Transcript Slide 1

IARP New England Fall
Conference
How to effectively implement a Transitional RTW program:
From the corporate office to the front lines
Kristin Tugman, MS, CRC, LPC
September 2012
1
Agenda

Health and Productivity Development

Transitional Return to Work Building the Business Case:
● To the corporate office
● Corporate concerns
● To the locations
● Top concerns typically voiced by the locations

Transitional RTW program implementation
● Development
● Manager training

Demonstrating Return on Investment – Case Studies

The impact of ADAAA
2
A Health and Productivity Vision
Medical costs, job performance
and lost time are connected
Corporate culture
impacts the H&P connections
The Corporate H&P information base
guides the application of corporate
and partner resources to:
Protect productivity
Health Risk Appraisal/ Disease Management/EAP
Return to full productivity
Collaborative solutions for all lost time events
Mitigate future health & productivity issues
Aging work force /musculoskeletal disorders
Ambiguous impairments (depression/fibromyalgia)
Medicalization of common health problems
3
Health & Productivity Challenges In the Modern Workforce
The Aging Population
 From 2000 – 2020 the 55-64 year old age group will increase by 73% and the 65 and older
group will increase by 54%
 EEs over 40 are out of work on average 8-18 days longer than the younger worker
 133 Million Americans live with Chronic disease and large portion of productivity, medical
costs and lost time are attributed to this growing population
Attracting and Retaining Younger Employees
 From 2000-2020 the 35-44 year old worker will decrease by 10%
 Do you live to work or work to live?
 The younger workforce demonstrates a higher utilization of intermittent FMLA
Ambiguous Impairments
 Depression claims have experienced double digit increases over the last 10 years
 Younger, less tenured, women are the most likely group to file a behavioral health claim
 The younger worker is 4xs more likely to RTW after a behavioral health claim
 There has been rise in other subjective disability claims
 Incidence related to the sandwich generation
There are Health and productivity program and integration solutions available to help address
all of these areas of concern
4
STEP 1.
BUILDING THE BUSINESS CASE
5
Company Research and Development - incidence and duration
by division and diagnosis
(2012 is through September 18)
Year
2011
2010
2012
Submitted in
Average Submitted in
Average Submitted in
Average
Policy-Division
Period (Paid) % column Duration Period (Paid) % column Duration Period (Paid) % column Duration
00133483-0001
4
2%
32.5
3
0%
74
1
0%
109
PNNL bargaining
65
25%
51.4
83
13%
45
67
17%
53.8
00133483-0003
8
3%
55
6
1%
36.2
19
PNNL non bargaining
176
69%
57.6
216
33%
64.2
137
36%
64.2
BCO
3
1%
331
51%
48.7
175
46%
59.4
00133483-0006
14
2%
41.2
4
1%
43.4
Totals
256
100%
55.4
653
100%
53.7
384
100%
60
Overall average duration has increased in 2012
BCO has increased most significantly
Musculoskeletal and injury drive incidence and duration – those ICD-9s are primarily back, arthritis,
sprains, fractures and dislocations
The other category is primarily ill-defined symptoms that turn into more serious conditions such as
heart. In addition there are about 5% vertigo and 2% ill-defined fatigue and pain
2010
Year
2011
Submitted in
Average Submitted in
Diagnosis Group
Period (Paid) % column Duration Period (Paid) % column
Circulatory
14
5%
59.5
36
6%
Digestive
19
7%
49.4
42
6%
Genitourinary
12
5%
53.9
39
6%
Infectious/Parasitic
6
2%
31
11
2%
Injury/Poisoning
34
13%
53.3
64
10%
Mental Disorder
15
6%
80.4
35
5%
Musculoskeletal/Connective Tissue55
21%
67.2
134
21%
Nervous/Sensory
11
4%
62
30
5%
Other
16
6%
37.2
34
5%
Pregnancy
37
14%
49.1
132
20%
Respiratory
16
6%
17.2
46
7%
Tumor
21
8%
79.9
50
8%
Totals
256
100%
55.4
653
100%
2012
Average Submitted in
Duration Period (Paid) % column
44.1
20
5%
34
27
7%
38.1
20
5%
44.9
6
2%
54
54
14%
92.6
14
4%
57.5
77
20%
54.4
18
5%
46.8
34
9%
52
80
21%
24.4
11
3%
93.6
23
6%
53.7
384
100%
Average
Duration
64
43.1
44.4
39.4
54.1
105.1
65.6
61.8
63.9
53.9
66
66.1
60
6
Company Research and Development - bargaining and nonbargaining – age by top diagnosis
Musculoskeletal non-bargaining
Age
Under 30
30 - 39
40 - 49
50 - 59
60 - 69
70 Plus
Totals
1/1/2011 - 9/18/2012
Submitted in
Average
Period (Paid)
% column
Duration
1
1%
69
8
11%
62
13
18%
86.4
30
41%
55.8
20
27%
69.3
1
1%
55
73
100%
65.5
Maternity duration hovers around
8 weeks driven by younger
population longer claims
Injury - bargaining
Age
Under 30
30 - 39
40 - 49
50 - 59
60 - 69
Totals
1/1/2011 - 9/18/2012
Submitted in
Average
Period (Paid)
% column
Duration
1
4%
89
5
18%
17.3
11
39%
37
9
32%
75.7
2
7%
122
28
100%
55.8
Musculoskeletal duration is driven by
40-49 age group with 50-59 age group
being lower
Maternity non-bargaining
Age
Under 30
30 - 39
40 - 49
Totals
1/1/2011 - 9/18/2012
Submitted in
Period (Paid)
% column
22
28%
56
70%
2
3%
80
100%
Average
Duration
64
50.7
51.5
54.4
The union group duration by age is as
expected – as age increases, duration
increases
7
Current Cost and Potential Savings
Lost Work Day Impact
A. Total Lost Days
(annualized per data analyzer)
Full Time Equivalent (FTE) Impact
B. F.T.E’s (A/260)
Indirect Productivity / Cost Impact
C. Average Salary
D. Indirect Cost @ 100% (B x C)
E. Direct Cost (B x C x 60% BenReplacement)
Total
Potential Savings
2012
Annualized
data
Expected
TRTW impact
Current lost time
10% reduction
34,152
30,000
1
131
115
2
$45,000
$5,910,923
$3,546,554
$9,457,477
3
4
5
$45,000
$5,192,308
$3,115,385
3
4
5
$8,307,692
$1,149,785
1.Manufacturing annualized STD lost time and 10% reduction.
2.FTEs out of work all year long as a result of STD
3. average salary.
4. Calculated by assuming 100% of direct costs. May include; hiring and training of replacement workers,
overtime, lower productivity from replacement workers, routine overstaffing
5. Direct costs at 60% of salary replacement.
8
Question 1.
WHAT ARE CORPORATE’S BIGGEST
CONCERNS?
9
Corporate’s biggest concerns/questions

How much time will this take? What are the commitments needed
from my team and the locations?

Will it work… this is my reputation on the line!

What have you seen for ROI in the past?

What if we don’t do this?

How will we figure out payroll if employees are working part time?
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Step 2.
MAKING THE CASE TO THE
LOCATIONS
11
The Pitch…
The Corporate Endorsement

Company ABC is experiencing over 131 full time equivalents
out of work all year long as a result of short term disability

We spend over 9 million dollars a year from our bottom line
in disability related costs

As result – we are piloting a Transitional RTW program and
I have Consultant X on the line to walk through the specifics
of that program and what it may mean to your organization
12
Transitional Work
Transitional Work
Transitional Work
Full work Capacity
Stay
Stayat
atwork
Work
)
(preserveproductivity)
productivity
(preserve
Absence
Absence
from work
Work
from
work
Return to Work
)
(restore productivity
productivity)
Transitional Return to Work Is:
•Based on the fact that employees do not regain 100% work
capacity instantly. Recovery is incremental.
•Time limited with a return to one’s own occupation
•Successful through manager participation
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What are Transitional RTW Pathways?

A method of reducing lost time

A process to define functional capacity
 What the employee is capable of doing within his or her own job

A strategy to reduce inconsistent and narrowly defined work site accommodations

A collection of agreed upon RTW pathways & options

A planning tool

A communication guide between employer, case manager/RTW Planner and physician

A method of documenting time limited accommodations offered and accepted
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14
How to Build Pathways
Apply
Support
Theoretical
to Actual
What’s
Possible?
Introduction
Define
readiness to
develop
pathways.
Initial
Brainstorming
session with:
1. Human
Resources
2. Employee
3. Physician
Discuss with
appropriate
staff to
identify likely
adjustments,
Challenges,
barriers that
may arise, as
well as
common
restrictions,
limitations,
and discuss
possible
pathway
options
Produce
pathway
options draft
based on
earlier
discussions for
testing out.
Define impact
on health and
disability
benefits, work
status, and
retirement
status
Submit to HR
& Conferences
for review.
Meet with
conference
managers to
solicit
feedback.
Apply
transitions
Monitor on
weekly basis
Revise to
reflect success
and desired
changes.
Confirm with
attending
physician to
determine
medical
readiness and
include as part
of treatment
plan
To define
options and
secure buy-in.
Establish Eligibility, as well as Entry/Exit Criteria
for Transitions (Prevent being stuck in permanent
light duty).
15
Transitional Work Example: Line Worker
Full Work Transitions
Capacity
Work
Full Work Transitions
Step 3:
Step 2:
Step 1:
Absen
Out offrom
Work
ce
Work
20
hours/wk
Cross
training
Work 40
hours per
week
On the
line in a
new
rotation
Full time
work
capacity
Seek out
assistance
as needed
Return to
(restore
Work )
productivity
Line worker who underwent back surgery and was out 6 weeks. It is recommended
that the individual return to work incrementally return and time limit is 2 weeks to
build up work capacity.
16
Sample Transitional RTW Pathways
Examples of Transitional return to work pathways for Manufacturing are below:
Restriction and
Transitions – up to 1
Limitations
week
Reduce Lifting
Assistance
Alternate work assignment
Remove Tasks
ie, cycle counting,
Temporary Assignment
inspections
Remove Tasks
Alternate work assignment
Temporary Assignment
ie, cycle counting,
Reduce Bend Twist
Transitions up to 30 days
inspections
Reduce
Remove Tasks
Alternate work assignment
Stand/Walk/Climbing
Temporary Assignment
ie, cycle counting,
inspections
Reduce Exposure to
Remove Tasks
Alternate work assignment
targeted stressors
Temporary Assignment
ie, cycle counting,
inspections
Reduced work hours
Shift Change
Shift Change
Modify work hours
Modify work hours
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1/1/2011 – 12/21/2011
Sample - RTW Statistics

554 STD claims submitted and paid for 2011

182 claims went longer than 40 days in duration and for the review period (not including
maternity)

212 reviews for RTW readiness during review period

48 RTW successes – RTW own occupation
 32 Musculoskeletal/Injury
 4 Nervous Sensory
 3 Cancer
 1 Other – (foot problem)
 4 Digestive
 1 Genitourinary
 1 Infectious Disease
 2 BH

2 RTW same ER, new occ – musculoskeletal, nervous/sensory

1 RTW plan not implemented, ER refused

2 RTW – release obtained

At least approximately 950 saved lost work days
18
Dramatic Increase in Reviews & SLWDs quarter over
quarter with increase in successes following… (Sample –
Service Industry)
200
180
160
140
120
100
80
60
40
20
0
TRTW
Readiness
Reviews
TRTW
Successes
Saved Lost
Work Days
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
Saved lost work days continue to rise – up to 185 for 4th quarter
1st qtr – 51, 2nd qtr – 70, 3rd qtr - 158
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Step 3.
SITE VISIT AND PROGRAM
DEVELOPMENT
20
Sample Site Visit Schedule

9:00 AM - 10:30 AM - Meet with HR Team to review critical issues
and program guidelines

10:30 AM – 11:00 AM - Meet with SR. Operations to review
program and ensure comfort level

11:00 AM - 12:00 PM - Meet with employees who have used the
benefit within the last year (individual meetings – 15 minutes
each)

12N – 12:30 PM – Lunch Break

12:30 – 2:00 PM - Tour of the facility

2:00 PM – 4:00 PM - Meet with representation of
supervisors/managers in groups (1 hr sessions) 5-8 managers per
hour is optimal.

4:00 PM - 4:30 PM - Question/Answer and review of visit. Discuss
next steps with hosts
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Question 2.
WHAT ARE THE LOCATION’S BIGGEST
CONCERNS?
22
The location’s top concerns

I don’t want to buy a workers’ compensation claim! Prove it!

We don’t have “light duty”

How will we adjust productivity measures to ensure managers don’t get penalized for
having a “light duty” worker

What if an employee is on heavy medication?

Now every employee is going to want to be on light duty!

I can’t have someone in my shop at less than 100% - the work is too physical, it is too
dangerous!

Why wouldn’t I just pay OT or a temporary worker and get 100% output so that I
ensure I meet my productivity goals!

What if patient care is negatively impacted because a less than 100% nurse couldn’t
effectively respond in an emergency?
23
Step 4/Question 3. Why?
MANAGER TRAINING
24
Question 3. Answer
WITHOUT MANAGERS
THERE IS NO PROGRAM!
25
Agenda

Transitional Return To Work (TRTW) Philosophy

Company’s TRTW Program

Location Statistics

What We Have Done so Far / Site Visits

Responsibilities

Process for the TRTW Program

Transitional Return to Work Pathways / Modification Options

Pay While on TRTW

RTW Tracking

Contacts / What’s Next

Questions
26
Rationale for the
Transitional Return to Work Program

Productivity & Staffing
 Lost time disrupts operations and productivity leading to overtime
or work not being completed.
• Leads to a drain on operations and overall EE well being.
 Operations already functions on a skeleton crew

Organizational Consistency
 Ensure employees are offered the same opportunity for transitional
return to work when appropriate
27
Transitional Work
Transitional Work
Transitional Work
Full work Capacity
Stay
Stayat
atwork
Work
)
(preserveproductivity)
productivity
(preserve
Absence
Absence
from work
Work
from
work
Return to Work
)
(restore productivity
productivity)
Employees do not regain 100% work capacity instantly.
Recovery is incremental.
28
Site Visits – Location 1 and Location 2
Purpose

Met with managers and supervisors to introduce the TRTW program and gain
insight into potential barriers or issues with the program

Toured facilities to fully understand job requirements
Findings

Order builders and night shift workers have the most lost time issues

Two to four week transition plans are optimal

Part-time to full-time transitional work preferred

Job modifications possible to a degree – preferable that TRTW plans do not
include “light duty” assignments typically given following occupational
injuries

Some managers not aware that STD costs are currently paid for through
payroll budgets
 TRTW will increase employee productivity
29
Company RTW Coordinator Responsibilities

Discuss the RTW plan with the Return to Work Liaison (Vocational
Consultant)

Discuss the RTW plan with the Employee’s Manager

Follow up with the Unum RTW Liaison with regard to the feasibility
of the plan

Be available to discuss progress with the Employee’s manager

Contact the RTW Liaison if questions with the plan arise
30
Company Manager/Supervisor Responsibilities

Discuss the RTW plan with and give feedback to Company RTW
Coordinator

Verify the employee is scheduled to work the number of hours
agreed upon in the TRTW plan

Meet with the Employee to discuss the plan upon the first day of
transitional work

Meet with the Employee daily or weekly to discuss progress and
ability to move on to the next step in the RTW plan

Follow up with company RTW Coordinator for your location if
progress is not moving as expected
HR is only involved in the initial set up of the program or when
escalated issues arise
31
Sample TRTW Plan
Transitional Return to Work Plan
Employee Name_________________
Manager Name_____________________
Date of Disability__4/1/2010_
Transitional RTW Date 7/1/2010
Expected Full Time RTW Date 7/24/2010
Actual FT RTW Date__________
Department: Warehouse – Order Builder
Restrictions and Limitations: part to full hours for 2 weeks, no lifting greater than 30lbs for 1 weeks with gradual
increase to full lifting duties over the next week, and limited bending for first week back in warehouse
Sign off
Initials
Timeframe


Week 1
Week 2
Week 3
Expectations
Accommodation


Reduced work hours
Alternate work
assignment
Results
MGR
EE
Work 4 hour shift
Work in POS


Reduced work hours
Temporary Assignment


Works 4 hours
Work Tygard Pallets


Reduced work hours
Temporary Assignment


Work 6 hours
Work Tygard 4 hours of the
shift

Full Capacity
Week 4
Resume use of screw gun
Seek out assistance as needed
32
Step 5.
RETURN ON INVESTMENT
CASE STUDIES
33
Hospital – Case Study
The Challenge

1200 life hospital group with high STD and LTD incidence and longer
than expected STD durations
Action steps

Performed Lost Analysis to determine areas of opportunity

Implemented structured TRTW program with TRTW pathways

Enhanced partnership through program solutions with claims teams
Outcomes

7 day reduction in STD durations 6 months over 6 months

79% reduction in flow through rate year over year

450 saved lost work days saved in less than one year
34
RTW Development – Hospital A Duration comparison
Consistent improvement during review period
2/1/08 8/31/08
Expected Duration =
55 Days
48.5
8/1/20071/31/2008
50.6
2/1/20077/31/2007
53.7
8/1/20061/31/2007
55.8
20
30
40
50
* Pilot TRTW
program
began
2/1/2007
60
70
*All duration experience above includes the STD elimination period and expected is based on plan design,
industry, and demographics
35
The Call Center Challenge

Call center environment with high incidence of Behavioral Health
claims with higher than average durations

High level of frustration among management due to high incidental
absence and the subjective nature of behavioral health claims

No structured return to work program

Increased employee anxiety around return to work
36
Transitional Return to Work Program
Implemented May 2009
Length of Transition Plans are more than 2 weeks and up to 30 days
o
o
o
o
Reduce Work Hours
 Shift change
 Modify Work Schedule
 Increase Breaks
Reduce Exposure to Targeted Stressors
 Training
 Project work
 Coaching
Alternate sit/stand
 sit and stand as is necessary at their desks
 Training
 Project work
 Coaching
Reduce Keying
 Training
 Coaching
37
Sample Transitional RTW Plan –
Major Depression
Prescribed Restrictions and Limitations: Reduced phone time for first day and then part time to full time hours over 2
week period
Length of Transitional Work: 2 weeks
Timeframe
Strategy
Application
Training
Modified Work Schedule




Day 1
Modified Work Schedule
Outcome
Sign off Initials
MGR
EE
Catch up on emails
Catch up on product updates
Listen in with another EE
Work 4 hours
Resume regular position 4
hours per shift

Day 2-5
Day 6-10
Modified Work Schedule
Modified Work Schedule

Work 6 hours per shift –
regular position

Return to full capacity
Day 11
38
Transitional Return to Work (TRTW)
and Behavioral Health (BH) Case Management
Call Center Data
Pre Implementation
(10/1/08 –
9/30/09)
Post Implementation
(10/1/09 –
9/30/10)
27
18
Average Duration of
BH STD Claims
88 days
86 days
STD BH Claims
Transitioning to LTD
6
2
BH TRTW Successes
0
7
FTEs out of work all
year due to BH STD
7
4
($341,000)
$119,000
BH STD Claims
Lost Time
(Cost)/Savings
for BH STD
39
A New Reason for Employer’s to Consider Transitional RTW
THE AMENDMENT TO THE ADA
40
Top 5 ADAAA Mistakes
1. Failure
to identify essential functions
2. Failure
to engage in the interactive process
3. Failure
to accommodate
4. Adopting
inflexible leave policies
5. Disregarding
privacy rights
41
41
Recent ADA violations

Sears
September 2009: EEOC reached a $6.2 million settlement with Sears, Roebuck & Co.
based on an alleged policy of failing to accommodate employees after leave

Supervalu
January 2011: EEOC reached $3.2M settlement with Supervalu Inc. based on
alleged policy of terminating employees at the end of medical leaves of absence
instead of bringing them back to work with reasonable accommodations and failure
to allow employees to participate in light duty programs if they were not injured on
the job.

JP Morgan
November 2009: EEOC reached a $2.2M settlement with JPMorgan Chase to settle a
class action suit alleging that employees were terminated after they exhausted sixmonth medical leaves without any analysis of whether it was possible to
accommodate their limitations so that they could return to work.
42
Additional Questions???
Kristin Tugman
[email protected]
207-575-2751
43