© Copyright 2006 Rogers Publishing Ltd. The following article first appeared in the November 2005 edition of BENEFITS CANADA magazine.
Frontlines of disability
Looking to get your employees off disability and back to work? Here are five innovations in disability management that can boost productivity and help cut claims costs.
By Alison MacAlpine

THE LANDSCAPE of disability management is changing. Providers are offering more flexibility, more customization and a wide range of options to help employees get back to work—including front-of-the-line medical attention, sophisticated job demands analysis and assistance with data collection that can help plan sponsors take control of disability management costs. BENEFITS CANADA asked experts in the field to identify the most important emerging trends in disability management. The following is an account of the top five major themes that are poised to break through into the mainstream.

Jane Sleeth, medical director of Optimal Performance Consultants Inc. in Toronto, believes that Canada’s healthcare system offers three tiers of service. The first tier, she says, is the public system delivered by the provincial medicare programs. The second tier is the private network of physiotherapists, dentists and other professionals who, for the most part, aren’t covered by provincial healthcare plans. And then there’s the third tier: the front-of-the-line service insurance companies and workers’ compensation boards routinely accessed to help employees get back to work more quickly.

“We help employers find the best in terms of rehab clinics, diagnostic centres, physicians and specialists, and some employers actually choose to pay privately for those services,” says Sleeth. “They’re trying to help the employee get in faster; instead of waiting six months for an MRI, for example, I’ve got one employer that’s sending people down to Buffalo and getting them in within 24 to 48 hours.

Some insurance companies are also starting to offer the so-called Best Doctors program as an add-on to plan sponsors’ long-term disability(LTD)plans. Best Doctors assembles panels of specialists to review the medical files of employees who are seriously ill. The specialists then prepare a comprehensive report that offers a second opinion and provides advice both on the latest research and treatment options and on how to navigate the healthcare system. Covered conditions are carefully defined, but may include anything from cancer and cardiovascular disease to blindness, deafness, severe burns and major trauma.

“There is a possibility that you could get Best Doctors to find you treatment elsewhere, either in another province or a close city or even the United States,” says Terry Zavitz, president of Terry Zavitz Insurance in London, Ont. “Our experience has been that we’ve had nobody go to the United States because of Best Doctors; we haven’t had anybody leave the community either. But, certainly, we have found positive responses from the employees and the doctors.”

The key benefit, she says, is that Best Doctors serves as a lifeline for employees, who start to feel more in control of their health.

Physical demands analysis is an established tool for identifying and quantifying the physical requirements of a job for the purposes of accommodation and return to work. But with the number of psychological claims soaring, insurance companies, plan sponsors and consultants are recognizing the value of cognitive demands analysis(CDA).

Liz Scott, principal of Organizational Solutions in Burlington, Ont., believes that cognitive demands analysis is the key to developing successful return-to-work strategies for employees with psychological conditions.

“Because the solution is focused on the demands of the job compared to the capabilities of the individual, it assists in identifying whether the individual has a psychological condition that disables them from work or whether it’s just everyday stress and anxiety,” she explains. “It also assists in being able to direct the therapeutic care because when someone has a psychological illness, in the past the therapeutic care was not necessarily focused on preparing them to return to work.”

Scott admits there are still challenges getting psychiatrists to buy into this approach, but points out that physicians initially resisted the shift in focus to return to work a decade ago, and they ultimately came on side.

In addition to CDA, Jane Sleeth suggests that plan sponsors should consider analyzing the behavioural demands of a job. When one of the employers she works with is struggling with an abundance of psychological claims, she teams up with Human Performance International to identify employees who aren’t a behavioural match for their jobs.

Understanding the cognitive and behavioural demands of a job, she says, can help plan sponsors assign employees to appropriate positions—and reduce disability claims.

Plan sponsors are beginning to consider the need to conform to national standards when considering disability management. The National Institute of Disability Management and Research (NIDMAR)has developed professional standards for Certified Disability Management Professionals and a consensus-based disability management audit tool that has been embraced by several jurisdictions within Canada and compensation boards and insurance companies as far as Germany, the United Kingdom, Ireland and Australia.

NIDMAR’s Victoria-based executive director, Wolfgang Zimmermann, says plan sponsors are using the audit tool—which cost $3 million to develop and test—to achieve rebates from compensation boards, to improve their disability management performance, and as a risk management strategy to document the company’s willingness to accommodate disabled employees.

“Employers that want to be on the leading edge, employers that want to be the most competitive in our global society, will do this because they will manage disability issues in terms of maximizing cost reduction potential, but also use it as a basis for collaboration with their workers,” says Zimmermann. “What it really comes down to is adopting a consensus-based model that recognizes the balance between economic and social outcomes in disability management, as opposed to a straight claims cost reduction model.”

Another global standard that is just starting to catch on among plan sponsors and providers in Canada is the use of a series of disability definitions that allow employers to distinguish between disability and behavioural issues. The definitions issued by the World Health Organization through a program called the International Classification of Functioning Disability and Health, describes four components that can lead to disability: body functions and structures, activities and participation, environmental factors and personal factors. Organizations such as Sleeth’s Optimal Performance Consultants Inc. are designing return-to-work programs for large and small, unionized and non-unionized companies founded on four parallel categories: medical, functional, environmental and psychological.

Sleeth sees these definitions as much more than an academic exercise because they allow employers to focus on the four factors that may be contributing to an employee’s disability. Plan sponsors can look beyond a doctor’s notes to the results of functional testing by physiotherapists, occupational therapists and kinesiologists; environmental attributes such as the physical workspace and interpersonal relationships; and psychological challenges at work and at home.

“Employees who are about to be let go, or who have just had some sort of discipline or performance appraisal that didn’t go well, will often appear with a note from a doctor saying they’re disabled,” Sleeth says. “There is a blurring between labour relations and human performance and disability. By virtue of having this system and making it as objective as possible, it allows the employee and the employer to separate those two issues out and deal with them accordingly.”

Greater flexibility and customization in short-term disability (STD)plan design is a trend Julie Fish believes many plan sponsors are getting excited about. A principal in Morneau Sobeco’s Absence and Disability Management Solutions Practice in Toronto, Fish is seeing closer partnerships between plan sponsors and disability management providers to design STD programs that dovetail with existing prevention and absence management initiatives.

“To effectively manage disability, it’s really important to understand what is top-of-mind to the plan sponsor and to understand the environment in which the employees work,” she says. “It’s not a one-size-fits-all business and it shouldn’t be approached in that way, although in the past it has been.”

STD is also receiving up close and personal attention from insurers with earlier intervention and more active management. According to Fish, issues such as workplace stress, the challenges of the sandwich generation and the struggle to maintain work-life balance are all making disability management more complex. “[In] managing absences,” she says, “it’s very crucial to know how to identify those types of peripheral issues and remove those barriers to the person working. Actively managing the claim is crucial and it will reduce the claims incidence.”

Sleeth is a fan of flexible plan design and active STD claim management as well. She works with her clients to extend their STD benefits up to 52 weeks in some cases because she sees the STD period as the best place to intervene and get people back to work. Often, plans put an employee on STD for 17 weeks and then bump them onto Employment Insurance. But at that point, the plan sponsor loses control, she says. Sleeth finds that keeping an employee on STD where he or she can be managed closely keeps costly LTD claims in check.

Twenty-twenty hindsight is always easy. Plan sponsors usually look back at what has worked and what has not and can make adjustments accordingly. However, what can plan sponsors do to make sure they understand the needs of employers at the starting block and not at the finish line?

“Corporations are stepping back and taking a more integrative look at this whole sleeve of benefits and issues surrounding employee health,” says Jean-Marc Mackenzie, vice-president and business leader of physical health and risk management at FGI World in Toronto. “They’re stepping back and saying, ‘all this data, it’s a lag indicator of something but it’s also a lead indicator.’”

Mackenzie believes that a new, strategic approach to disability management is being driven in part by the requirement for good corporate governance and the rising tide of human rights complaints related to accommodation. The result is a shift away from managing individual line items towards looking at, for example, what drug data says about absenteeism or employee health or health and safety in the workplace.

Tim Spark, vice-president at HKMB People Solutions in Toronto—an international insurance broker—is finding plan sponsors much more receptive these days to strategies that bring together worker’s compensation, short-term, long-term and casual disability under one set of processes and parameters. “A disproportionate amount of your compensation is going to benefits every year, and it increases by 15% every year,” he says. “As a result we want to look at some ideas and some programs that will help you start to get some level of control or some sense that this is not a runaway part of your business. And an easy one to do right out of the gate, because you can show real dollars in a relatively straightforward manner, is absenteeism.”

Mackenzie adds, “Once you start taking a more sophisticated approach to the way that you look at employee health and corporate health—which are along the same continuum —and once we start understanding what are the metrics: lead and lag of the organization…then you’re in a better position to do more targeted investments of other dollars.”

Helping organizations work out their metrics are tools such as Hewitt Associates’ Disability Absence Index Survey (DAIS). Originally designed to provide a benchmark for plan sponsors concerned about rising employee absence statistics, it has been used by Hewitt’s clients to work out the availability and quality of data within their organization, and develop a plan to collect the data they’re not currently capturing.

“With this information, they can develop business cases to promote to senior leadership. That’s step one in being able to start doing anything different at the workplace,” says Hewitt’s Toronto-based national practice lead for organizational health, Rochelle Morandini. “And part of DAIS, having it available, definitely helps us steer the programs so they are much more targeted to what that employer specifically needs and what their specific issues are.”

Putting Best Practices to the Test

Three years ago, forestry company Weyerhaeuser became one of the test sites for the National Institute of Disability Management and Research(NIDMAR)disability management audit tool. Mike Rushby, Weyerhaeuser’s Vancouver-based vice-president of human resources and NIDMAR’s business co-chair, arranged for all of his company’s units in Western Canada to participate in the two-day audit process. It was an informative, if humbling, experience.

“Units that felt they were very good found that they were not as good as they thought they were,” he says.

The process itself involved collecting answers to 180 questions. Some were evidence- based and relied on the auditor’s judgement. Others required consensus among representatives from management and staff. A final set asked randomlyselected employees questions about disability management.

An 80% score on the audit represents the pass mark for best practice, and today one-third of Weyerhaeuser’s units qualify. The rest are expected to meet minimum standards, including employing a full-time or part-time return-to-work coordinator, identifying modified work options that are available to employees for a period of time and preparing a comprehensive disability management program document.

Rushby believes that an audit run by professional auditors can help companies understand the high costs associated with poor disability management. He thinks this kind of internal analysis will become more important as a “safe harbour” as jurisprudence takes a harder line on companies that demonstrate a failure to accommodate.

However, he advises plan sponsors that are just beginning to explore this option to speak with a trained auditor first, or perhaps run a “mini-audit,” so they can get some programs up and running before signing on for a comprehensive analysis.

“It’s been a learning journey for everyone concerned, but the thing that sticks out most for me is that everybody has come together; union, management and employees have come together and realized that this is in the best interest of employees as well as the organization,” Rushby says.

Alison MacAlpine is a freelance writer in Toronto. alison@amcommunications.ca