Social Determinants of Health Drive Outcomes and Costs for Injured Workers
Tammy Bradly
Sr. Director, Clinical Product Marketing
The discussion around a whole-person approach generates a number of important questions. For one, how do we support the whole person by offering one comprehensive solution? And what part do digital health programs play in meeting the needs of injured workers and improving outcomes as demonstrated by reduced disability durations and optimal recovery? Further, how do we deliver a personalized experience and meet injured workers where they are in their journey to recovery? Social determinants of health are a big part of the answer to any of these questions. According to the nonprofit Robert Wood Johnson Foundation, 80 percent of health outcomes are determined by non-clinical factors. Given that, it only makes sense to examine the social determinants of health and their impact on recovery and return-to-work. As we do this, we should look for ways to align our care-management approach to identify and address non-medical barriers.
We’ve always known social determinants are important
As case managers, it is hard to ignore social determinants of health even if we haven’t always applied that term to what we were observing. Consider that we often meet injured workers in their homes or workplaces. We often get to know their spouses and other individuals in their lives and most likely know more about the workers than anyone else involved in their claims. This relative intimacy presents unique opportunities to deliver support through a variety of methods: phone calls, video conferences, and, of course, face-to-face visits. As a best practice, case managers should make every opportunity to connect with and support the injured worker. The more we know about people the better we can engage with them at their comfort level to improve their experiences. We can help ensure that our clinical programs avoid the pitfalls of treating the primary diagnosis only. Instead, we can look at the whole person and identify those social determinants of health that might be impeding recovery.
We’ll take a look at the following factors, which have been identified as social determinants of health:
- Economic stability
- Physical environment
- Education
- Access to healthy food
- Community and social context
- Health care system
As case managers, we are always looking to help the people we serve achieve the best possible outcomes. We usually define such outcomes as return-to-function or return-to-work — and more broadly, return to their pre-injury lives. We are in a unique position to listen to our patients and ask the right questions. Active listening has long been a core component of good case management though it is a skill that requires training and reinforcement. In 2011, Coventry created the LASER program, a behavioral-coaching model to assist case managers in active listening and other cognitive behavior techniques that help to understand what underlying issues might be presenting obstacles to recovery and return-to-work. In 2012, we conducted a pre-post study of two pilot groups Social Determinants of Health—Whitepaper 20200127 2to measure the results of the LASER training using return-to-work percentage as a target metric. Pilot group one achieved a 14.2% increase in return-to-work. Pilot group two achieved a 13.9% increase. We implemented LASER across our case management organization. We continue to research and invest in other tools and techniques to improve our overall impact on those we serve. In 2016, we began piloting the Healthwise Coach and Healthwise Communicate™ tool. We have since adopted health education and coaching into our clinical service delivery model to support our holistic view of the patient. Most of us, it turns out, could use a little guidance: The U.S. Department of Health and Human Services reports only 12 percent of Americans are proficient in health literacy such that they are able to understand their health and health issues well enough to make decisions and take care of themselves without support.
We’ll need to communicate more as the work force changes
The challenges around health literacy and communicating important health information are only likely to grow as the nation’s labor force further diversifies. The U.S. population is seeing an increase in the percentage of people who are of Hispanic and Asian descent. In 2017, foreign-born workers made up 17.1% of the labor force. (Hispanics/Latinos represented about half that group while Asians comprised about a quarter.) By 2024, Hispanics/Latinos are projected to be nearly one-fifth of the work force as a result of being the fastest-growing ethnic group. As a result of these and other demographic shifts, our coaching and education tool at Coventry is expanding beyond its English and Spanish offerings. We believe this will be critical to improving the ability of injured workers to access information, make informed decisions, and improve their health literacy. The added languages will include Arabic, Bengali, Bosnian, Chinese (Simplified), Farsi, French, Haitian Creole, Korean, Nepali, Polish, Portuguese (Brazil), Russian, Somali, Tagalog, and Vietnamese. Even speaking workers’ native languages, however, isn’t enough on its own. We must always look to reinforce our clinical competencies. Most recently, at Coventry, we did this by introducing our motivational interviewing and rapid engagement and influencing without authority trainings. In 2020, we will be conducting a study to determine whether our enhanced service delivery model has improved overall patient satisfaction, engagement, and claim outcomes. Beyond that, we will be introducing a digital health application that supports injured workers as they prepare for and recover from the most common surgical procedures in workers’ compensation.
We can get to know workers by knowing what’s affecting them
All of these efforts are designed around the idea that meeting workers where they are and understanding the challenges they face gives us the best chance at helping them achieve the best-possible outcomes. If we have deeper knowledge of the circumstances that surround injured workers we can intervene in ways that are more impactful. Plus, we know how important trust is in workers’ recoveries. Most injured workers will appreciate that we’re showing interest in their circumstances. Beyond knowing about the hurdles that might be present, it’s important for workers to simply know we want to know. Understanding the social determinants of health affecting workers is crucial to understanding workers and to seeing their path to recovery.
About Tammy Bradly
Tammy Bradly is vice president of clinical product development for Coventry. Bradly is a certified case manager with more than 25 years of comprehensive industry experience through service delivery, operations management, and product development. She holds several national certifications, including certified case manager (CCM), certified rehabilitation counselor (CRC), certified program disability manager (CPDM), and critical incident stress management (CISM).
About Coventry
Coventry offers workers’ compensation care-management and cost-containment solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 35 years of industry experience, knowledge, and data analytics. As a part of the specialty division of Aetna our mission is returning people to work, to play, and to life. And our care-management and cost-containment solutions do just that. Our networks, clinical solutions, specialty programs, and business tools will help you focus on total outcomes.