Impacting Workers’ Compensation Costs Through Wellness and Total Worker Health Programs Mike Egan – League of CA Cities Gayle Cannon – Kaiser on the Job, Kaiser Permanente Matt Szenderski – KeenanWell, Keenan & Associates May 2015

Our goals for today: We want to help you: Help your city’s bottom line on both sides of the ‘house’…wellness and workers’ comp Keep your city’s business & employees safe, healthy, and productive

Latest Research and Findings Leading Edge Strategies and Solutions Kaiser Permanente’s Approach Keenan Client Example Keenan’s Approach

Latest Research & Findings

Reframing the Workforce Health Conversation Group Health Insurance Workers’ Comp Insurance Risk pool management Injury reduction Return to work Reduce claims cost Benefit strategies Risk pool management Rate negotiation Compliance Wellness strategies, programs Population Health Management Total cost of poor health: Workers’ Comp claims, absenteeism, productivity and health insurance costs Health education/engagement/ prevention Integrated care management and delivery

A BETTER WAY to take care of business Workers’ Compensation 101—What does this have to do with health benefits?  A claim = an accident or injury (not a bill)  Every U.S. employer with 1+ employees must provide  State regulated and state sets fee schedules  Total cost of workers’ comp claims includes: 1) Expense of medical treatment 2) Disability payments while off work 3) Litigation expenses for both sides 4) Permanent disability award payments 5) Vocational rehab vouchers (when issued) 6) Future medical expenses per claim, when awarded  Additional driver/multiplier = Chronic health conditions 6 September 16, 2014 | © Kaiser Permanente All Rights Reserved.

A BETTER WAY to take care of business Game Changer in the Workers’ Comp Industry: The Type of Rising workers’ compensation costs & the pain employers feel 7 September 16, 2014 | © Kaiser Permanente All Rights Reserved. 20% 50% 60% © 2013 Workers’ Compensation Insurance Rating Bureau of California. (2013). WIRCB Report on September 30, 2013 Insurer Experience. San Francisco, CA: Medical Care

A BETTER WAY to take care of business Game Changer: Why would employers care about this story? 8 September 16, 2014 | © Kaiser Permanente All Rights Reserved.

A BETTER WAY to take care of business Why would employers care about this story? 9 September 16, 2014 | © Kaiser Permanente All Rights Reserved.

Strategies & Solutions- Kaiser Permanente

A BETTER WAY to take care of business So, what is Kaiser Permanente doing to help? When an employer chooses KP as their health plan, they are also addressing their skyrocketing workers’ comp costs! Team-based, award-winning treatment of members with chronic health conditions Focus on employee population health 11 September 16, 2014 | © Kaiser Permanente All Rights Reserved.

A BETTER WAY to take care of business Group health and workers’ comp care are typically fragmented 12 September 16, 2014 | © Kaiser Permanente All Rights Reserved.

A BETTER WAY to take care of business 13 September 16, 2014 | © Kaiser Permanente All Rights Reserved. Helps employees stay healthy, safe and more productive Available to any employer, any JPA, any workers’ compensation insurance carrier Available to all employees – not just KP members It’s not insurance coverage — it’s differentiated occupational health care So……What is Kaiser On-the-Job ® ?

A BETTER WAY to take care of business Game changer for your clients’ workforce health and work comp costs: Kaiser’s integrated model & HealthConnect® 14 September 16, 2014 | © Kaiser Permanente All Rights Reserved.

Advantages of an integrated model:  Minimizes duplicate treatment and tests  Reduces fraud  Reduces administrative costs  Reduces litigation  Reduces prescription/medication errors  Fewer delays and disputes  Decreased occupational and non-occ costs  Enables coordinated disease management  Improves ability to recognize comorbidities  Improved productivity

KOJ combines cost saving with quality care A year-long study with Macy’s compared the costs of occupational health services

Strategies & Solutions- Keenan Client

License No Innovative Solutions. Enduring Principles. 18 Keenan Client (School District) – Workers’ Comp and Wellness Integration Onsite medical/wellness clinic - Physician and occupational health nurse Clinic services: - Annual physicals - Flu shots - Preventive screenings - Health education counseling - Basic medical procedures & care - Weight management - Accident prevention - Smoking cessation - Promotes employee wellness activities

License No Innovative Solutions. Enduring Principles. 19 Employee is injured and files workers’ comp claim Telephonic outreach by occupational health nurse Occupational health nurse works with attending physician to co-manage employee’s care for duration of absence This approach allows for increased face time with injured worker, assuring their compliance and facilitating a quick return to work. Onsite clinic assists with the transition of injured employee back into the workforce. Appropriate wellness resources are provided based on employee’s risk factors and health conditions, to help prevent re-injury and promote optimal health Self Manage Emergency Room Keenan Client (School District) – Workers’ Comp and Wellness Integration Clinic Appointment Triage

License No Innovative Solutions. Enduring Principles. 20 Best-Practice Wellness Program Components Biometric Screenings Health Assessment Healthy Challenges

License No Innovative Solutions. Enduring Principles. 21 Low-Cost/No-Cost Wellness Program Options Carrier and Vendor Resources ◦ Health assessment ◦ Online health education modules ◦ Onsite presentations Community Resources ◦ American Heart Association ◦ American Diabetes Association ◦ American Cancer Society Wellness Campaigns ◦ American Cancer Society ◦ National Health Observances Calendar:

Strategies & Solutions- Keenan Approach

License No Innovative Solutions. Enduring Principles. 23  Program Goals Promotion of optimal health status Prevention of illness, chronic conditions, and injuries Management of injuries and chronic conditions that can affect recovery Facilitation of recovery/transition back into the workforce Avoiding recurrence of injuries  Three Integrated Components Wellness Condition Management Workers’ Compensation Case Management  Partnering with Program Service Providers Keenan consultants Healthcare carriers Third-party vendors 23 Total Worker Health Program

License No Innovative Solutions. Enduring Principles. 24 Integrated Health Management Data Incentives Data Workers’ Comp Claims Data Biometric Data HRA Data Medical Claims Wellness & CM Participation Data Pharmacy Claims Wellness Condition Management Integrating Data for Total Worker Health Management WC Case Management Reporting 24 Total Worker Health Program

License No Innovative Solutions. Enduring Principles. 25 Total Worker Health Program Process 1.Establish a TWH Committee (Employer, Union, HC Carrier, & 3 rd Party Vendor reps) 2.Analyze Health Management Data to Identify Health Status of the Employee Population Workers’ comp claims Medical and pharmacy claims Biometric data Health risk assessment data 3.Conduct Strategic Planning Review data analysis results Identify priority needs Develop a three-year TWH program blueprint, including incentives design

License No Innovative Solutions. Enduring Principles. 26 Total Worker Health Program 4.Establish a Program Data Tracking System 5.Develop Engagement Approaches Communications Wellness champions network 6.Implement the TWH Program Components (Wellness, CM, WC) 7.Coordinate the Program TWH Nurse Case Manager to provide assessment, guidance, and referral to appropriate wellness and/or CM program services 8.Conduct Program Evaluation Process Impact Outcome

QUESTIONS?