April 1, 2004 by Maria Vandenhurk & Susan Philchuk
A recently conducted study by Henry Harder and Donald Voaklander of nearly 300 employers, unions and services providers in disability management shows that only 28% of respondents reported “satisfaction” with the abilities and knowledge of their external disability management (DM) providers. Roughly 79% of employers reported the need for improvement in the way DM services are delivered in their organization while 63% of them indicated that there was a shortage of well-trained DM practitioners. Notably, about 79% of the study’s respondents reported that the need for well-trained DM practitioners would increase in the next five years.
According to the Harder-Voaklander study, “disability management is a new and burgeoning field that has not yet coalesced around established educational and credentialing requirements”. Writing in ING Re’s “Disability Forum” newsletter in late 2003, Gary Anderberg also notes, “the concept of integrated disability management (IDM) emerged about 10 years ago as a small number of large employers began bringing occupational and non-occupational disability claim management into the same service environment. Many of these early plans reported significant savings in terms of total claims costs as well as an overall reduction in the durations of both types of disability events.”
While there is no doubt that a unified professional body for DM service delivery would benefit practices in this arena, the problem in satisfactory service delivery may also relate to a difficulty that many practitioners with rehabilitation/human support service backgrounds face in embracing a business mind set in their service delivery. The bottom-line focus of today’s business environment requires that DM initiatives be treated like any other important business strategy.
The argument that DM is the “right thing to do” is not enough to get “customer buy-in” for DM initiatives. DM services must involve a clear, compelling business case. Most DM practitioners come from academic training grounds where clinical care, quality of life and advocacy-oriented philosophies dominate. Given this, it is no surprise that it does not come naturally to adopt a practice focus that combines both a client-centered approach with the business interests of our customers. Rather than celebrate a 5-degree increase in the client’s range of motion or documenting evidence that the client has gained insight about their self-defeating behavior, we must be able to question whether our positive outcomes will be meaningful to our customer. In most cases, this means ending the absence from the workplace, facilitating a successful return to work or contributing to alternative options for closure of the claim (i.e. financial resolution).
Our client-centered treatment/intervention approach is only supportable if it also has a positive impact on the customer’s cost/benefit ratio and successfully contributes to the customer’s overall business objectives. If this is not achievable and services are still delivered, we enter the realm where DM services hinder the payer’s overall interests, and ultimately create dissatisfaction with DM services.
There is no doubt that some individuals in the DM service arena experience difficulty embracing a business mindset while still playing a helping role. The practice of disability management involves ethical challenges and navigating between competing interests/agendas, while still honoring our code of ethics and striving for principled practice. As practitioners in the field of DM, we need to be clear on our mandate, set clear boundaries with our clients/customers from the outset and draw on sophisticated communication skills (written and verbal) in order to navigate files to successful outcomes.
DM providers need to be engaged in a “partnership” with the payer. While the need for a working rapport with our clients is well documented, the need for a working rapport with our customer is only now coming into focus. Many customers refer files to their internal and/or external DM service provider without investing the time to place the referral in context.
At the same time, DM providers do not always seek the necessary information they need in order to understand the customer’s business interests, the nature/application of coverage and a clear understanding as to what constitutes a meaningful outcome in that customer’s particular environment. Without this front end and ongoing communication, the DM provider cannot accurately anticipate the scope of their service involvement.
While customers always agree that they want successful return to work plans, resolution to workplace conflicts and cost-effective service delivery, they can differ greatly in terms of how they expect those goals to be achieved. As external vendors of DM services, we know that our customers are not consistent in:
The extent to which client interviewing should be handled telephonically versus in-person;
Acceptable turn-around times on service delivery;
The extent to which they want the DM provider discussing policy coverage with the client;
The extent to which the DM provider is considered a welcome participant in the alternate resolution process (if alternate resolution is embraced at all); and
The extent to which they want the DM provider to provide recommendations and input into the DM process.
What seems readily apparent is that successful DM service delivery depends on a working partnership. In order to create that working partnership, customers should:
Select a provider that demonstrates capacity for a business mind set and maintains a clear understanding of their professional guidelines and regulations. Choose a provider that you are confident is capable of understanding your business objectives, policies and service mandates. Concurrently, you want a provider who is engaged and conversant with their relevant professional regulations and guidelines. DM work involves regular ethical challenges. The integrity of your organization can be compromised by a DM provider not knowing or failing to assert professional boundaries and principled practice in the course of delivery service.
Plan to invest time with your provider to ensure they are informed about your business objectives, your benefit contracts (and interpretation thereof) and what constitutes meaningful outcomes in your organization. Choose a provider who is willing to engage in that process on a non-billable basis. A business minded provider will understand that this is all part of doing business. Know that this front-end and ongoing investment will save you money in the long run.
Require your DM provider to submit a cost/benefit analysis. Establish a process with your DM provider so that their recommendations are accompanied by a cost/benefit analysis. This should eliminate recommendations and plans that do not fare well in a cost/benefit review.
Develop an outcome measures program before you get started. Ensure that outcomes measured are identified in advance and tracked consistently. It is important to recognize that external providers of DM services are not always able to track outcomes that are meaningful to the customer because there is no access to important information/measures like the number of claim closures, sustained closures at six months and reserves released. External providers are limited to measuring outcomes such as turn-around times, total dollars spent on DM services, successful return to works and customer/client satisfaction. While still valuable measures, they do not speak to the customer at the same level as would a measure of reserves released.
A successful partnering relationship between an insurance carrier and ourselves enabled us to identify that for every hour of DM services purchased over a 12-month period, an average of $3,297 in reserves was released – hardly a bad return on the investment. This measure could not have been tracked without the partnering relationship established with our customer. Furthe
rmore, this is not only a measure of the success of DMC services but reflects the positive impact of a well-honed partnership between claims and DMC services.
Provide feedback. Your DM provider needs to know when they are achieving expectations and when they are not. Without feedback, the service delivery cannot evolve according to your needs.