Replicating and Adapting Centers for Occupational Health and Education Strategies - Part 2
Virtual Discussion Hosted By IMPAQ International for the SAW/RTW Policy Collaborative
Friday, March 10, 2017 -- 2:00 P.M. CT
Services provided by: Caption First, Inc., P.O. Box 3066, Monument, CO 80132,
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This text is being provided in a realtime format. Communication Access Realtime Translation (CART) or captioning are provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.
Welcome
LINDA TOMS BARKER: There we go. So welcome to both returning participants -- I know many of you joined us on our last session -- and also to new participants. We are really pleased to have some other folks joining us today. I am going to just turn it on over to Dr. Kay McGill. She is the team lead for our Policy Collaboratives Policy Working Groups, and she is our moderator for today's session.
KAY MAGILL: Thank you, Linda. Hello, and welcome. Just as a quick introduction to what we are doing today so we can get right into the presentation with our speakers, we are going to do a quick recap of the earlier presentation, the earlier webinar that we did on February 14, and touch on what the key features are of COHE and also provide some evidence of the success of the overall program and different features of it.
We are also going to talk with a representative from Colorado who is looking at how to replicate some of the COHE strategies in that state and will describe how the kinds of policy considerations they've had and also the programmatic implications of adapting COHE.
We are going to answer questions that arose in the previous discussion. As Linda mentioned, we had a very full time then and did not get to all of the questions that came up, and any new ones that are presented you can include in our Chat. We'll talk in a second about how to do that. And what we want to look at is what kinds of strategies are appealing for your state, and in particular, what kind of policies would be needed in your state for you to adopt or adapt some of Washington's effective practices. (Technical difficulties)
Our technical expert, Kelly Anne, will take a minute to show how to ask a question or make a comment or seek help for any technical difficulties. So Kelly Anne?
KELLY ANNE JOHNSON: Great. Thank you. The Chat pod is where anyone can post a comment or ask a question. We encourage you to do just that. You can enter your comment in the white field at the bottom of your Chat box, and when you are ready to post, click the talk bubble button to the right. If we don't get to all of your questions today or if a question needs a longer response, we will respond by email. And if you are looking at a pod and it looks like the information might be cut off, just look to the right side of the pod for a scroll bar.
Also, if you experience any technical difficulties and need help, you raise your hand. At the top of the session screen, you can see a little guy waving at you. Click on the arrow next to him to view the drop-down window, and then select "raise hand." It's the first item on the list. We will assist you as soon as we can, and you can actually go back to the same drop-down and select "unraise hand" if you change your mind. And there is also a Help button at the top right for more technical detail. That's it.
LINDA TOMS BARKER: Great. Thank you.
So let's just take a quick look in the lower left-hand side there and see what kind of folks we have joining us. We have some others, so if you want to let us know in the Chat box why you clicked "other," that would be really helpful to us. We have someone from a state workers' comp agency, healthcare provider, a few rehabilitation professionals, a couple of insurer payers. And we encourage you to continue to vote on this as we move forward the next couple of minutes. We'll leave that up. We'd still like to learn more about who else has joined us. Thank you.
KAY MAGILL: So just as a quick introduction to talk about the COHE strategies that are happening in Washington State, let's just look for a second at what COHE is. It's a program established by the workers' compensation fund in the State of Washington, and by coordinating communication between these different parties that are shown in the picture -- the injured workers, medical providers, employers, the Labor & Industries Department -- and by promoting the use of occupational health best practices, Washington State is achieving its goal of improving injured worker outcomes and reducing disability. And even though different states have different visions for how to address the challenge of improving outcomes for injured workers and increasing workforce attachment, we find that many aspects of COHE are relevant to how other states might develop their stay-at-work and return-to-work policies and programs.
So we did have questions that arose in our last session. We are going to be addressing some of those now, and as I mentioned, if there are any other questions or comments that people have, please feel free to use the Chat box. And if you haven't answered the polling question yet, please go ahead and do that as well.
Speaker: Susan Campbell
So let me turn it over now to Susan Campbell. She is the COHE contract manager at Kaiser Permanente and has 15 years' experience developing and working with COHEs. She led the implementation of the activity coaching program at the Department of Labor and Industries, and will talk now about what has been happening with the COHE program. And as you listen, think about what aspects of COHE fit into your state's vision for helping injured workers stay at work or return to work.
Susan?
SUSAN CAMPBELL: Thank you.
So I am not going to go back over what a COHE is. I am going to give you a quick overview. Could I have the next slide? The quick overview of our best practice, the role of the health services coordinators, and then I am going to answer the questions from last time.
The best practices. The occupational health best practices that we use in the COHE are not clinical. They are all helping with communication. We train the providers to send their report of accident, their initial report of accident, to us within two working days and to send it in complete. We also talk to them about filling out the activity prescription form whenever someone cannot go back to work full duty and to share that with the provider, the employer, the worker, and they also send that to us. And we ask that they do that within -- at least one within the first 12 weeks of the claim. And then we ask that if someone isn't going back to work that they connect with the employer, either through the health services coordinator, or by picking up the phone themselves and calling the employer. We have one provider who asks injured workers to call their supervisor on their cell phone, and they communicate about what this worker can and cannot do and facilitate the whole light-duty process.
Finally, if someone isn't back to work but appears that there aren't medical issues, we ask them to review the file with the worker and with the health services coordinator to see what are the barriers keeping that person from going back to work.
Our other part is the health services coordination. I will talk about that in a minute. We also have specialty follow-up, and the specialists in the COHE agree to see our workers sooner than they might in other situations.
Finally, we give the providers regular performance feedback on how well they are doing on these best practices.
Next slide. So the health services coordinators are key in this system. They are not our employees. They work at the COHE. They are hired by the COHE. They are seen by the providers in the community as their help in getting what they need for their injured workers. Something like 80% of our injured workers go to providers who have very low volume, so they need help. They don't do this every day. They can call the health services coordinator to have them explain what the forms are to help them do what they need to do. They help connect to claims manager. They also ensure that the employer and worker are called and that everyone is on the same page on what that activity prescription form says for that injured worker. Finally, they document all their work in our system, and it goes directly into the claim file, viewable by the claim manager and also by other parties to the claim.
Next slide. So now I am going to try to answer some of the questions from last time. One question was about provider incentives. We do not have robust financial incentives for providers. They do get 50% more for every ROA (Report of Accident) that comes in in a timely manner. But really, the health services coordinators are a non-financial incentive that's most important to them because that's someone who helps manage their claim. They also get training and support from the COHE staff. Once a year they have to have at least a half an hour of review of occupational health best practices and L&I policies and procedures.
Next slide. Another question that came up was the effectiveness of COHE. This is our favorite slide. It shows over a period of time what our actuaries predicted for costs for the COHE versus non-COHE claims. And it's been between $2,000 and $3,000 savings per claim for quite some time. Tom Wickizer is going to talk about that a little bit more, so I am not going to say more about that now.
The last two questions are about SIMPs. SIMPs are our structured, intensive, multidisciplinary programs that are treatment for chronic pain. And the question is how do the SIMPs interact with the COHEs? One thing the COHEs do is focus on the claim early on, those first crucial three months, where we can do disability prevention. SIMPs are often much later in the claim. Certainly a COHE could refer someone to a SIMP, but there isn't a direct connection between the COHEs in part because the COHEs focus earlier on in the claim.
Finally, next slide, there was a question about what performance measures we do. This is a standard provider-level report that each provider gets. Their names would be on the far left in the white area there because this is made anonymous. And it shows our four best practices, and it shows what percentage of their claims have met our targets, and the targets are the yellow cells there. The fourth best practice does not have a numerical target. We just hope they are doing some, and we keep track of how many they do.
That's all I had. Thank you.
The slide here gives the contact people for the main people involved. Morgan Wear is the COHE program director. Diana Drylie has been working on these COHEs the last 18 years and is the lead of our unit. And then our webpage is there as well.
Then we had a question for you. I think that's the next slide. I am quite interested in knowing if your workers' compensation program in your state, either public or private insurance, use healthcare coordination as we do in the COHEs. So you can answer that polling question on your screen there, and we'll get back to the answer in a bit.
Speaker: Thomas Wickizer
SUSAN CAMPBELL: Next slide. So now it's my pleasure to introduce Tom Wickizer. Tom used to be in Washington State, is now in Ohio at Ohio State University, but we met 17 years ago when he was still doing research for us, and he also was in charge of the evaluation of the COHEs early on. He is going to talk about an eight-year evaluation that he is currently working on.
Tom, are you there?
THOMAS WICKIZER: Yeah. Thanks, Susan. Can you hear me?
LINDA TOMS BARKER: Yes, thank you.
THOMAS WICKIZER: Okay. Let me get the right slide here.
Just before I start discussing the long-term outcomes, I would just like to point out that we early on -- and Susan and others at L&I were part of this, but did an evaluation of short-term one-year outcomes and made many briefings and internal reports to L&I and our advisory group. And all that work led in the spring of 2011 to the passage of a state law that expanded the two pilot sites that had been in initial evaluation, expanded them on a statewide basis and made this whole COHE delivery system a permanent fixture in the state workers' comp system. So since that time, the COHEs have operated in six different sites and now account for approximately 54% of the treatment of all injured workers in the state. So we, through hard work and the evaluation team, many other people besides myself certainly, participated in that, but we were able to, I think, generate evidence that convinced the legislators and the governor that this COHE experiment was worthwhile putting in place on a permanent basis.
So the prior COHE evaluation, as I said, really looked at short-term one-year outcomes, and on the slide here are the measures we focused on, off work and on disability one year, disability days, and then disability and medical costs. We wrote up several papers. The one that presents the final results of the initial evaluation is a paper published in Medical Care in 2011.
And we found that the COHE was associated with favorable outcomes across these four measures. But we really became interested in also examining the long-term outcomes of the COHE well beyond one year. And so over time, we have worked with administrative staff at L&I, and we now have eight years of follow-up data on all the claims involved in the initial COHE evaluation.
And so this initial evaluation took place on a cohort of approximately 105,000 injured workers. So as I said, we have eight years of post-injury data for the following measures: Again, disability days, a new measure of pensions. There were a small proportion of people went on with more serious injuries to be pensioned. And then we also obtained information not from the Social Security system, but from L&I if somebody is on a pension or on disability and they go on a Social Security Disability Insurance, there is a flag in their record, so you can tell the date that they became eligible for Social Security Disability Insurance. So that's an important measure. And then we also included disability and medical costs.
So these are just some of our preliminary findings, and I would stress preliminary, but injured workers treated through the COHE eight years after injury had a lower risk of having long-term disability or being pensioned or being on SSDI: The average disability costs are shown there. For the COHE group, it's $2068 versus $3782 for the comparison group. The COHE group also had lower average medical costs, and these are shown there, $2982 versus $4146. They also had fewer average disability days, as you would imagine, because they had lower disability costs. That's about 35.7 days versus 58.9 days. And if you sort of scale that -- those disability days up on a per-10,000 workers, the difference was 357,887 disability days for 10,000 workers for workers treated through the COHE versus 589,766 disability days per 10,000 workers for the comparison group. So really, even though a small percent of workers end up on extended disability, as you accumulate that disability over time, in this case up to eight years, it really accounts for very substantial disability burden and a very substantial cost burden over time. And so I think as Susan has already said or alluded to, you know, by preventing disability in the short run, COHE, at least as best we can understand today, COHE improves long-term outcomes.
And I think that that's the end of my presentation.
So this is a question I guess I will read if I am supposed to:
In your state workers' compensation program, do you use care coordinators -- oh, I thought this was already up there -- the way Washington COHE's do?
LINDA TOMS BARKER: That's right. We are just going to check in on the results on that. It looks like among the people that have voted so far, everybody says no, which is probably why we are all here today because what Washington's been doing is, in terms of this whole care coordination model, is out front, and we are all trying to learn from it. We've got some mother folks voting. Let's just leave that up for another minute or so, and this is a great time for anybody in the audience here to ask questions of Susan from Washington COHE or Tom, as the person that's been doing the evaluation. So if you have questions for them, go ahead and type them into the Chat box.