DMEF0309 by Catharine Snell

June 2009 Vol. 1, No. 3

OFFICIAL PUBLICATION OF THE DISABILITY MANAGEMENT EMPLOYER COALITION

DMEC Annual International Conference Presorted Std. U.S. Postage PAID FARGO, ND PERMIT 43

Portland Delivers Beauty & Value

In This Issue: Disability Management in a Downturn Economy

www.dmec.org

Spend less time on employee absence paperwork… and more time being productive.

Learn how MetLife’s Total Absence Management solution can help. MetLife’s Total Absence ManagementSM solution focuses on helping employers maximize workforce productivity by managing the impact of employee absences. We can help by assuming the administration of Family and Medical Leave and company-sponsored leaves of absence in addition to providing insured Short Term Disability and Long Term Disability coverage. We also deliver a sophisticated claim and service model that combines expert management with expert resources to provide a superior service experience for our customers and their employees. We look forward to seeing you at the 2009 DMEC Conference. Please stop by the MetLife booth or visit our website at whymetlife.com/TAM. MetLife is proud to be a diamond sponsor and supporter of DMEC, and member since 2000. Metropolitan Life Insurance Company, New York, NY 10166. ©2009 MetLife, Inc. © UFS 0903-0963 0309028592[exp0310][All States]

WHO DO YOU HAVE YOUR DISABILITY BENEFITS WITH? Contact your broker or consultant to find out how Anthem Life can make a difference for you today. We take great pride in delivering timely benefit payments and great service, but our story doesn’t end there. We know you need your employees to be healthy, productive and at work to run your business successfully. That’s why we go beyond just providing a simple benefit check.

And as part of the nation’s largest health insurance company, we have the tools to make a difference. Our newest integrated health and disability product, Productivity Solutions helps employees stay at work or begin their claim process earlier. We do this by proactively identifying employees with a potential disability claim. Then, we provide them with appropriate access to variety of medical, behavioral and disability management resources to help them stay at work or get back to work faster.

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Aetna members can have confidence knowing that all their insurance benefits are designed to work together. Integrating Medical, Dental, Pharmacy and Disability can improve outcomes and lower medical costs because it allows for an earlier exchange of information and can help members and their doctors to spot and treat health conditions sooner. It’s just one of the ways that Aetna supports its 17 million members one member at a time. To learn more, visit Aetna.com or call your consultant, broker or Aetna representative.

For more information about Aetna’s Health and Productivity solutions, please visit us at the DMEC National Conference.

©2009 Aetna Inc. Plans offered by Aetna Life Insurance Company (Aetna) and its affiliates. Health, dental, life and disability insurance plans/policies contain exclusions and limitations. Policy forms issued in OK include:GR-9/GR-9N, GR-23 and/or GR-29/GR-29N. 2009038

Editorial Policy: All articles and content Copyright ©DMEC 2009. @work is the offi cial publication of the Disability Management Employer Coalition (DMEC). The magazine’s goal is to present industry and association news, highlight member achievements and promote the exchange of specialized professional information. The statements and opinions expressed herein are those of the individual authors and do not necessarily represent the views of the association, its staff, board of directors or its editors. Likewise, the appearance of advertisers does not constitute an endorsement of products or services featured in this, past or subsequent issues of this publication. DMEC makes no representations, warranties or assurances as to accuracy of the information contained in the articles.

@work welcomes submission of articles of interest to disability and absence management professionals at all levels. Complete instructions to authors are published online at www.dmec.org. DMEC membership: Individuals receive @work by being members of DMEC. Call 800.789.3632 or go online to www.dmec.org for more information. Change of address: DMEC members, notify DMEC 60 days in advance. We cannot guarantee to supply back issues on late renewals or late address corrections. Contact DMEC: Mail: 5173 Waring Road Suite 134, San Diego, CA 92120-2705. Phone Editor Peter Mead at 541.434.9029, fax to 541-844-1880; other DMEC business to 800.789.3632, fax to 877.789.3632, email to Assistant@dmec.org.

contents June 2009 Vol. 1, No. 3

DEPARTMENTS 6 7

President’s Letter Purpose and Passion – The Ties That Bind DMEC Members

Compliance Memos More COBRA Support; Domestic Violence Leave Laws Growing Trend Nationally

DMEC News

Chapter Developments

Blurb TO COME

Switching Focus from Infrastructure to People

Editor in Chief: Rebecca Milot-Bradford Editor: Peter Mead Sponsors Diamond Sponsors MetLife The Hartford Platinum Sponsors CIGNA Crawford Absence & Care Management Crowe Paradis Liberty Mutual Mercer Sedgwick CMS Spring Consulting Group The Standard Unum Gold Sponsors Anthem Life Prudential Silver Sponsors MES Solutions Nationwide Better Health Virtual Education Forum Unum Leadership Series Liberty Mutual

THEME: DISABILITY FEATURES MANAGEMENT IN DOWNTURN ECONOMY

8 12 16

Outsourcing During a Recession Informed involvement yields impressive returns

Mental Health Parity From turbulence to savings

Pay Attention to Retention Employers can provide positives in turbulent times

Published by: Naylor, LLC 5950 N.W. First Place Gainesville, FL 32607 352.332.1252 or 800.369.6220 fax: 352.331.3525 | www.naylor.com Managing Editor: Lyle Fitzsimmons Publisher: Mark Migliore Sales Manager: Jon Meurlott Project Manager: Albert Quintero Marketing: Allie Hansen Publication Director: Rya Boyce Advertising Representatives: Beth Sheahan, Pam Blasetti Layout & Design: Catharine Snell Advertising Art: Elaine Connell DME-F0309/8762/June 2009

COLUMNS 18

Absence Matters – Bryon E. Bass

Tips From the Edge – Carol Harnett/John Davis

21 26

Managing the Unpredictable – New insight in the control of intermittent leave

We Want to be Like Shane Battier – Sacrificing self-interest for the betterment of team

Behavioral in the Trenches – David Whitehouse, M.D. Don’t Ask, Don’t Tell, Do Understand – CBT opens doors to positive messages

Index of Advertisers www.dmec.org • @work 5

President’sLetterJune2009

Purpose and Passion The ties that bind DMEC members

E Marcia Carruthers, MBA, CPDM President and CEO, DMEC

very time I attend a DMEC conference, it occurs to me that one of the threads that binds us as members is the strong sense of purpose in our professional lives and the passion that ignites our level of support for the work we do. It is evident in the discussions, tone and drive that surround each interaction. Why is this so predominant in our industry? Selfless, self selection – There are a number of more profitable professions we could have chosen along the way. Somewhere along the line the fork in the road led to the job that afforded each of us more fulfillment than dollars; more good feelings when we left the office that we had truly “made the difference” in someone’s life. Return to work, wellness and employee assistance all

There are a number of more profitable professions we could have chosen along the way. Somewhere along the line the fork in the road led to the job that afforded each of us more fulfillment than dollars; more good feelings when we left the office that we had truly “made the difference” in someone’s life. Return to work, wellness and employee assistance all have a positive ring to them. Walking that walk requires giving back rather than taking.

6 @work • June 2009 Vol. 1, No. 3

have a positive ring to them. Walking that walk requires giving back rather than taking. Getting personal – There’s a story behind the passion. In some way, large or small, an event has occurred in our life that drives us to pay special attention to some aspect of disability and health. A family member who has suffered from cancer. A friend who has incurred a life-altering injury and come back fighting. A mental health issue that never resolved. Whatever the impetus; a call to action that said taking the high road would provide some means of helping the next person to avoid similar circumstances. Vision and voice – The ability to look down the road and see the need for a better way to do things. A creative mind that looks to find an innovative alternative to what we’ve always have done while hitting our heads against the wall. Life engineers if you will, with a goal to make things a bit better for our workforce as the first goal, and with the silver lining of “lining” the pockets of our employer as well. Common purpose/Shared view of the world – We find like minds and like visions as we network locally, nationally and now internationally. This common thread binds us whether we are in Europe, Canada, South Africa or Australia. It makes the world seem a bit smaller and our goals a bit easier to achieve. I’m sure there are other reasons you have chosen this as your career path. I’d love to hear your thoughts on this. Tap me on the shoulder at the Portland conference and let me know what drives your disability engine. Thanks for being a member of such a special fraternity! Be well.

COMPLIANCEMemo

CM#5: More COBRA Support

ore definitive information is coming online from federal agencies to help HR and benefits departments plan out responses to a new COBRA premium subsidy contained in the American Recovery and Reinvestment Act. The act funds a 65 percent subsidy of COBRA premiums for all employees involuntarily terminated between Sept. 1, 2008 and Dec. 31, 2009. For employees who choose to participate, employers will collect 35 percent of the premium and be refunded by the federal government by taking a credit on its payroll taxes. As employers plan out programs to comply with the new requirements, several questions have arisen: • What are the full details on who qualiﬁes for the subsidy? • Does reduction to part-time qualify under any circumstances? (Usually not, but if an employee responds with a “voluntary” termination, potentially yes.) • Does voluntary termination qualify under any circumstances? (Under at least two scenarios, yes.) • Has involuntary termination occurred if the employee has exhausted all beneﬁts and remedies but continues to have a disability or illness, and has been terminated for not returning to work? (Potentially yes.)

A guidance from the IRS, Notice 2009-27, released on March 31, contains 58 Question/Answer items to help employers, third-party administrators and others. To download the complete notice, go to: http:// www.irs.gov/pub/irs-drop/n-09-27.pdf. Other resources were provided by the Department of Labor, which published model notices that employers are required to circulate to current employees or to former employees who may still qualify for the COBRA premium subsidy. April 18 was the deadline for employers to customize these notices as appropriate for individual employees and distribute them. Insurers used the notice titled “Alternative Notice.” Employers used three notices – a full General Notice, a General Notice Abbreviated Version and a Notice in Connection with Extended Election Periods – for employees in various categories. The model notices can be found at http://www.dol. gov/ebsa/COBRAmodelnotice.html. In addition to posting model notices, the Department of Labor also posted new frequently asked questions and answers to those questions. For more details on this topic, visit the DMEC Legislative Update blog at http://dmeclegal.wordpress.com.

CM#6: Domestic Violence Leave Laws Growing Trend Nationally

hiladelphia has joined a growing list of jurisdictions that require leave related to domestic violence. A few states, including California, Florida, Illinois and Washington, require unpaid leave for services related to domestic violence. Sick leave ordinances in Milwaukee and the District of Columbia require paid leave related to domestic violence as well as other reasons. A temporary injunction has delayed the effective date of Milwaukee’s rule. Eﬀective Jan. 5, 2009, a new Philadelphia ordinance titled “Entitlement to Leave Due to Domestic or Sexual Violence,” became law. It will be enforced by the Philadelphia Commission on Human Relations. The new law amends the Philadelphia Fair Practices Ordinance and requires employers to provide certain

amounts of unpaid work leave to victims of domestic abuse, sexual assault or stalking, or their qualifying family or household members. Employees may take this leave to receive applicable victim support services. The ordinance provides for job and beneﬁts protection during the leave and prohibits retaliation against employees or interference with leave rights. Employers with 50 or more employees must allow up to eight weeks of leave in a 12-month period. Smaller employers must allow up to four weeks of leave. Employers are required to post a notice, which can be found at: http://www.phila.gov/humanrelations/ pdfs/Domestic_Violence_Le.pdf. While leave laws provide one type of help for victims of domestic abuse, other forms of help may also be available in some beneﬁt plans, such as employee assistance programs. ● www.dmec.org • @work 7

FEATUREDisabilityManagementinaDownturnEconomy

Outsourcing During a Recession Informed involvement yields impressive returns

ou are fortunate if: • You led an outsourcing initiative three years ago; • You retained adequate staff in-house; • Your initiative is now showing an impressive ROI (return on investment);

• Senior management regards absence and disability management as tools to reduce claim costs and litigation, increase productivity and enhance human capital.

8 @work • June 2009 Vol. 1, No. 3

And if the RFP (request for proposal) isn’t released yet and you can help direct the process, then you can be a hero. When outsourcing is done well, the end result can look like the scenario here. When it’s unilaterally imposed by upper management simply to reduce staff count and save money, it can be a disaster. However, “Outsourcing disability management (DM) is a powerful tool to be leveraged by employers, who simply cannot keep up with the evolution and complexity of medical case management and the legal landscape of claims administration,” notes Kate Saracene, a labor and employment attorney with the Nixon Peabody office in Rochester, N.Y. Saracene is on the panel of the “DM in a Down-turn Economy” session at the DMEC Annual International Conference in July. A healthy outsourcing scenario has several traits, said Betsy Robinson, VP of products and marketing for Philadelphia-based Intracorp, a provider of absence and disability management solutions. Robinson will moderate the “DM in a Down-turn Economy” session. In a recession, it’s a core function of senior management to reduce costs. Outsourcing can achieve that goal without eliminating existing in-house absence and DM expertise. Now is the time for DM professionals to take the offensive and articulate the full scope of savings currently provided by their team, so the process doesn’t focus exclusively on slashing administrative cost while losing sight of the larger picture of claim and litigation costs. The traits of a healthy outsourcing process, said Robinson, are: • The process is guided by an experienced, qualified consultant; • A qualified absence and DM organization is quoting; • In-house stakeholders are engaged; • The process is aimed at a custom solution complementing in-house resources, to design an effective absence and DM workflow, rather than simply imposing a new scheme in order to eliminate in-house staff; • Historic program data are available to define the company’s particular absence and DM challenges, with insights about each of the major job categories, occupational and nonoccupational health issues affecting productivity and specific medical cost drivers in the employee population; • The process can address common disability scenarios in your company and “what-ifs.”

“Outsourcing disability management is a powerful tool to be leveraged by employers, who simply cannot keep up with the evolution and complexity of medical case management and the legal landscape of claims administration.” Kate Saracene

“If an employer doesn’t provide specifics about their current program structure, claim experience and outcomes to guide the process, it’s just forcing the vendor to quote something ‘standard’ making price the sole differentiator for vendor selection,” said Robinson. Outsourcing activity has increased, said Robinson. “In the last quarter of 2008, the activity was down significantly,” she said. “But activity picked up dramatically in the first quarter of 2009. Our organization has been operating at capacity to respond to all the interest from major corporations in exploring a customized absence and disability management solution.” Clearly, the recession hasn’t changed the basic cost factors making absence and DM so important. If anything, the recession amplifies them. So do new laws already passed and more being developed. In this new environment, the risk of excess claims cost is up dramatically, and so is the risk of litigation. In the middle of these concerns is the question of how to use outsourcing effectively. What’s the right balance of outsourcing and retained in-house expertise? Outsourcing Concerns

Most mid-sized and larger employers selfinsure their disability programs. Employers are finding ways to outsource more functions to vendors in order to keep a smaller program shell and fewer staff in-house. The goal is to get the best of both worlds, the flexibility of selfinsurance and the reduction of in-house staff that goes with insurance. Effective outsourcing can reduce the burden on in-house staff, provide new resources and help an organization achieve greater consistency in complying with federal regulations, especially the Family and Medical Leave Act. Outsourcing www.dmec.org • @work 9

initiative, then back to Nixon Peabody,” she said. She adds, “(At most corporations) people in-house don’t understand and accept this cost (of disability management) it tends to be a mystery to senior management.”

“If an employer doesn’t provide specifics about their current program structure, claim experience and outcomes to guide the process, it’s just forcing the vendor to quote something ‘standard’ making price the sole differentiator for vendor selection.”

Recession Dynamics

Betsy Robinson

programs can target speciﬁc functions, or can be used to totally eliminate entire absence and DM programs. Saracene mentioned several questions raised by outsourcing: what expertise to retain in-house, how to address tough cases, how to support ADA compliance (e.g., with accommodations) and how to avoid losing control of claim and litigation risks. The “DM in a Down-turn Economy” session will tackle these stay-

up-at-night questions. Saracene understands those questions at greater depth than most people. In addition to her expertise as an attorney, she has been in a long-term in-house and outsourced relationship with Xerox Corporation. “I began my career in human resources at Xerox, then went to practice at Nixon Peabody, one of the outside law ﬁrms Xerox uses, then back to Xerox to start an integrated absence and disability management

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10 @work •1 424872_Professional.indd

June 2009 Vol. 1, No. 3

3/31/09 9:12:04 PM

Another factor driving outsourcing decisions is whether an organization expects a longer recession. Significant outsourcing usually doesn’t generate immediate cost reductions; it’s a complex process, has significant startup costs and takes time to install a new program. It’s a rule of thumb, said Saracene, that “it takes up to 24 months before an employer saves on effort.” Cost savings may arrive earlier or later. Any outsourcing initiative during a recession probably will get the acid test. Layoffs are up dramatically, and during layoffs, disability cases come out of the woodwork. The condition that was made tolerable by a paycheck becomes intolerable. The prospect of layoff makes people look for a life raft in a disability claim. Even applications for Social Security Disability Insurance are up to their highest levels ever, with more than 600,000 new applications every quarter. And it’s not just a rising volume of disability cases. Complex cases with greater litigation potential also are increasing. “What do you do with someone who’s already on disability when the layoff occurs, or someone who gets on disability in anticipation of a layoff ?” Saracene asks. Cases like this could trigger provisions of the federal ERISA law.

Higher Litigation Costs from New Compliance Mandates

Employers with history in absence and DM have data establishing a baseline for the range of claim costs and lost time. An absence and disability management team can – and should – articulate its vision for what constitutes avoidable excess cost and the ROI of capturing those savings. It’s harder to estimate the cost of avoidable litigation related to compliance with government mandates that run parallel to absence and DM. Several factors point to a significant increase in litigation cost, however, based primarily on the new ADA Amendments Act (ADAAA). • Many more individuals are qualified to bring suit as of Jan. 1, 2009, because the new ADAAA greatly expands the definitions of disability from the original ADA. • The new ADAAA applies not only to new hires, but also to people returning from longer-term disabilities, in some cases. • It’s not a question of “if” but “when” the new ADAAA will be litigated. Disability advocates understand that the ball is in their court to test what the new ADAAA covers. • Testing the new law could be costly. Precedents in one judicial circuit may not apply in another, Saracene

said, so an employer may have to fund litigation even though similar litigation is happening in another circuit. Under some scenarios, total outsourcing that eliminates in-house expertise may make it harder for an employer to sustain policies and procedures that can prevent litigation. Under other scenarios, an employer could use outsourcing to reduce litigation risk.

Conclusion

Will your organization undertake signiﬁcant outsourcing during this recession? If so, will outsourcing bring new consistency and capacity to your absence and DM functions? Or will it generate new problems by eliminating needed in-house expertise? Those decisions rest with senior management, which needs input and education from your absence and disability management team. ●

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www.dmec.org • @work 12/16/08 11 11:49:01

FEATUREDisabilityManagementinaDownturnEconomy

Mental Health

Parity From turbulence to savings

hile FML A may demand more immediate focus, the Oct. 3 implement date* for federal mental health parity laws may be raising more employer questions.

The *asterisk on the compliance deadline is like so many other aspects of the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008. It’s not well understood, despite its potentially huge impact. The law’s implement date is Oct. 3, 2009, but all calendar-year plans – probably the majority – have until Jan. 1, 2010 to install a parity plan. If your plan is not on a calendar year, it must comply with parity in the next plan year beginning on or after Oct. 3, 2009. If your current plan year ends before then, your organization has until its anniversary date later in 2010 to craft a compliance plan. Collectively-bargained contracts governing health plans also may delay the implement date to later in 2010, or even beyond in cases with multi-year contracts. Many employers may rely heavily on their health insurance providers, plus consultant advice, to craft their compliance strategies.

12 @work • June 2009 Vol. 1, No. 3

Parity Basics

Parity includes both mental health and substance abuse (MHSA) treatment. Parity doesn’t mandate that MHSA coverage be provided, but if it is provided, it must be substantially equivalent to medical and surgical coverage. “Equivalent” includes: • Annual or lifetime dollar limits on MHSA benefits cannot be less than those for medical and surgical benefits. • Financial requirements for MHSA benefits cannot be more restrictive than the predominant ones applied to substantially all medical and surgical benefits. • Treatment limits for MHSA benefits cannot be more restrictive than the predominant ones applied to substantially all medical and surgical benefits. • Plans cannot apply separate cost-sharing or treatment limits to MHSA benefits. • Out-of-network treatment is paid on the same guidelines for MHSA or medical. The first four points above were provided by Denise Weaver, Ph.D., JD, and Lisa Podeschi, Ph.D., of Marsh, Phoenix, in their “Guidelines for Cost-Effective Implementation of the Mental Health Parity and Addiction Equity Act of 2008” session at DMEC’s 2009 Behavioral Risk in the Workplace Conference. Some of the ambiguities in the parity law are unavoidable, because the two fields operate differently in some regards. Further definition is due by Oct. 3 from the agencies that will regulate the law’s various provisions – the IRS, Department of Labor and the Food and Drug Administration. Moving Target

Parity deﬁnitions in the new law do not rule out cost-containment measures for mental health or substance abuse treatment, according to Rich Bedrosian, Ph.D., director of behavioral health for HealthMedia. Bedrosian is a copresenter in the “Mental Health Parity: Myths, Costs, and Opportunities” session at DMEC’s Annual International Conference in July. “Employers fear unbridled spending, but the act doesn’t eliminate the ability to regulate usage. They’re not throwing managed care out the window, there will still be utilization management — and employers and health plans can still limit covered diagnoses,” said Bedrosian. “In Massachusetts where I practice, there are so-called ‘parity’ diagnoses and ‘non-parity’ www.dmec.org • @work 13

diagnoses. Presumably the patient must have a mental illness or a biologically-based condition in order to be considered under parity,” he said. “However, deﬁning the perimeters of parity is going to be a moving target and a matter of controversy.” As a result, it appears likely that employers and health plans can expect to see litigation over this subject. And that’s not just because signiﬁcant dollar costs are at stake, Bedrosian explained. “The mental health

professional disciplines are newer, they’ve had less time to develop standards of care. Much of our regulation was established when insurance companies entered the ﬁeld and instituted utilization management. The diagnostic list for mental health is less developed than for medicine.” The mental health professions are entering a political phase, with the industry standard Diagnostic Statistical Manual up for review. The last review, in 1994, established the current

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• June 2009 Vol. 1, No. 3

DSM-IV manual. When the dust settles, there will probably be a new DSM-V manual. Currently, medical practitioners, psychiatrists, pharmacy companies and other key stakeholders are jockeying to serve on the working committees to establish the new standard. Although the debate over parity eventually eliminated the requirement that parity include all conditions listed in the DSM-IV manual, the new parity law can only turn up the pressure on development of the DSM-V manual. To summarize, employers can use MHSA cost management tools, but they can expect controversy and litigation due to the high-dollar stakes for health care and to the stage of development of the mental health disciplines. How Will Employers React?

In his contact with employers, Bedrosian said he hasn’t seen clear consensus in favor of any compliance/ cost strategy. “It’s too early to tell,” he said. He hasn’t heard any employers threaten to discontinue MHSA coverage altogether, just to avoid having to provide equivalent MHSA coverage. Such a move would be using the proverbial baseball bat for a fly-swatter, according to estimates of the total cost impact of MHSA parity. It may only increase total health plan costs by 0.6 percent, according to Bedrosian’s co-presenter, Steve Melek, a principal and consulting actuary with Milli8:06:32 PM man in Denver. “We developed an analysis of HR1424 for an average set of benefit plan designs and (that was) our expected health-care cost impact,” said Melek. This was for plans not increasing their level of behavioral health utilization management. For those increasing their rigor around the use of this cost management tool – allowed under parity – Milliman projected a mere 0.1 percent total cost increase. A less drastic strategy would be to raise medical co-pays to offset the cost of MHSA treatment; in essence, increasing medical co-pays rather than reducing MHSA co-pays. Even this Melek finds unnecessary. “It is a legal strategy, but I do not think plans are looking to raise

4/3/09 8:40:01 PM

physical health health-care co-pays just to cove cover the costs of mental health parity. In the normal course of annual plan renewal design review, co-pays may be revised as an overall cost management approach, but again, I think it is unlikely that plan co-pays will be raised speciﬁcally because of mental health parity.” In a more measured approach, Weaver and Podeschi of Marsh discussed various ways to ﬁne-tune health plan and MHSA provisions.

In all the concern about health plan costs, some opponents of parity may be losing sight of the bbigger picture: combin health plan and bined disabi disability cost. Five of the top 110 causes of disability are related to behavfa ioral risk factors, and up to 66 percent l of claims involve co-morbid or secondary psychiatric problems that contribute to disability or impede return to work. Many thought leaders argue that expanding employee access to MHSA care may drive down disability costs, oﬀsetting any increase in total health plan costs driven by parity. Managing mental health more eﬀectively may even reduce total medical costs, with disability savings a further bonus. Some employers are pursuing this logic. Bedrosian is active in the New York Business Group on Health (NYBGH), an employer coalition

focused on reducing health plan costs. He is serving in NYBGH’s Mental Health Task Force in a “One Voice” initiative on depression, which employers believe is under-treated and driving higher health-care costs. They are promoting physician use of the PHQ-9 questionnaire as an early screening tool, recognizing that most people seek mental health care first from their primary care physician, not from specialists. “We’re looking at what these disorders cost by their very nature, not just their medical cost,” said Bedrosian. “These are the people who aren’t taking care of themselves, who have comorbid problems.” This initiative, for employees and the general public, will quantify the value of more effective spending on integrated medical and behavioral treatment. When employers start taking a similar focus on more effective spending in parity, more data will be available to illuminate the cost-reduction potential of behavioral treatment. ●

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FEATUREDisabilityManagementinaDownturnEconomy

Pay Attention to R Employers can provide positives in turbulent times By Marjorie Savage

Editor’s note: With many organizations running on lean staﬃng, employee retention is more important than ever. What happens when the one person who performs a function (or two or three) is oﬀ work? Employees are often forced to operate in crisis mode for sustained periods, and need support from their organization. This article describes a key component in employee retention.

.S. workers are more concerned than ever about immediate and long-term financial prospects. Employees are worried about making ends meet, caring for their children or an aging parent, saving for emergencies and financing their retirement.

More than half (55 percent) of Americans say financial concerns cause them the most stress, according to The Hartford’s 2008 Time-Off Survey. Sixty-one percent of women said personal finances are the leading cause of stress in their lives, compared to 49 percent of men. Other concerns include work issues (37 percent) and balancing work and family (26 percent). Persistent worry saps a person’s energy, which can diminish their efficiency on the job and ultimately impact productivity. Increasingly, workers are turning to their employers for help. The question then becomes: What can employers do to provide guidance and advice to a worried workforce? Income Protection and Investing in the Future

Now is a good time to help employees understand the ﬁnancial tools oﬀered through their 16 @work • June 2009 Vol. 1, No. 3

benefits package, such as group disability insurance. Communication that reinforces the value of these benefits – helping to protect their income and save for their future – can help alleviate some of the worry. Reminding employees of these benefits should resonate now more than ever. As individuals struggle to pay bills and put money aside for family and retirement, they value the financial security they receive from wages and income protection provided through their employer. Ninety-six percent of disability claimants said they would likely have suffered financial hardships if they had not received disability benefits from their employer, according to a 2008 survey by market research firm Harris Interactive. The Hartford’s research also found that employees consider their workplace/human resources one of their top sources of information

Retention about benefits. That means employers have the opportunity to help increase understanding of benefits such as disability insurance, and how those benefits can help protect family finances. Staying Connected

Compensation alone is not enough to assuage the unease. Employees today are seeking assurance that they can turn to their employer for honest, open communication on the state of the company. When employees feel connected to the overall goals of the organization and value the work they do, they are energized, motivated and eager to see the company succeed. The degree to which the employee feels engaged depends in part on the employer’s level of support, leadership and the sense of purpose it provides. Engaging the workforce can pay dividends. An engaged workforce often translates into employee retention and a high level of productivity. Companies with high employee engagement enjoyed 26 percent higher productivity, had lower turnover and are more likely to attract top talent, according to a 2008/2009 study by consulting ﬁrm Watson Wyatt Worldwide. Here’s what you can do to engage your workforce:

• Frequent, eﬀective communication – When employees are provided honest, clear information, know management expectations and the employer’s goals for getting through the current economic turmoil, they feel more connected to the organization and are better able to focus on their jobs. Eﬀective communication is often the underpinning of

successful companies with high productivity and a dedicated workforce. • Education/training – No employer can guarantee job security. But by providing an environment where training and learning are encouraged (possibly through subsidized tuition reimbursement), an employer could offer employees the opportunity to enhance education and job skills, resulting in a more skilled and engaged workforce. • Reward and recognition – Letting employees know they are valued and that they are doing a good job reinforces belief that management views them as contributors to the overall health of the organization. This often has a trickle-down effect. Other employees see colleagues recognized for a job well done and are encouraged to put forth extra effort to become engaged in the common mission of the company. Becoming a Trusted Advisor

Studies show optimistic people are generally healthier and recover from illness faster than those who are pessimistic. A 2005 study by the American Psychological Association on longterm happiness showed a correlation between positive emotion and various life experiences, finding that people who more frequently experience positive emotions are generally more successful in three life domains – work, relationships and health. Helping to keep employees’ morale up and their outlooks positive can go a long way toward reducing absenteeism, bolstering employee retention and strengthening connections between employer and employee. Employees today are experiencing high stress on a multitude of fronts. It is against this backdrop of heightened anxiety that employers have an opportunity to become trusted advisers in helping get through difficult times. ● Marjorie Savage is the director of product development for absence management for the Group Benefits Division of The Hartford, providing financial services and group disability insurance. She can be reached at Marjorie.Savage@hartfordlife.com and (860) 843-1880. www.dmec.org • @work 17

ABSENCEMatters

Managing the Unpredictable

I Bryon E. Bass VP/Absence Management Practice Leader Sedgwick CMS

ntermittent absence is arguably the single most complicated aspect of the FMLA to manage. Employers have had to contend with this struggle since the enactment of the FMLA in 1993. Over the years, the Department of Labor (DOL) has offered guidance in opinion letters and courts have provided their interpretation. Yet this guidance generally focused on: • When it was appropriate for a re-certification of the medical condition, • How often a new certification can be requested and subjected to second medical opinions, and • The timeliness with which employees should report their need for intermittent absence. Thankfully, with the implementation of new regulations on Jan. 16, 2009, the DOL has provided some clearer guidelines around intermittent absence that employers can use to manage it much more effectively. In this issue, I’ll focus on three: the contents of a medical certification, employee notice requirements and re-certification. Contents of Medical Certification

Under the new regulations, the DOL has given additional leverage to employers to require a “complete and sufficient” medical certification. With respect to intermittent leave, the DOL suggests that a medical certification is not “complete and sufficient” unless it provides some estimate of both the frequency of episodes of incapacity and the duration of absence associated with each episode. In general, if an employee provides a medical certification that is lacking this level of detail the employer can request clarification on this particular area. This provision will greatly help employers to reject carte-blanche “as needed” certifications, as one employer described doing in the April issue of @Work. Employee Notice Requirements

The new employee notice obligations can help curb attendance problems, provided that employers modify leave policies to take advantage of clariﬁcations and changes. Probably the most beneﬁcial in this area is the ability for employers to require an employee

18 @work • June 2009 Vol. 1, No. 3

to comply with the “usual and customary notice and procedural requirements for requesting leave, absent extenuating circumstances.” That is, that an employer may require an employee to provide notice in accordance with the requirements of other similar types of leave – such as sick leave or paid time oﬀ. If an employer requires employees to call in within an hour of shift start time, for example, that requirement can be extended to requests for FMLA. The regulation further clariﬁes that an employee can be disciplined for violating these consistently-enforced policies. This regulation can be especially helpful in situations where an employee who is being disciplined for too many absences argues that the absence they took a few weeks earlier should have been protected under the FMLA. The employer, in this situation, could deny those absences because notice was not provided as soon as practicable. Recertification

When we combine medical certifications and employee notice requirements, employers have a very powerful set of tools to manage intermittent absence. When employees exceed the frequency and duration as certified by the health-care provider, employers have the ability to require the employee to recertify their need for the additional absences. However, employers should act quickly in requiring this because there is a burden to provide just as timely notice to employees regarding recertification as the employee is required to report their intermittent absences. When requesting a recertification you are encouraged to provide a listing of the employee’s absences – inclusive of the dates and number of hours absent. And, request that the health-care provider consider whether or not the absences, in their opinion, are consistent with the employee’s medical condition. At the DMEC Annual International Conference on Monday, July 20, I will be speaking in conjunction with Southern California Edison and University of Pittsburgh Medical Center on their efforts to curb intermittent abuse and the strategies they utilize to manage these types of absence. ●

TIPSfromtheEdge

We Want to be Like Shane Battier Carol Harnett Clinical Physiologist/ National Disability and Life Practice Leader The Hartford

Sacrificing self-interest for the betterment of team

efore we look at the world from our viewpoint and consider data that justify our perspective, let’s look at the big picture from our employees’ angle. Let’s put the “who” and the “what” before the “why.” Let’s start with one remarkable employee. The Houston Rockets’ front office calls Shane Battier “Lego.” As Daryl Morey explains in a Feb. 15, 2008, New York Times interview, “When he’s on the court, all the pieces start to fit together. And everything that leads to winning that you can get through intellect… Shane excels in.” The Times labeled Battier a basketball mystery. While he twice garnered the Naismith Award as a John Davis Paralympic Athlete/ high school and college senior, Shane’s NBA box Downhill Chariot score statistics are ho-hum. Innovator-Racer/ The Rockets’ winning percentage is not. BatMotivational Speaker tier’s presence on the hardwood makes his teammates play better, his opponents play worse and represents the difference between 41 and 60 wins in a season. We want to be like Shane Battier. But we’re hesitant to tell you that. Why? This does not seem like a “practical” tip. Most dictionaries define practical as meaning disposed to action as opposed to speculation. Why would it be speculative to say we want our colleagues to perform better when we’re around? It seems like we’re talking about leadership. There are no practical shortcuts to becoming a leader, or are there? Almost no one would call Shane Battier a basketball floor general anymore – no one, that is, except the Rockets’ general management. They recognize Battier makes choices which sacrifice his own perceived self-interest for the benefit of the team. We recently experienced an a-ha moment related to self sacrifice. The ocean researcher, Sylvia Earle, made a wish at the 2009 TED conference “to ignite public support for a global network of marine-protected areas, hope spots large enough to save and restore the ocean, the blue heart of the

planet.” People stepped up with offers to provide boats for expeditions and venues to show films. Dr. Earle was enthusiastic but said the respondents forgot to look in the mirror. The most effective thing we can do to save the oceans is to stop eating sushi and big fish such as tuna. The gentleman sitting next to us said, “I’ll donate my boat, but I’m not going to stop eating sushi.” When told the story, our friend, Tracie, responded, “It’s easier to give than to give up. It’s too personal.” Consider the conundrum President Obama faces. He states he wants to fix health care as quickly as possible, yet he struggles with freeing himself from nicotine addiction. The most practical thing you can do when presented with a challenge is to start with yourself, since you’re the only person you can control. If you’re going to have a positive impact on your company’s productivity, profitability and bottom line, we need you to lead us. Ongoing research at The Hartford indicates employers who land on a list like the Fortune 100 Best Companies to Work For may experience approximately 25 percent fewer short-term and 10 percent fewer long-term disability claims – when excluding maternity claims – than companies who do not make the list. What are the major drivers that make employees happy at work? Work environments that generate a feeling of trust, pride and camaraderie. In our last column we outlined specific steps you can take to foster an environment that employees rate as satisfying. Lao-tzu, the Chinese Taoist sage, is often quoted as saying, “A journey of a thousand miles begins with a single step.” This is a free translation. He actually said something more like, “The journey of a thousand miles begins beneath your feet.” Be like Shane Battier. When you step into your workplace create an immediate experience for coworkers allowing them to trust in you while feeling pride in their work and a sense of camaraderie. That’s a practical tip that returns measurable outcomes for the team. ● www.dmec.org • @work 19

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• June 2009 Vol. 1, No. 3

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BEHAVIORALintheTrenches

Don’t Ask, Don’t Tell, Do Understand CBT opens doors to positive messages

M David Whitehouse, MD Chief Medical Officer for Strategy and Innovation OptumHealth Behavioral Solutions

anagers learn how to forget about communications that weren’t intended for them. Medical information, especially, is allowed to reach a supervisor only with an employee’s signed release. Yet slips happen, from the employee or a co-worker or other source. So when you hear an employee is missing work to attend therapy sessions, you follow a “handsoff ” policy and don’t engage with or acknowledge this information. But you can’t help thinking. Let’s address your concerns in this invisible area of your job. For some of us, “therapy” conjures up images of someone lying on a leather couch, rambling through childhood memories. A white-bearded therapist softly utters vague encouragements. This could continue for years. One therapist described 40 such sessions as “a mere hello.” It’s no wonder Sigmund Freud spawned an entire genre of comedy. You imagine your team member sinking into that couch. Meanwhile, back at the office, you’re short-handed, putting out fires and wondering, “Don’t they have pills for that?” The short answer is, yes. Drug therapy probably is available for many conditions, such as anxiety or depression, your team member might be experiencing. Drug therapy can provide shortterm relief from overwhelming symptoms, if the patient is receiving the right medication, the right dosage and the needed guidance to improve his or her life. In the longer term, however, your team member needs the help of therapy to learn new ways of thought and perception, making him/her less prone to emotional disruption and more resilient. When therapy is successful you’ll get a happier, more productive co-worker. Therapy has undergone a radical transformation. Psychoanalysis as humorist Woody Allen knew it has almost disappeared, and your insurance plan probably doesn’t pay for it. If your team member is attending therapy sessions, she/he almost certainly is getting some form of

Cognitive Behavioral Therapy, now a dominant practice in the field. Far from a passive ramble down memory lane, Cognitive Behavioral Therapy (CBT) demands work to uncover the hidden negative beliefs or “cognitions” that undermine positive behavior. It’s a system for taking unconscious thought processes and bringing them into consciousness, where we can modify them and their impact on us. Not all cognitions are negative. “I have a great memory” or “I can multi-task” are positive cognitions that support good job performance. CBT identifies negative cognitions that undermine success on the job and in other areas of life, and bring them into the patient’s conscious realm, beliefs like: “People think I’m bright at first but I usually disappoint them.” “I always work well with men but not with women.” “I usually make a fool of myself when I ask questions.” Negative cognitions can be “self-fulfilling prophecies” that undermine good behavior, and also can increase adrenaline levels and maintain constant stress, preventing sleep and forcing a downward spiral emotionally. Drug therapy is used to reduce the impact of negative cognitions, but cognitive behavioral therapy is needed to modify or displace those cognitions. CBT can transform “I don’t work well with women” into “I use extra care when working with women who remind me of mother.” The therapist assists the process, but most of the work of transformation comes from the patients themselves. At the beginning of a course of CBT, the therapist often assigns homework. Among other things, these exercises test the person’s readiness to change. If a person fails to complete two or three assignments, it may indicate a need to attend to other priorities first, or get further benefit from drug therapy, before having the energy to do CBT. This ensures a person is fully engaged in the transformative process – and that time away from work is productive. www.dmec.org • @work 21

DMECNews

There’s Still Time

Why you must attend the Portland conference

“I

DMEC Annual International Conference July 19-22, 2009 Hilton Doubletree Hotel – Lloyd Center Portland, Ore.

t’s not too late to sign up and attend the annual international conference,” said Lisa McGrath, DMEC director – conferences and education. “We welcome lastminute registrations on Sunday, and Monday when the conference formally opens.” As the economy shows signs of life, some employers with training and travel restrictions are beginning to authorize exceptions. Here’s why your organization must send you to Portland, Ore., for the conference July 19-22. More than ever, your company needs your knowledge as an integrated absence and disability management (IDAM) professional. But when was the last time upper management heard the data showing IDAM is an investment with a solid ROI? If your team hasn’t been delivering the business case for IDAM, your function could suﬀer. Your team wants to avoid this scenario. So do employees who need disability and absence management support to avoid extended disabilities and permanent impairments. And so does your company, which must compete during a recession. When a company runs with lean staﬃng, fewer employees carry more functions and a greater volume of work, so preventing or reducing lost work days is more important than ever.

DMEC’s Annual International Absence & Disability Management Conference is aimed at these corporate needs. It’s the industry’s employer-driven resource to help your team confidently answer the questions, “What have you done for me lately? What can you do in 2010?” The conference in Portland will update and re-focus our profession for the current economy, in such sessions as: • The Total Cost of Absence • Disability Management in a Down-turn Economy • FMLA: Effective Management of Absence in a Time of Change • The Benefits of an Internal Return to Work Team • The Employers Guide to Outsourcing Absence Management • Integrating with the Medical Community: Doctor Talk Going beyond the historic IDAM core, your organization also needs to respond to new cost and compliance concerns. This may not be the time to propose new programs to manage new costs coming from the ADA Amendments Act and other emerging cost trends. But it’s your job to assess their potential size and start planning. The conference has special sessions devoted to helping you prevent surprising new compliance costs. ●

GREEN PORTLAND Portland is the perfect mix of what you and your organization want in a conference host city. For you: World-class beauty in America’s greenest city, where a regional wine industry rivals the great growing regions of France. The environmental ethos has spawned unique civic treats like Farmer’s Market, and a swinging local indie movie, music and nightlife scene. For them: First-tier conference and amenities, at a second-tier price. DMEC’s most affordable annual conference ever boasts lower employer registration rates, room rates, meal and entertainment bargains. Clean public transit is only $3 from the airport to the hotel, and free in the Fareless Zone. It’s not too late. Come join your professional peers with DMEC in Portland!

22 @work • June 2009 Vol. 1, No. 3

DISABILITY MANAGEMENT EMPLOYER COALITION 14th Annual International CONFERENCE 0 9

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2009 Vol. 1, No. 3

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CHAPTERDevelopments

Switching Focus from Infrastructure to People

hapter and Volunteer Liaison Sharon Milligan has arrived at a new phase in her function, after all the hard work to develop support infrastructure for chapter functions. “Now I get to focus on people!” she says. If you’ve met Milligan, you may think that was already her function. But with key projects ﬁnished that provide resources for chapter growth, Sharon is looking forward to meeting as many people as possible at the Annual International Conference next month in Portland and sharing the value of belonging to regional chapters. She wants to meet all the board members at every chapter, as well as people from cities that don’t have chapters yet. You’ll see her face at registration, the president’s meeting and just about everywhere else. The blonde hair and quick smile make her easy to spot. The turning point for Milligan’s function came in February, when she trained chapter boards on how to use all the new resources. “We want to provide the board oﬃcers and

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committee chairs everything they need to feel conﬁdent about their functions, knowing they have the tools they need and DMEC’s personal support,” said Milligan. “If they feel connected they can help our members get connected and reach out to new members with conﬁdence.” Now comes the fun part – connecting! See you at the conference, Sharon. ●

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INDEXofAdvertisers ABSENCE & CARE MANAGEMENT Crawford Absence and Care Managment ........26 www.crawfordandcompany.com Sedgwick CMS................................................24 www.sedgwickcms.com BENEFITS, VOLUNTARY UNUM.............................................................14 CASE MANGEMENT GENEX Services, Inc. ......................................24 www.genexservices.com CONSULTING Spring Consulting Group LLC ...........................24 www.springgroup.com

CONSULTING/NURSE Actief Case Management, Inc. ...inside back cover www.actief-cm.com

ERGONOMICS CONSULTING Eucentra Consulting ........................................ 11 www.eucentra.com

EMPLOYEE BENEFITS Aetna ................................................................4 www.aetna.com Liberty Mutual...........................................20, 25 www.libertymutualgroup.com Mercer ......................................inside back cover www.mercer.com Met Life ....................................inside front cover www.whymetlife.com Reliance Standard Life Insurance Company/Matrix Absence Management, Inc. ...............outside back cover www.reliancestandard.com

HEALTH BENEFITS Anthem Life ......................................................3 HEALTHCARE CONSULTING Actief Case Management, Inc. ...inside back cover www.actief-cm.com INSURANCE Actief Case Management, Inc. ...inside back cover www.actief-cm.com The Hartford ...................................................15 www.hartfordlife.com Prudential .......................................................24 www.prudential.com Reliance Standard Life Insurance Company/Matrix Absence Management, Inc. ...............outside back cover www.reliancestandard.com The Standard ............................inside back cover www.standard.com INSURANCE, DISABILITY Liberty Mutual...........................................20, 25 www.libertymutualgroup.com LEGAL SERVICES Crowe Paradis ................................................. 11 www.croweparadis.com MEDICAL MANAGEMENT SERVICES MES Solutions...........................inside back cover www.messolutions.com RETURN-TO-WORK PROGRAMS CIGNA Group Insurance...................................14 www.cigna.com RISK MANAGEMENT Professional Disability Associates ....................10 www.professionaldisabilityassociates.com SOCIAL SECURITY ATTORNEY REPRESENTATION Social Security Law Group ...............................25 www.sslg.com VISION PLANS VSP ................................................................24 www.vsp.com VOCATIONAL SERVICES Catalyst RTW ..................................................20 www.catalystrtw.com VOLUNTARY BENEFITS Reliance Standard Life Insurance Company/Matrix Absence Management, Inc. ...................outside back cover www.reliancestandard.com WORKERS’ COMPENSATION Actief Case Management, Inc. ...inside back cover www.actief-cm.com

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• June 2009 Vol. 1, No. 3

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June 2009 Vol. 1, No. 3

OFFICIAL PUBLICATION OF THE DISABILITY MANAGEMENT EMPLOYER COALITION

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Portland Delivers Beauty & Value

In This Issue: Disability Management in a Downturn Economy