Integrated health and disability plans Featured

10:44am EDT December 21, 2004
In today's business environment, managing benefits costs and maximizing employee health and productivity are crucial issues. To address these, most business owners look to insurers to provide programs for health care and disability services. When integrated, these programs can work seamlessly together, like two runners in a relay, to achieve success.

When it comes to improving an sick or injured employee's chances of returning to work sooner, timing is everything. Disability services are effective in helping employees, but, when information is shared between health and disability, it enhances an employee's ability to address his or her health condition.

That's why employers are increasingly pursuing programs that offer integrated health and disability (IHD) services. These programs link medical, short-term disability and long-term disability plans, viewing employee health more holistically, which can mean better identification and resolution of tough health issues.

Information sharing

With this integrated model, employees who have a certain health or disability claim are asked for permission to share data between the insurer's health and disability staffs. This provides protection for health information in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Once permission is granted, case managers from both disciplines work together to achieve the greatest impact on the employee's overall health. By looking at the employee's medical needs and ability to work, the insurer can identify opportunities to help the person return to the workplace sooner and avoid an extended disability claim.

Some insurers with IHD capabilities can help you achieve even greater preventive results by integrating your enrollees' medical and disability data. By analyzing historical claims data, they may apply certain predictive models that identify members at risk for adverse health and disability events. This allows them to implement early intervention programs designed to avoid or lessen disabilities and time away from work.

Employer and worker benefits

When your insurer links medical and disability claims information, claims processes and case management, it benefits you and your employees by:

* Improving plan administration

* Providing a consistent medical case manager for the employee

* Supporting complete, efficient interactions between your employees and health and disability staff

This last point can be especially effective in helping employees cope with the intricacies of difficult medical situations. IHD offers employees and their doctors a single point of contact for interacting with the insurer on complex treatment issues, eliminating multiple phone calls and duplicative paperwork.

IHD case scenario

Let's look at an example of the IHD model in action. Imagine that David, 50, is out on disability due to low back pain. He also has diabetes, a chronic and potentially dangerous condition.

Rather than look narrowly at the back injury, David's IHD case management team would review his situation holistically. With permission, the information is shared between medical and disability case management, and the disability team learns that David was also recently admitted to the hospital after suffering a diabetic coma.

With a handle on both of these health events, the team would then develop a common plan to help David more fully understand his condition and contributing factors. The team would also be aware of the potential for co-existing conditions such as depression and help David and his physician access providers to manage the depression.

This coordination of care could help David reduce his risk of future hospitalizations by taking proactive, preventive steps.

A closer look

There are many examples of how an integrated health and disability approach can lead to improved medical outcomes and reduce employer benefits costs at the same time. You may want to get in touch with your insurance broker or consultant to analyze how your organization might benefit from IHD and smarter, clearer handoffs between the people who help manage your employees' health.

Mark Hanrahan is vice president of sales and service for Aetna's north central west region. Reach him at (312) 928-3104 or HanrahanM@aetna.com.