Return to work

Morgan Wear jokes that his job is easy. He said it’s because his predecessor at the Washington State Department of Labor & Industries took the Centers of Occupational Health and Education program from concept to reality before Wear took over as program director in 2013.

Wear said he gets “to talk about (the program’s) successes all the time.”

The COHE program is designed to get injured workers back on the job while curbing long-term disability rates. It began in 2002 with pilot sites and has since expanded to six sponsoring health care organizations and more than 3,400 individual providers across the state.

A federal Department of Labor analysis published in September 2016 states that the COHE program reduced the number of workers who “went on to receive [Social Security Disability Insurance] in the next eight years by 26 percent.”

Washington L&I’s own internal estimates (as of Dec. 31) show an average savings of about $2,000 in incurred cost per claim when injured workers visited COHE providers instead of an outside provider. And a study published in 2011 in the journal Medical Care concluded that COHE patients had 19.7 percent fewer days on disability and a $510 reduction in costs per claim.

Spending fewer days away from work is important because the generally accepted likelihood of an employee leaving a job permanently drops to about 50 percent if he or she is off work for 12 or more weeks. Wear said that at the one-year mark, “you’re probably never returning to work at all.”

He’s also aware of the human side of getting injured people back to work.

“When a person is injured on the job, if the medical issues aren’t addressed in a timely way, that person’s life can spiral into a very bad place and can end up in permanent disability,” Wear said.

A NIOSH-funded study led by researchers from Boston University in 2016 seems to support Wear’s statement. It found that lost-time occupational injuries were linked with higher rates of mortality.

“This implies an important formerly unmeasured cost of these injuries and a further reason to focus on preventing them,” the study abstract states.

How the program works

The COHE program centers largely on removing administrative obstacles or impediments in the workers’ comp process. As an example, Wear said to imagine going to a doctor’s office and someone there is unable to approve a needed procedure or has to talk to another party before getting approval.

“‘Come back in a month,’” he said, continuing the scenario. “If you hear that when you’re in pain, what does that do to your psychological well-being?”

Most likely, it’s going to cause frustration and the injured worker probably will give up.

“A timely initiation of workers’ comp insurance and getting those decisions moving forward has a huge impact on eventual outcomes,” Wear said. “It’s one easy way we can prevent long-term disability.”

To aid that cause, the COHE program seeks to get all of those involved – providers, injured workers, employers and Washington L&I – on the same page. Wear said a health care facility in Washington state might see one or two workers’ comp cases per year, and helping the people at those facilities understand what is required in certain cases are COHE’s health service coordinators, who act as a hub among the various parties. Wear called the health service coordinators the “heartbeat of our program.”

“The HSC tracks specific claims in order to ensure early return-to-work services, care coordination and improved clinical outcomes of injured workers,” the Washington L&I website states.

Another key component of the program is sharing occupational health best practices. When providers seek to join a COHE, they get training on best practices and “continual support and feedback,” according to a video on COHE’s website.

Other states

In August 2017, the Stay-at-Work/Return-to-Work Policy Collaborative, established by the Office of Disability Employment Policy at the federal Department of Labor, listed three topics that its policy working groups focused on in 2017. First on that list, “Replicating and adapting the state of Washington’s Centers of Occupational Health and Education (COHE) model.”

That group also issued a policy brief on the subject that same month.

In an April 2017 post on its Science Blog, titled, “Worker Recovery and Return to Work,” NIOSH listed COHE prominently among its worker recovery resources.

President Donald Trump’s budget proposals for fiscal years 2018 and 2019 have included requests to redeploy the Disability Employment Initiative for “a new demonstration project modeled on Washington state’s successful [COHE] program to improve labor force participation and attachment of individuals with temporary injuries and disabilities.”

In an effort to improve its system, the Colorado Division of Workers’ Compensation issued a regulation, Rule 18, which went into effect in January 2017. Part of that rule, 18-8(D), solicits proposals on pilot programs. That was inspired in large part by Washington state’s COHE efforts, said Dan Sung, manager of medical policy at Colorado DWC.

Colorado’s workers’ comp system is significantly different from Washington state’s, in that insurance is purchased from a commercial entity. Washington’s system is administered via a state fund and organizations can’t buy insurance from a private provider.

Because of that, Colorado is proposing to focus not only on administrative inefficiencies, but also on coordinating quality care for injured workers.

“For example, the authorized treating physician is aware of what the surgeon is doing, and vice versa, and the surgeon is aware of what the physical therapist is doing, and vice versa,” Sung said. “All of that clinical information is exchanged in a meaningful way so everyone is working as a team to ensure that the best care is truly being delivered.”

In Ohio, the state’s Bureau of Workers’ Compensation has continued its efforts to improve return-to-work outcomes in the past couple of years with a pilot program that focuses on treating knee injuries. The Enhanced Care Program, which started in 16 counties in northeast Ohio, now is expanding to the entire state.

The program centers on a “high-quality physician of record,” according to the BWC website, with the goal of getting injured workers at “risk of poorer outcomes” to have their care managed by those practitioners. Those physicians are tasked with developing a comprehensive plan of care and coordinating with any specialists or other physicians.

“These programs are designed to resolve the claim and deliver on the system’s promise made to employers and injured workers,” said Freddie Johnson, chief of medical services and compliance officer at BWC. “That is, we’re going to do what we can to safely and promptly return injured workers back to work and a positive, quality life.”