Disability unit takes integrated approach
Internal case managers deliver cost savings
Pitney Bowes in Stamford, CT, provides an elaborate health care plan for 24,000 employees in the United States. The benefits are deep, and the focus is on quality. One important element that helps the self-insured employer keep costs down while delivering high quality services is its internal disability management unit.
The company and the disability management unit take an integrated, aggressive approach to improving the health of its employees. That approach earned Pitney Bowes national attention in 1996 as a winner of the C. Everett Koop Award for excellence in health care.
Average payment reduced by 16%
When your benefits include 22 weeks of short-term disability at full pay, you have to be aggressive. By internally managing all disability claims, whether workers’ compensation or non-occupational, case managers in Pitney Bowes’ disability unit reduced the claims’ average duration by 15% and their average payment by 16% in 1995.
The disability unit is divided into three teams. Each has a nurse case manager, a claims adjuster, and a benefit service representative. Employees must call a voice response system on the fourth day they’re away from work to report a disability, and physicians must call by the sixth day, says Barbara Bianco, RN, CCM, case manager for disability management at Pitney Bowes.
Certain diagnoses are red-flagged to receive immediate attention by nurse case managers. "We have strict guidelines for claims. For example, AIDS, cancer with potential for bone marrow transplant, most psych claims, pregnancies requesting time out prior to delivery, and cardiac claims always come to us," says Bianco. "What we’re finding is that with the voice response system, we often know there’s a problem before the health benefit [payer] case manager or work comp nurse. We end up alerting them and starting work early on the claim."
Case managers alert the payer that there is a problem and interact with the payer case manager to push them to provide services Pitney Bowes’ case managers think are best for its employees.
"Sometimes, when you are dealing with a health maintenance organization [HMO] on a slow-moving claim, the response of the HMO case manager is that everything is fine because the employee is in the network. Return-to-work is rarely considered by health benefit case managers unless the claim is a comp case," Bianco says. "We always consider return-to-work for any claim. We also look for the best treatment. The employee may have a rare respiratory problem that is most effectively treated by a national center, not an in-network physician. We push for those services we think will get the employee well and back to work safely."
Disability unit case managers also check with the employee and family members to let them know the case manager is available to explain benefits and help them navigate through the system, Bianco says. "If it’s a comp claim, we contact the nurse involved with the case and maximize our efforts to obtain a good return-to-work," she says.
"I find a simple telephone call to an employee starts a relationship that has paid off as much as anything else we do," she notes. "It gives employees a good feeling that there is someone in this maze who wants to help them."
"If I were to be disabled tomorrow, Barbara would find some kind of work for me to do. The return-to-work policies of our external vendors wasn’t focused enough for us. We believe that when people return to work faster, they sometimes recover faster. So, one of the objectives of our disability unit is to assist our employees with a smooth transition back into the work environment," says David Hom, the company’s executive director of corporate benefits, medical services, and information systems.
The company also has made a substantial investment in on-site clinics at several of its larger locations, Hom says. "The clinics help our employees enter into the system early to get immediate triage to appropriate levels of care."
The on-site clinics also help ease the transition back to work following disability, Bianco says. "We in disability try to set it up so that when the employee returns, the clinic staff knows what the situation is and what the plan is," she says. "Sometimes, an employee will try to come in to work, end up in the clinic, and go back on disability. We put a real team effort into cases like that. If the employee goes into the clinic, we call the comp nurse immediately. We speak to the doctor. We speak to the employee. The claim never sits. We’re on top of it."
Sometimes, a successful return to work requires bringing in the employee assistance program (EAP) or human resources.
"Return[ing] to work can be very complex. By working on the inside, we can keep facilitating and following up to make sure we have a comfortable fit for return-to-work. We can pick up the phone and ask human resources how an employee is doing. We can alert EAP that the employee may need some additional counseling. We make any accommodation we reasonably can to facilitate the best resolution of each case," says Bianco.
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