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The Impact of Comorbidities on Whole Person Recovery Management

Whole person care managementThe phrase “whole person recovery management” is a relatively straightforward, self-defining term. When an individual is trying to recover from an occupational injury or illness, the team supporting that process should consider the whole person – mind, body, soul – to optimize the medical and financial outcomes and accelerate Return to Work. However, in a complex regulatory environment with many stakeholders and potential friction points, it can be easier said than done.

Whether deemed work-related or not, many facets of this “whole person” can either positively or negatively impact the trajectory of their medical care and ultimately the RTW process. Workers’ compensation historically has ignored factors that are not directly compensable. However, a broad discussion of the bio-psycho-social treatment and claims advocacy model over the past decade has brought an awareness that incorporating a “whole person” mindset is in the best interests of both the injured employee and their employer.

Physical comorbidities that predate the occupational injury or illness can have a significant impact on the treatment regimen and its success. Uncontrolled diabetes, hypertension, age, obesity, immunodeficiency conditions, chronic pain, and other medical conditions can lengthen disability if not taken as inputs to the scope of work comp treatment. Psychosocial comorbidities such as depression, anxiety, Adverse Childhood Experiences (ACE), social determinants of health, sleep difficulties, prolonged stress, and emotional dysregulation can likewise negatively influence the response to care. Poor nutrition, lack of proper hydration, medical illiteracy, and a sedentary lifestyle can slow recovery. Most of these have little to do with workplace accidents but can dramatically impact the ability of work comp stakeholders to promote prompt RTW.

The application of Clinical Flags by stakeholders serving an injured employee can be helpful in uncovering issues:

  • Red flag: Signs of serious pathology
  • Orange flag: Psychiatric symptoms
  • Yellow flag: Beliefs, emotional responses, pain behavior
  • Blue flag: Perceptions about the relationship between work and health
  • Black flag: System or contextual obstacles

The workers’ compensation ecosystem is increasingly connecting these various “non-related” issues to the success of returning the individual to their routine, income, family, and sense of belonging. Many injured employees do not have physical and/or psychosocial comorbidities that impact the claim process so their journey back to function is at a reasonable pace. However, those who lack physical and/or psychological resilience have a slower recovery and RTW process which increases claims and productivity costs for the employer and the long-term effects on the injured employee and their family. Time is money and anything that lengthens disability creates a cascade of negative effects.

Injury management should address both physical and mental components, therefore a bio-psycho-social treatment model that addresses the “whole person” is key in those circumstances where the injured employee’s progress is not tracking as expected. For individuals who demonstrate any of the Clinical Flags and whose individual trajectory does not compare favorably to large-data disability duration studies, empathetic communication by all stakeholders (especially claims professionals who are the primary contact) and the use of case management to identify concerns and advocate for their solution can be a way to get that injured employee back on track.

Addressing the general health (“whole person”) of workers is right for many reasons. Having this mindset and process will improve the health of the organization (productivity of the workplace, experience modification rating) and the health of the injured employee and their family. Helping that individual get better with a “whole person” paradigm sends the message of value to that person and their colleagues, so the benefits may extend beyond this particular claim. Doing the right thing seems subjective and emotional, but work comp is understanding that it yields tangible positive results and provides a win to both the injured employee and employer.

About the Authors:

Mark Pew, WorkCompCollege.com founding partner and Provost, is an award-winning international speaker, author, and jurisdictional advisor in Workers’ Compensation. The RxProfessor has focused on the intersection of chronic pain and appropriate treatment since 2003. Mark created “Qualified Medical Intervention” which won a 2012 Business Insurance Innovation Award. He received WorkCompCentral’s Magna Comp Laude award in 2016, IAIABC’s Samuel Gompers Award in 2017, “Top 100 Healthcare Leader” by IFAH in 2021, and the Health 2.0 Outstanding Leadership Award in 2022. He is a co-founder of The Transitions and is on the Advisory Boards of Harvard MedTech, Simple Therapy, and Goldfinch Health.

Troy Prevot, Mr. Troy Prevot, MBA, PA-C, ATC, has diverse experience in both insurance, and risk management settings. Following eight years as a Physician Assistant with the Orthopaedic and Sports Medicine Center, he co-founded CORE LLC Occupational Medicine Resource Company, providing professional occupational medicine staffing, urgent care staffing, case management, toxicology/chemical medical surveillance, DOT consulting, and management of occupational medicine programs.

Published November 2, 2023.

The information contained in this article concerns the ODG guidelines (or solutions) as of the date of publication, and may not reflect revisions made to the guidelines (or solutions) or any other developments in the subject matter after the publication date of the article.

The post The Impact of Comorbidities on Whole Person Recovery Management appeared first on ODG by MCG.

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