How to bridge the insurer, physician divide in disability management

Despite mental health accounting for more than 30 per cent of long-term disability claims, there’s a disconnect between medical practitioners and insurers that unwittingly impedes the ability of plan members to receive timely care.

Samuel Mikail, senior consultant for mental health at Sun Life Financial, told attendees at Benefits Canada’s 2017 Mental Health Summit in Toronto on Nov. 7 that a siloed approach to disability management is leading to inappropriate, inadequate and delayed treatment.

Read: The role of technology in improving access to timely care

“In Ontario, it isn’t unusual for patients to have to wait 12 to 18 months to see a psychiatrist. And the longer symptoms are active and in place, the more difficult it becomes to treat the disorder or relieve the symptoms,” he noted.

Disability management, according to Mikail, is a whole system comprised of multiple players, including human resources, the insurer, health professionals, family, co-workers, supervisors and case managers. “Each player has a vital role in helping the plan member get back to work and health. But due to a gross lack of co-ordination, they often end up functioning in silos. The physician doesn’t always talk to the psychologist. The psychologist doesn’t always talk to family members. This lack of communication becomes a significant barrier in successful return to and reintegration at work.”

When it comes to coping with mental health, Mikail noted collaboration is a key ingredient of the treatment plan. “Primary care clinics, where you have a practitioner working with a social worker, nurse, dietician, occupational therapist and, perhaps, even a psychologist, allow for much more comprehensive, efficient and swift patient management than solo practitioners,” he said.

Read: Early detection, treatment key to addressing mental disorders

Context, he added, is equally critical. “It’s important to think about the disability in the context that it occurs. Knowing the nature of the impairment and how it intersects with the requirements of the job forms the basis for determining disability.”

In other words, someone who’s in a depression wouldn’t automatically qualify as having a disability from an insurance perspective. A parking kiosk attendant who has a social anxiety disorder, for example, could still function reasonably well given the relatively minimal level of social engagement.

Mikail told attendees insurers take into account the diagnosis, impairment and disability. Diagnosis entails symptoms. Impairment is the loss of psychological, physical or social function associated with a particular condition. Disability takes that impairment and puts it within the broader context of the work-related demands placed on the individual.

Read: A call for urgency in treating mental disorders

For better synergy with insurance providers, Mikail said primary care physicians need to understand and honour that distinction and provide a detailed list of impairments so a case manager can determine the right treatment plan and return-to-work options.

And to maintain credibility, he suggested, physicians need to remain objective, rather than assume an advocacy role for their patients. Measurement-based care, he added, could help maintain that transparency and trust with insurers. “When we don’t measure and document responsiveness to treatment, we fall short of the mark in terms of our effectiveness,” he said.

Mikail decried the often-adversarial relationship between the medical community and insurers, saying it eventually hurts the person who desperately needs the care. “The objectives of insurers aren’t always clear to physicians. But it’s important for practitioners to understand and appreciate that insurers are on the same side,” he said. “They’re equally committed, invested and interested in trying to return someone back to a state of well-being and maximum productivity.”

Read more stories from the 2017 Mental Health Summit