Employers are grappling with health care costs and looking for maximum leverage from their health and disability programs.
Disease and disability management
Disease management empowers employees with information to help them stay healthy and avoid events that may lead to disability. Those with chronic conditions are identified early so there's more opportunity to keep them healthy. The result is not only significant medical cost savings, but also happier, healthier, more productive employees with fewer absences.
Disease management is a systematic approach to medicine that encourages patients to follow health-promoting behaviors through a strong patient-doctor relationship. The most effective programs align physicians and patients through education and support programs for asthma, low-back pain, diabetes, cardiac disease and other chronic conditions. Disease management also responds to consumer demand for more personalized care. The perfect companion to disease management is disability management, which uses simple processes and quality management to identify and manage factors that influence an employee's return to work. Better disability management processes are providing employees greater ease in reporting a disability and faster, more effective return-to-work planning from the moment the claim is reported.
Through disability management, barriers to an employee's return to work are identified and assistance is provided early -- while the employee is recovering -- through modified work arrangements, vocational rehabilitation or retraining. At the heart of any disability management program is an employer who is responsive to the needs of sick or injured employees and who is willing to offer modified job duties or flexible schedules to help the employee ease back to work.
Caring for the whole person
The return-to-work planning process begins almost immediately after receiving the report of a disability. Most complex diagnoses have multiple factors that affect return to work.
Heart disease patients may suffer depression after surgery, and both the physical and psychological impacts of the disease must be addressed. The best disability management programs ensure that one person manages the disability, developing a customized strategy for each claim and shepherding it through the entire process to ensure smooth, consistent management without disruption or time lags.
Health and disability insurers are beginning to use disability predictive models to forecast disability claims that have a higher risk of delayed return to work. The process involves looking at the whole person and the medical and nonmedical factors affecting the ability to return to work. While more traditional models depend entirely on medical factors to determine return-to-work probability, new models point to the psychosocial, behavioral and environmental factors that affect the disability.
For example, if an employee has no access to public transportation and can't drive because of a broken leg, paying for taxi or shuttle service to facilitate return-to-work might be in order.
Continuum of care
Disease and disability management programs, working hand in hand, are part of a continuum of care that:
- Helps manage chronic conditions and reduce chances of worsening.
- Enables people with potentially disabling illnesses and injuries to return to work with the support they need.
Combining disease management with disability management is an effective method of preventing some disease conditions from turning into a disability. Disease management for asthma can prevent it from worsening and enhances the patient's ability to perform the job.
This also lessens the possibility of the individual becoming disabled due to asthma. If a disability does occur, an integrated disease/disability management program can help the person return to work and productivity sooner.
Employers will get the best results -- from both a clinical and employee productivity standpoint -- by integrating disease and disability management into complementary benefits. In this way, employees can continue to live productive working lives and employers can make the most of their employee benefits programs.
Barton Margoshes, M.D., is national medical officer, CIGNA Disability Management Solution; Z. Colette Edwards, M.D., M.B.A., is vice president and senior medical director, CIGNA HealthCare of Ohio. CIGNA is one of the nation's leading providers of health benefit programs, with managed care networks in 45 states, the District of Columbia and Puerto Rico. Reach Edwards at (800) 541-7526.