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At HealthEast Care System in Minneapolis/St. Paul, a return-to-work (RTW) program is being rolled out systemwide to assist ill or injured employees to come back to work as soon as medically feasible. The RTW program, which was tested in a pilot at two HealthEast locations, received strong support from top executives who saw the value of offering the program for occupational and non-occupational illnesses and injuries.
Even before the RTW program is implemented fully, however, HealthEast plans to do more—namely, to extend its reach to help employees stay at work once they have returned to their jobs. To accomplish this, HealthEast, which has 6,700 employees and 1,400 physicians on staff, is looking to integrate its RTW program with its health and productivity programs that focus on wellness and prevention.
“When we presented the RTW program to top executives, we showed them the results from the pilot to ask for their support to make the program permanent,” explains Teresa K. Helm, director of benefits for HealthEast. “At the same time, we painted the bigger health and productivity picture. We showed them these programs as ‘pocket areas,’ and then we showed them how they could be integrated. Management grasped the concept immediately.”
HealthEast is the largest health care provider in the Twin Cities’ East Metro area, including three hospitals and a health campus, as well as outpatient services, clinics, pharmacies, home care and transportation services. The employer understands that it's essential to forge a link among its programs and to keep employees on the job by preventing future unscheduled absences.
“Especially with the aging workforce, keeping people at work is so important,” Helm says. Given the nursing shortage in health care, “We need to figure out how to keep our employees healthy.”
The Stay-at-Work Mentality
Employers are increasingly realizing that RTW programs—while important and beneficial—on their own are not enough.
Typically, RTW involves strategies such as:
These allow employees who are still recuperating to return to productive work. What often happens, however, is that once the employee is back to work, follow-up is limited to a specific time. In other words, after the employee is back at his or her regular job, the case is considered “closed.”
Yet there may very well be underlying, and unresolved, reasons why the employee was off work in the first place. It could be a workplace or ergonomic issue, or a health risk factor that either caused or compounded the reason for the absence. If the root cause or the health risk is not mitigated, it is probable that the employee will be off work again.
To bridge that gap, employers are adopting stay-at-work strategies, in which health, wellness and prevention initiatives can be paired with RTW initiatives. For instance, as employees ease back into the workplace through an RTW placement, they are offered support to improve their overall health and reduce risk factors. This may include:
Pamela Caggianelli, manager for corporate health for Bausch & Lomb Inc. in Rochester, N.Y., gives the example of employees who have cancer. With improvements in medicine and technology, these individuals are often able to come back to work while continuing to receive cancer treatments.
Stay-at-work efforts can include “a partnering plan” that allows employees to provide input into how they can remain productive. "The emphasis is on what employees can do—not on what they can’t—to allow them to stay connected with the workplace, retain their earnings power and medical benefits, and contribute to productivity," explains Caggianelli, who is the immediate past chair of the Certification of Disability Management Specialists Commission (CDMSC).
Another example she provides is that of an employee who has been injured on the job and is reluctant to return because of a fear of reinjury. In these situations, the EAP may be able to provide short-term counseling to help the individual cope, come back to work, and stay at work.
“Stay-at-work may involve creative ways to help the person return to work step-by-step, with support,” and thus to avoid relapses and further absences, Caggianelli says.
The Wellness Focus
Stay-at-work is a natural fit with employers’ increased emphasis on health, wellness and intervention. Often, these initiatives stem from group health as a way to identify and address health risks within the employee population, which may be identified through self-reporting during special health and wellness offerings or via health risk assessments, or by analyzing claims data.
Although the wellness thrust is usually to reduce health care costs, there have been additional positive returns from wellness initiatives: workers’ compensation and disability costs for employees who participate in these programs are also lower. In other words, companies realize lower average workers’ compensation or disability costs per participant for those who are enrolled in wellness programs than for those who are not.
As HR consulting firm Watson Wyatt reported in its 2007/2008 Staying@Work Report: Building an Effective Health & Productivity Framework, companies with the most effective health and productivity initiatives “are more likely to have lower program costs and incidence rates for short- and long-term disability and incidental sick pay programs compared with last year.”
Watson Wyatt found that the most common health and productivity programs “provide tools that encourage health and wellness (85 percent), promote emotional health (82 percent) and educate employees on safety (63 percent).”
Working Toward Integration
At HealthEast Care System, there is a strong commitment to health and productivity, with a variety of offerings that include care management, disease management, weight loss and smoking cessation, as well as EAP programs that also have a wellness model to address behavioral factors. The company stresses safety, including safe patient handling to improve patient safety and avoid injuries incurred by staff.
Until recently, however, the programs were “somewhat siloed,” Helm admits. Now, HealthEast is looking at integration and how to make referrals more easily from one program to the other. For example, if an employee who has been out on a workers’ compensation claim has a condition that can be addressed through disease management, which is part of the health plan, how can the individual be referred?
As employers are discovering, referrals among programs might require someone—such as the disability manager—to take “ownership” of a case. The disability manager acts as the bridge, providing not only information but also support for the ill or injured employee. Enrollment in an appropriate wellness program can be encouraged and facilitated to reduce an underlying health risk or encourage a lifestyle transformation, such as better diet and exercise.
Return to—and Stay at—Work
The RTW model remains effective as a means to help employees who have been ill or injured to come back to work as quickly as possible, to restore their earnings power and to contribute to the company’s productivity. While it is an important program offered by employers, efforts cannot end there. Wellness, prevention and other interventions can address health issues that might have caused or compounded the reason for the disability or other work absence. By putting the two approaches together, the goal becomes to help employees return to– and stay at –work.
Edwin W. Quick, MA, MBA, CDMS, CCM, CRC, is a commissioner with the Certification of Disability Management Specialists Commission (CDMSC), and also leader, employee health and productivity, for General Electric Co. in Schenectady, New York. He is a member of the SHRM special expertise panel for Employee Health, Safety and Security.
Renee Mattaliano, MA, CRC, CDMS, is chair of the CDMSC and an absence management consultant at Zurich North America Insurance in Schaumburg, Illinois.
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