Disease management is not imminent
Workers’ comp professionals claiming we’re on the verge of an industrywide movement into disease management may be putting the cart before the horse, some industry observers say.
"I certainly don’t see it even beginning before the turn of the century," says Karen Reutter, MBA, CPCU, ARM, managed care director of The St. Paul (MN) Companies, a group of companies providing insurance services worldwide. "The reason I say that is because a whole mindset has to change.
"You’re getting into the realm of pre-work comp loss, while the whole mechanism, even within managed care, has emphasized dealing with a situation once an injury or an illness has occurred and how we can manage the case to keep costs down."
Not that she doesn’t see the possibilities. "There’s a great opportunity [to control costs] by stratifying folks [according to risk level], but that’s not necessarily the mentality now," she notes.
Joe Paduda, MS, an independent workers’ comp/managed care consultant based in Madison, CT, sees a number of other obstacles. "First, it’s difficult to identify people with chronic illness upfront," he says. "And a lot of them have psychological issues attached to them, like depression and substance abuse. So the confidentiality issues associated with them are tremendous, and they can’t be pushed aside lightly."
Paduda also foresees an administrative nightmare. "It’s like the proverbial dog chasing the bus what do you do when you catch it? Say you have 1,000 people with chronic back pain. How many will have a claim? Probably not too many. Now, you can say chronic back pain might predispose someone for an injury, but it’s a chicken and egg situation; does the occupational situation cause a chronic injury, or vice versa?"
Reutter is convinced that comprehensive disease management and workers’ compensation will not be integrated in the near future. "What is talked about more is wellness management in the workers’ comp area workout routines, stretching, to avoid injury. That is a pre-loss strategy, but it’s not disease management.
"First, let’s get integration of coverage done," she cautions. "Disease management is an interesting concept, but is it part of the workers’ comp systems response? If we’re talking true integration, it is, but the time is not now."
In order for true integration to be accomplished, she says, employers, health care providers, and the managed care companies all need to share the same mindset. "It’s to their financial benefit to look at the employee as a unit early on. Then, systems integration [between insurers] needs to happen. Another big key is the regulatory environment each state is like another country."
Paduda sums the situation up succinctly: "I have no question that it makes sense for holistic health management," he says. "But the complexities can’t be overstated."
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