1. Back to Work Strategies & Solutions Following Illness Or Injury 9/5/2015 Contents are proprietary and confidential. Copyright 2008 Benefits Advisor Network Presented by: Dr. David Rearick Strategic Benefit Solutions, Inc. Michael Brown, ARM VoCare Services Incorporated, Inc.

2. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 2 15%85% Employer Payroll Cost Wages Paid for Time at Work Wages Paid for Time-Off and Disability Days (including workers’ compensation (WC) medical expense) The Magnitude of Absence Benefit Costs Equivalent to: 27 scheduled days off + 11 unscheduled days off per year Watson Wyatt, “WBGH Staying@Work Survey 2000/2001.” US Census Bureau Projections, 1998. Note: Disability includes: sick leave, workers comp, and short term / long term disability.

3. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 3 Hidden Costs by Program

4. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 4 Full Costs by Program – EE Costs

5. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 5 The Problem: The Full Cost of Employee Illness Medical & Pharmacy Costs *$6,020 PEPY Health-related Productivity Costs $12,000 PEPY 33% 66% Workers’ Comp Medical Costs Salary Continuation Personal Health Costs Medical Care Pharmacy Hospitalization Behavioral Health Productivity Costs Presenteeism Turnover Replacement Training Temporary Staffing Administrative Costs Variable Product Quality Employee Dissatisfaction Customer Dissatisfaction Overtime Off-Site Travel for Care STD LTD Sources: Loeppke, et.al., JOEM, 2003; 45:349-359 and Brady, et.al., JOEM, 1997; 39:224-231 Total PEPY = $18,020 *2003 PEPY Avg. Absenteeism

6. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 6 Disability costs > 12% of Payroll Costs are Projected to Rise Disability Costs as a Percentage of Payroll Direct Costs of Disabilities in the US (in billions) Watson Wyatt, “WBGH Staying@Work Survey 2000/2001.” US Census Bureau Projections, 1998. Note: Disability includes: sick leave, workers comp, and short term / long term disability.

7. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 7 The Link Between Disability and Disease Management Impact of Employee Absence Source:Managing Health Care Costs in a New Era - 10th Annual National Business Group on Health/Watson Wyatt Survey Report 2005 Note: Survey only includes employers with >1,000 employees Source:UnumProvident Employers Interested in Integrating Health Care & Disability

8. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 8 When to Refer Early Intervention – Workers Compensation 85% of all injured workers do not return to work after being off-duty one year. 50% do not return to work after being off duty 12 weeks. 10 days =$13,142 30 days =$20,167 2005 Ohio Bureau of Workers Compensation

9. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 9 Early Intervention  Increased success Bob MacBride, MD, The Prudential Insurance Company of America

10. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 10

11. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 11 What is Disability Management? "a workplace prevention and remediation strategy that seeks to prevent disability from occurring or, lacking that, to intervene early following the onset of disability, using coordinated, cost-conscious, quality rehabilitation service that reflects an organizational commitment to continued employment of those experiencing functional work limitations. The remediation goal of disability management is successful job maintenance, or optimum timing for return-to-work..." Akabas et al. (1992)

12. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 12 STD LTD WC FMLA STD LTD FMLA WC STD LTD FMLA WC PTO STD LTD FMLA WC PTO Incidental Absence Presenteeism STD LTD WC FMLA WC TraditionalIntegrated Disability ManagementAbsence Benefit Management

13. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 13 Medical Treatment Return to Life Activities Vocational Rehabilitation Medical Stability Social Model Changing Priorities 100% 0% Medical Model Capacity Validation 100% Bob MacBride, MD, The Prudential Insurance Company of America

14. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 14 Back to Work Strategies Intervene as early as possible after an actual or potentially disabling event. Identify and provide necessary return- to-work assistance effectively. TWP Structure cash and medical benefits to encourage return work.

15. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 15 Case Example Large Employer with Call Centers 10% of Employees 34% of all absence Referral of all STD claims within 5 days of absence. Medical Case Management with EAP and Disease Management coordination 53% with Comorbid conditions Comorbid increase days by approx 50% 18 months out Absence reduce by 43%

16. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 16 Case Example: Timeliness Saves Days Lost Opportunity Days: The number of days late in making a referral after the targeted 5 days. Source: AdvoCare Incorporated 2009 Referal Time One day = $240 in direct pay.

17. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 17 Healthcare Costs by Age x Risk Source: Musich, McDonald, Hirschland, Edington, Disease Managements & Health Outcomes 2002; 10(4): 251-258; University of Michigan Health Management Research Center. Used with permission. Dee Edington, Ph.D. University of Michigan, Ann Arbor, Michigan

18. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 18 Benefits of Early Intervention For the Employer Productive work force Reduced number of replacement workers Employer can be more involved in a claim Reserves FASB 112 ADAAA compliance Cost Control

19. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 19 Benefits Cont. For the Employee Feelings of self-worth, purpose Involvement in active program vs. passively sitting at home Keeps them in the routine of work Vocational Rehabilitation provides an additional support structure for the injured worker during recovery Assistance in finding alternative work when unable to return to work with original employer Reduce wage loss

20. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 20 Controlling Return to Work Early Notification of Absence Case Management Claims Management Job Descriptions – Physical demands Cognitive demands Temperments Communication with Physician Communication with Employee Transitional Work Program Occ. & Non Occ. Functional Capacity Evaluations On-site Therapy Vocational Rehabilitation

21. Notifies Manager Employee Assessed by RTW Nurse Coordinator Injured /Ill Employee Assessment complete Initial Eval & F/U only. Completes FROI And ROI Industrial Non-Industrial Claim Denied Claim Accepted Claim Investigated Occ. Med Clinic Specialis t On-site Occupationa l Therapist Meets MCM Criteria Medical Only. No F/U -Ergo Evaluations -Brown Bag (Lunch) mini-seminars on Ergonomics Refer to Personal MD C as e M gr … … … … C Mgt Team Job Description Adjuster s PT/OT/Vo c/Diagnosti cs HRLega l Employee Voc Rehab Famili es RTW-Reg Wk Activity RTW Modified duty (QIW) Qualified Injured Worker + Accommodations Can not Accommodate Back Home PERMANENT RESCRICTIONS ADAAA Meeting (HR/Mg t/Ns/Leg al Can not Accom- modate _____ Physicians Voc Rehab

22. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 22 Job Analysis Help Wanted KITCHEN ASSOCIATE Line Cook Needed. Unmotivated slob who has a nasty disposition, no worthwhile abilities, and bad at communication. Can't handle a spoon, spatula, or knife and wouldn't want to lead people if their life depended on it. Of course we don't want an experienced person, nor do we want to train you. Evening shift, maybe days, maybe part time, maybe full time. Norwalk Reflector

23. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 23 EMPAQ ® Employer Measures of Productivity, Absence and QualitySM. EMPAQ®: uniform, standardized metrics and reporting system for health, productivity and disability management for all employers.  useful comparison of benefit programs across major industry sectors  employer participation in this national metrics benchmarking project  creation of an industry-accepted set of standardized benchmarking metrics  DMEC, NBGH, IBI

24. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 24 Recommendations Discuss with current providers their capacity to assist. Establish a model for the program that fits the organization and its needs. Develop a core set of RTW strategies (e.g., designating transitional RTW pathways). Create policies that support RTW. Develop linkages with local healthcare and rehabilitation providers.

25. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 25 Recommendations Provide staff development and mentoring through research and education (Mitchell, 1998). Define indicators of effective RTW outcomes and milestones for evaluating progress. Evaluate and monitor progress. Provide supervisor and physician training. Provide usable program evaluation information. Keep the program up to date

26. Contents are proprietary and confidential. Copyright 2010 Benefit Advisors Network, LLCSeptember 5, 2015 26

27. Questions ? 9/5/2015 Contents are proprietary and confidential. Copyright 2010 Benefits Advisor Network Michael Brown, VoCare Services, Inc. mikeb@vocare-inc.com 888-840-1221 x 270