Program integration is an oft-used phrase in workers’ comp, yet the substance behind those words is often lacking. In this edition of Inside Workers’ Comp, Ron Skrocki identifies disconnects that can affect program cohesion and how to overcome them.
Tom Kerr (TK): Welcome to Inside Workers’ Comp, a regular multimedia series in which subject matter experts discuss problems and offer solutions to top issues affecting our industry.
I’m Tom Kerr, and today we're talking about integration of workers' comp services with Ron Skrocki of Genex. Ron, thanks for joining us today.
Ron Skrocki (RS): Great to be here, Tom.
TK: To start off, tell us what you think are the disconnects in workers' comp services that are affecting return to work.
RS: One of the frequent disconnects that we see is the disconnects in the care for planning or planning of the care, the coordination of care, the approval of care, the payment of care, the communication of all of that care and that care plan with the injured worker.
What slows down the process, which slows down recovery, which slows down return to work, is the lack of effective coordination.
The other obstacle here and what's lacking in some programs is just the proactive planning for return to work. Acknowledging that while we don't want injuries, we're going to have them, using the history of injuries in the type of work that an employer has to inform us into the types of return to work programs that work, what kinds of modified duty, what kind of timeframes, what kind of transitions, all of that done in advance integrated with the actual delivery of post‑injury care coordination and return-to-work coordination, yields a far better result than the individual components not planned, coordinated and integrated.
TK: We hear the term integration services being used a lot in workers’ comp, so how would you define it?
RS: At Genex, we define integration as the putting together of a managed care program in a way that the total outperforms the individual components. We hear people talk about integration that has far more emphasis on the integration of claims management with medical management.
Now, we know and we understand and our clients work hard with us to make sure that the claims process, the claims practice, the role of the claims professional, is clear, defined, and synchronized with the role of the medical management process, whether it's the nurse, physician advisor, or any of the various services that can be coordinated and integrated.
Our emphasis, our obsession, our expertise, is in integrating the managed care components. Far less time is spent in many payer organizations on that integration, and far more time is spent on what I'll call administrative integration between the claims payer, the adjuster, and the managed care process as sort of one large bubble.
TK: What are some of the challenges of implementing a truly integrated program?
RS: One is a focus. You have to have the time and the energy, the effort, the obsession on making sure that these integrations work extremely well together.
The other thing, and it's lacking sometimes, is an overarching goal to achieve, guiding, because we can endlessly refine anything in life or in business, and you get to the point of diminishing returns.
There's not a lot of perfect things in the world, and there's a reason for that, one of which is you get to a point of refinement that's enough, that base, that cost to get 80 percent of the refinement and the benefit of that is really all that can be justified. Going that extra 20 percent is going to cost you a lot of time and effort, focus, money.
You have to be really sure about what you're trying to achieve in terms of your end goal, in order to know how much integration is enough and how much incremental improvement can lend to the health of the injured worker, to their experience, to my overall cost of risk. And then I think you have to have a financial commitment to go after it.
TK: Thanks Ron, in part two of this podcast we’ll discuss what a true integration program should look like and determine who the players are that drive it. Until then, thanks for listening.
Continue to Part 2
Tom Kerr (TK): Welcome to Inside Workers’ Comp, a regular multimedia series in which subject matter experts discuss problems and offer solutions to top issues affecting our industry. I’m Tom Kerr and in part two of our discussion, Ron Skrocki details the process for accomplishing true integration in workers’ comp.
Ron, let’s start with this … what players would you say are the missing links to true integration?
Ron Skrocki (RS): Every integrative program that we work on ... if it's missing, it doesn't work ‑‑ is the clear and unambiguous definition of the role of claims and the role of nurses and managed care.
It's fundamental to these programs. Dysfunction exists, and it's hard to integrate yourself around or through dysfunction when the role of the claims organization and the adjuster are not crystal clear relative to the role of the nurse case manager, or the physician advisor, or these other managed care components that we bring to the table and we work with clients on.
So, you have to have an engaged claims partner in order to make integration work effectively. It has to be based on an understanding and agreement of what we do best, what you do best, and how we connect those together to make both of us better than we would be on our own.
TK: How does a truly integrated program work?
RS: While there is variation on design, some of the steps that every integrated program has in them, or characteristics, again, start with shared goals and objectives, and spend the time to make sure they're clear and unambiguous. What are we going after? How will we measure success? How will we determine whether we've made progress? What's our guidepost?
Because as you get into integrated program and process design, you are going to have to make some decisions about where you're going to spend your time, what you're going to refine the most, and you have to be able to link and point back to these overarching goals and the impact of your decisions on those goals.
You have to work the details of who does what, in what order and how are they connected. It doesn't do any good to define roles, to build a workflow, and to have goals if you have no feedback loop. You've got to have a way to know what's happening both in the process and also in your overall program metrics.
Then you've got to commit to continuous improvement by getting the players together, getting constituents together, fueled by data, fueled by input information and outcome measurements, and constantly figure out how you can do better. What do we need to do differently? What have we over engineered? What's creating value? What's an obstacle of value? What are the new cost drivers? What are some of the innovations that we can bring to the table that the previous model didn't have access to?
It's not a once‑and‑done deal. These programs take commitment and take some of the characteristics and steps that I just described in order to be successful in the long run.
TK: What results have you seen from an integrated return to work program?
RS: The bottom‑line numbers, the bottom‑line metric, the bottom‑line goal of almost all of these involve some level of reduction in disability days, average disability duration. Some have clearly shown medical cost‑savings, medical utilization savings, safer medical treatment, more treatment aligned with guidelines, more treatment directed to providers with higher quality metrics.
Those are all sort of the kinds of goals, the kinds of achievements, the kinds of results we see from the various integrated programs that we work with.
TK: Great info, Ron. In our next Inside Workers’ Comp, we’ll take a closer look at a hot topic in the industry, utilization review. Until then, thanks for listening.
Click here to listen to Part 1: Connecting the Dots in Workers' Comp