An innovative program designed to improve the delivery of health care to injured workers is lowering both days lost to disability and workers’ compensation costs in Washington State. Dr. Thomas Wickizer, professor of Health Services at the University of Washington, shared the results of this pilot program at the Institute for Work & Health (IWH)’s annual Alf Nachemson Memorial Lecture. Held in Toronto in October, the 2008 lecture attracted more than 85 people in the occupational health and safety community.
You really can make progress in fostering better outcomes for injured workers, Wickizer said.
There really is hope. According to Wickizer, the project is successful because it provides organizational support and infrastructure changes that allow family physicians to improve the quality of care to injured workers. It doesn’t rely on financial incentives alone.
Redesign pushes quality improvements
The pilot program, called the Occupational Health Services Project, began in 1998 with a redesign of some elements of the workers’ compensation health-care delivery system. (Washington State is not a “managed care” system, and workers are free to see the doctor of their choice.) The major changes included the following:
- Developing quality indicators. The system was redesigned to measure a number of practices required of physicians: the timely submission of accident reports, two-way communication with employers, the assessment of impediments to return to work (including psychological or social barriers), the completion of activity prescription forms (akin to functional abilities forms) and the use of best practices for treating specific conditions.
- Developing financial and non-financial incentives for physicians. Incentives were built into the system to reward physicians who undertook the “quality” practices above. For example, doctors were paid 50 per cent more for accident reports submitted within two business days of an injured worker’s first visit.
- Establishing centres for occupational health and education (COHEs). These centres had two objectives: one, to provide the support that would allow community physicians to offer better care to injured workers and, two, to identify and handle high-risk cases. As for supporting physicians, the centres offered continuing medical education, made senior doctors available as mentors to help with complex cases, and disseminated treatment guidelines and best practices. They also provided health services case managers to help coordinate care, improve communications with employers about return to work and reduce the paperwork burden on doctors.
Program decreases net cost per claim
The redesigned system was launched within two communities in Washington State: in Renton in 2002 and in Spokane in 2003. Over 175 physicians were recruited in Renton and 650 in Spokane.
The program was assessed in the third and fourth years of operation, and the results were convincing. The study compared injured workers who saw doctors in the pilot with workers who did not. The
- decreased the number of time-loss days per claim by four days;
- decreased the time-loss costs per claim by $347; and
- decreased the medical costs per claim by $245.
The net cost savings was $480 per claim, after taking into account the increased administration cost of $65 per claim and increased payments to physicians of $55 per claim. The pilot also resulted in fewer rejected claims and appeals, fewer reopened claims, and fewer claims that involved a lawyer.
What’s more, both doctors and employers welcomed the program. Both highly valued, in particular, the involvement of health services coordinators. They saw these case managers as instrumental in improving return-to-work communications between doctors and employers, and as problem-solvers during points of potential friction within the workers’ compensation system.
Interestingly, the physicians noted that the financial incentives were only moderately helpful in promoting occupational health best practices. “The additional financial incentive alone did not improve the quality of health care injured workers received,” Wickizer said.
For a copy of Dr. Wickizer’s slides, visit: www.iwh.on.ca/nachemson-lecture.