Integrating benefits Featured

6:21am EDT April 29, 2004
In today's competitive business environment, loss of productivity due to employee disabilities is a growing concern.

The strong desire to retain employees and the high cost of replacement workers are important drivers behind growing employer interest in integrating medical and disability benefits. A Mercer Human Resource Consulting study found that companies spent 15 percent of payroll on employee absence in 2002.

In addition, chronic diseases are on the rise in the United States. According to the American Diabetes Association, almost 17 million people in the United States have diabetes, yet about one-third don't even know they have the disease.

Researchers have estimated that diabetes cost the country $132 billion in medical expenses and lost productivity in 2002.

Return to productivity

By combining health and disability data to get an overall picture of a patient's health, physicians can help their patients remain healthy and productive. An integrated health and disability management approach can't necessarily prevent disease, but it can help a patient manage the progression of the disease and open up new options for workplace accommodations.

Here's an example. Bob, a 41-year old employee who works at a manufacturing plant, has a nonwork related injury and visits his doctor. His doctor determines that he's having lower back pain, says he should be out of work for a week, prescribes a muscle relaxant and anti-inflammatory medicine, and recommends physical therapy.

When Bob files his disability insurance claim, he agrees to join the integrated health and disability program and signs an authorization allowing the medical and disability staff to share information about his condition.

Over the weekend, Bob complains of frequent urination, thirst and hunger. He becomes disoriented, passes out and is admitted to the emergency room. His attending physician discovers that Bob is suffering from diabetic ketoacidosis and has very high blood sugar.

Bob's wife calls his disability insurance specialist and explains that Bob was taken to the hospital due to disorientation. She does not mention diabetes to the disability specialist. However, the disability insurer requires a statement from the attending physician and contacts the doctor's office.

The nurse tells the disability specialist that Bob was admitted to the hospital in a diabetic coma. The disability specialist explores the matter further and discovers a history of depression (a common, co-existing condition) and the new diagnosis of diabetes.

At this point, the disability specialist can continue with approval of the disability claim, and because Bob has previously granted permission to share information between his medical and disability case managers, she also makes a referral to the medical case management team responsible for Bob. When Bob is discharged, he is still experiencing lower back pain and is a newly diagnosed diabetic, so his doctor advises him to remain off work for four more weeks.

In the meantime, his medical case manager has also received a referral from the hospital. The medical case manager refers the case to the insurer's behavioral health and diabetes disease management area for follow-up.

In this scenario, Bob would get case management assistance from a care team that reviews his case in its entirety, develops a common plan to understand the link between his depression and his diabetes, and synchronizes the efforts of the medical and disability staff to help him return to work earlier than otherwise expected.

This holistic management approach focuses on the root causes of absences that generate health and disability claims. It links health effectiveness to functional outcomes, return-to-work and work/life issues. The total health model also enables employers to measure the value of health care products, at least partially, by their impact on productivity. Dr. Burton VanderLaan is a board-certified oncologist. He serves as regional medical director for Aetna and is responsible for quality and utilization activities for a 16-state region. He is a member of the board of governors and a past president of the Institute of Medicine of Chicago, and has served as a member of the board of trustees of the Illinois Hospital Association. He also is a fellow of the American College of Physicians. Reach him at (312) 928-3580 or VanderlaanB@aetna.com.