t die soon, higher salary • Massive reserves - $250,000 • Can be “physical” – pain, fatigue, chronic fatigue syndrome, fibromyalgia

11. The facts…. Bottom line “on the street” Only 1 in 16…. or 6 in 100 good care rate Over 40% of all Dr notes are inappropriate * Coyne, 1995 ** Katon, 1995 *** Kessler, JAMA, April 2003

12. The Facts…. Long hours. The employee puts in to demonstrate that the employee has a high level of commitment.

13. The Facts…. Illness. Employee going into work with sicknesses (migraine, colds, flu, allergies) and are unable to work at a normal output level

14. The Facts…. Presenteeism. At work but not working. Time spent on other actions such as personal email, phone calls, internet surfing, “water cooler chitchat”, daydreaming.

15. The facts…. CAUSES: • Mental and physical illness • Work/Life challenges • Corporate culture Workplaces have little power to reduce actual illnesses, mental and physical, but have tremendous power in changing the sense of Work/Life Balance their employees experience and creating a Corporate Culture that supports and enhances its employee’s lives. In managing Presenteeism and mutual health disability, companies can effect change in the cost of absenteeism and STD.

16. How the health of the organization will impact outcomes

17. Could you insure the quality of your service and products……. • If each employee spent 2 to 6 weeks at work not able to do the job well?

18. Can you be confident about safety…. • If 30 – 40% of your employees are to tired or sedated with diminished cognitive function and dexterity?

19. Understanding Health at Work Psychsocial Work environment Healthy work environment Physical Work environment Individual Health practices

20. Basic Mental Health Needsin the Workplace • Respect & appreciation • Being heard and listened to • Sense of self-worth • Sense of belonging to a meaningful and supportive work group • Learning and challenge • Role clarity Shain, M. Best Advice on Stress Risk Management in the Workplace

21. Work Factors That Threaten Well-Being • Work overload and time pressures • Lack of influence over day-to-day work • Lack of training • Poor communication - ambiguity • Too little or too much responsibility • Lack of status rewards • Discrimination/harassment • Role overload Shain,M. Best Advice on Stress Risk Management in the Workplace

22. Understanding Health at Work High JobPressure Low Job Control HomeStress Low SocialSupport = Increased Risk to Mental and Physical Health Illness, injury, infection, anxiety, depression, substance abuse

23. Sociobiological Translation A mechanism by which human beings receive messages about the social environment and convert these messages into biological signals that trigger the processes of disease development or health promotion. Tarlov, 1996

24. Impact of The Organization on Employee Health 3x Heart Problems 3x Back Pains 2x Substance Abuse High Effort/ Low Reward + High Demand/ Low Control 5x Certain Cancers 2x -3x Injuries 2x - 3x Conflicts 2x -3x Infections 2x - 3x Mental Health Problems Shain, M. (2000) NQI - A Healthy Workplace

25. Important Learning's… • Work-life balance can be affected by workplace responses • How work is managed and how decisions are made within an organization is an important variable • Accountability and infrastructure support are essential • Real benefits accrue to organizations who make a commitment

26. The Underlying Framework Workplace Necessities Trust Fairness Purpose Programs

27. Trust An understanding attitude towards employees is much healthier than denying the existence of family and family obligation

28. Fairness 2 Components: • Distributive - who get what, and when • Procedural - the process through which decisions are made

29. Sense of Purpose • Understanding of the vision, mission and values • Understanding of how an individual contributes to the achievement of the vision, mission and values

30. Programs • Design programs to assist employees in making the right choices • Lunch and learns • Newsletters • Fitness

31. What Employees Can Do ATTITUDE INTERVENTIONS • Learning to Dance with Life! • Commit to staying healthy!

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34. The Value of Early Intervention The Solution

35. What is Disability Management ... • An integrated systematic process of returning people to functioning lifestyles following an event of disability Organizational Solutions, 2002

36. The Solution… The Bigger Picture Workplace Events • Early Intervention Disability Management Absence Management Prevention Programs Adjudication Disability to Ability Mgt. Interventions Return to Work Employee Hired (promises made) Time Treatment & Recovery Work Trials Return To Work Presenteeism Work Absences Healthy Employee Events

37. The Solution…. Disability Management Early Intervention = Success

38. Disability Management as Part of the Business Plan The Solution

39. Why Disability Management ? Probability of Returning To Work 100 80 60 Probability of RTW (in %) 40 20 0 0 3 6 9 12 15 18 21 24 36 Duration of absence (in months)

40. The Solutions…. CORPORATE CULTURE • Policies and Procedures that support and are usable for managers and supervisors • Managers that have face to face managerial time built into their job • Clear role definition • Managers have Clarity- they are able to communicate, observe situations from a non-personal position • Build trust

41. The Solutions…. WORK/LIFE BALANCE • Live it! • Policies and procedures that are fairly created and implemented • Humour and sense of fun at work • Flexibility when exceptions are presented • Managers and supervisors that manage little challenges before they become large issues • Implementation and promotion of EFAP • Workshops that are meaningful to the employees

42. The Solutions…. Claim Initiation • Appropriate paperwork • Appropriate treatment • Focus on RTW / capability

43. Claims Management • Right care, right time, right outcome • Ensure employees have a “its my job to get better” attitude • Be in contact with the employee, Dr. and Manager

44. Disease / Care Management • Claims management consists of monitoring a claim from the time it occurs until its final resolution. • Communication with the disabled employee during recovery should be frequent and should contain important messages, • Convey genuine concern, • Set expectation the employee will comply with company policies • Express a commitment to return them to work within their capabilities.

45. Claims Management • Only 20% of diagnosed depressions get appropriate “guideline care” • Specialist more likely to provide appropriate care then the family doctor • What is guideline care – CPA website

46. Return to Work • What is the RTW expectation? • Establish a clear path • Is it based on functional objective information or opinion? • Ensure they progress once they RTW • Prevent recurrence

47. Cognitive Job Demands vs. Cognitive Capabilities • Do they have the cognitive capabilities to perform the cognitive demands of the job • Quantify – much like the PDA vs FAE approach • What can the employee do vs What they need to do • Positive work environment will be essential

48. Old Management Approach!

49. The New Approach Right care, at the right time, for the right outcome

50. Thank You HRPAO Presentation - 2006 Liz R. Scott PhD Organizational Solutions lscott@orgsoln.com Michelle MacIntosh Baylis & Associates mmacintosh@baylis-efap.com Please feel free to use and benefit from any of the materials provided. If you do reproduce please give appropriate credit / reference to the originating source / forum as stated above. Thanks.