Spring/Summer 2020

Live Better, Heal Better: Employee Wellness in Workers’ Comp

Fast Focus

Understanding employees’ overall health is a growing component of workers’ comp. Comorbidities, fatigue, mental health, and other personal health factors can not only impact the effective management of claims, but in some cases the likelihood of injury.

Understanding employees’ overall health is a growing component of workers’ comp. Comorbidities, fatigue, mental health, and other personal health factors can not only impact the effective management of claims, but in some cases the likelihood of injury.

Among many insights pulled from a 2020 workers’ comp industry survey conducted by Healthesystems, claims professionals ranked comorbidities and poor worker health the number one program challenge facing the industry, and the third biggest challenge overall. Specific to health risks, comorbidities ranked second, while mental health ranked third.1

COMORBIDITIES = #1

Program Challenge to Workers’ Comp1

Understanding employees’ overall health is a growing component of workers’ comp. Comorbidities, fatigue, mental health, and other personal health factors can not only impact the effective management of claims, but in some cases the likelihood of injury.

Among many insights pulled from a 2020 workers’ comp industry survey conducted by Healthesystems, claims professionals ranked comorbidities and poor worker health the number one program challenge facing the industry, and the third biggest challenge overall. Specific to health risks, comorbidities ranked second, while mental health ranked third.1

80%
of a person’s health is attributable to health behaviors related to physical environment and socioeconomic conditions
– PricewaterhouseCoopers2

With a need to improve employee wellness and workplace environments, what key issues do payers and employers face, and what steps can they take to address these issues?

COMORBIDITIES

A comorbidity is the presence of an additional, often independent, medical condition co-occurring with a primary condition; in workers’ comp the primary condition would be the workplace injury. In workers’ comp, “comorbidity” frequently refers to a chronic health condition that may be lifelong.

EXAMPLES OF COMORBIDITIES INCLUDE BUT ARE NOT LIMITED TO:

Diabetes
Hypertension and cardiovascular diseases
Depression
Chronic obstructive pulmonary disease (COPD) and other breathing disorders
Arthritis
Obesity

Comorbid conditions are impacted by lifestyle choices, including diet, exercise, smoking, drinking, and other substance use, as well as by genetics, socioeconomic factors, and more.

THE PREVALENCE OF COMORBIDITIES

Despite increases to life expectancy, healthcare spending, and improved health outcomes, chronic comorbid conditions continue to rise in the U.S.2 For example:

66%
of the population is obese or overweight2
1 in 3 Americans
have high blood pressure5
30million+
Americans are affected by diabetes4

IMPACT ON WORKERS’ COMPENSATION

Workers’ comp claims with a comorbid diagnosis have tripled in the last decade, and such claims typically are associated with twice the medical costs of other claims.6

3x increase
Americans are affected by diabetes4

Oftentimes, workers’ comp claims must manage comorbidities in order to effectively help injured workers recover, essentially complexifying claims and increasing costs.

COMORBID DIVERSITY FACTORS

Diverse populations face diverse health risks. Certain age and ethnicity groups are more likely to experience particular chronic conditions:

latino populations
2x
as likely as whites to visit the emergency department for asthma7
black populations
More likely to have high blood pressure and/or diabetes9
50%
more likely to die from diabetes or liver disease8
Older Populations
70%
of people aged 50-64 have one or more chronic condition10
black & lation populations
Both are at higher risk for obesity and physical inactivity8, 9

COMORBID DRUG CONCERNS IN WORKERS’ COMP

When faced with comorbidities, patients may require medications to manage these conditions. However, when coupled with a workplace injury, there is the potential for various drug-drug and drug-disease interactions. Furthermore, the side effects of various comorbid and workplace injury medications may require treatment, and if not managed properly, could lead to polypharmacy, the problematic use of several concurrent medications.

COMORBID CONCERN

TYPICAL INJURY TREATMENTS

REASON FOR CONCERN

HEART DISEASE
NSAIDs, antidepressants
These drugs can increase blood pressure, increasing comorbid risks
MENTAL HEALTH DISORDERS
Opioids
Opioid interact negatively with antidepressants and benzodiazepines used for mental health
BREATHING DISORDERS
Opioids, gabapentinoids
These drugs risks include respiratory depression, which can exacerbate pre-existing breathing difficulties
DIABETES
Acetaminophen
Acetaminophen can lead to liver and kidney dysfunction, a risk already present in patients with diabetes
GASTROINTESTINAL (GI) DISORDERS
NSAIDs
NSAIDs can cause GI bleeding risks, compounding pre-existing GI conditions

UTILIZING WELLNESS PROGRAMS

Wellness programs are comprehensive health initiatives designed to maintain or improve wellbeing by encouraging proper diet, exercise, stress management, and illness prevention. When effectively deployed, they have the potential to improve employees’ overall health, which could also decrease medical care costs down the line, and by extension, medical premiums.

Wellness programs often include wellness screenings to identify health risks and create intervention opportunities to promote healthier lifestyles. This can include the collection of biometric data and the use of health questionnaires.

Approximately half of U.S. employers offer wellness promotion initiatives, and the larger the employer, the more likely they are to have a comprehensive program.11 Wellness programs differ greatly, but often they include information resources, health management tools, campaigns, and other components to carry out health initiatives including:

The detection, prevention, and management of chronic illnesses
Smoking cessation, which can include counseling and nicotine replacement therapy
Promotion of exercise and appropriate dietary recommendations, both for general health and to lower obesity
General health education
Stress management

THE BENEFITS OF WELLNESS PROGRAMS

Because wellness programs can improve employee health to manage comorbidities, they can help injured workers down the line. But exactly how effective are wellness programs in accomplishing this?

According to a study of 33,000 employees, worksites with a wellness program had an 8.3% higher rate of employees who reportedly engaged in regular physical exercise, and a 13.6% higher rate of employees who reported actively managing their weight.12

Wellness programs are also linked to statistically significant and clinically meaningful reductions in smoking behavior.11 However, not all wellness programs are built the same, and some can be ineffective at improving wellness.

More research is needed to determine which types of wellness programs are most effective and for what health concerns, especially considering that only half of employers have formally evaluated program impacts.11 But a key component to best utilizing wellness programs is tailoring such programs to specific work organizations.

TAILORING WELLNESS PROGRAMS

Employers need to take an active hand in forming wellness programs so they can best serve employees, and so they can best maximize employee participation. In one study, of the employees who had access to wellness programs, only 57.8% used them.13

Effective wellness programs approach wellness with a continuous quality improvement attitude and solicit feedback from employees to improve the program.11 Key facilitators of effective wellness programs include:11

Broad outreach and clear messaging from organizational leaders
Making wellness activities convenient and accessible for all employees
Making wellness an organizational priority among senior leaders
Leveraging existing resources and building relationships with health plans to expand offerings at little to no cost

Furthermore, research found that employers who use incentives for health screening activities reported significantly higher participation rates than employers that did not offer incentives. Employers that offered incentives saw 69% of their workforce complete health risk assessments (HRA) and 57% complete clinical screenings; employers that offered no incentives saw 29% completion for HRAs and 38% completion for clinical screenings.11

FATIGUE

Fatigue can be described as a level of tiredness, sleepiness, and reduced energy that requires increased effort to perform tasks at a desired level. If not properly managed, fatigue can increase the likelihood of injury and long-term health effects.

HEALTH IMPACTS OF WORKPLACE FATIGUE

13
% of workplace injuries
are attributable to fatigue14
90
% of employers
report being negatively impacted by fatigue16
62
% higher risk of injury
for fatigued workers14
47
of employers experienced decreased productivity due to fatigue16

Heart problems

and hypertension can arise from fatigue, increasing long-term risks for adverse cardiac events15

Poor eating habits,

illness, and lack of physical activity can be caused by fatigue17

CAUSES OF FATIGUE

Loss of sleep
Night shifts that are counteractive to circadian rhythm
Environmental conditions
Rotating work schedules that prevent significant rest
Excessive time spent on a single task
Constant strenuous work demands

Approximately 35% of workers cite lack of sleep as a top impediment to a healthy lifestyle,2 and depending on industry and work environments, this can be much higher.

ALARMING FATIGUE TRENDS

While employers are greatly concerned with fatigue, only 20% of workers understand the risks of fatigue,18 potentially putting them at risk for workplace injuries and long-term health effects. This is made worse considering:18

43
% of workers
don’t get enough sleep
27
% of workers
have unintentionally fallen asleep on the job
14
% of workers
don’t get sufficient time off between shifts
10
% of workers
do not get a rest break

AT RISK POPULATIONS

While any job can be tiring, certain workers are more at risk than others. Approximately 15 million Americans work full time on evening, night, rotating, or other irregular shifts, and these work schedules can increase the odds of fatigue.17

The following workers see greater risks related to fatigue:

Night shift workers are 3x more likely to be injured19

59% of night shift workers sleep two or more risk factors for fatigue21 less than 7 hours18

Over 50% of retail workers, particularly food and beverage workers, have nonstandard shifts or workweeks longer than 48 hours20

92% of construction workers and

94% of transportation workers had 59% of night shift workers sleep two or more risk factors for fatigue21

DRUGS THAT EXACERBATE FATIGUE IN THE WORKPLACE

Whether an employee has a pre-existing condition or is taking medications for a workplace injury, it is important to note that their drug regimen could be increasing fatigue. The following drugs can increase workplace fatigue:

CNS depressants
Anticonvulsants
Hypnotics
Benzodiazepines
Muscle relaxants

MANAGING EMPLOYEE FATIGUE

Because the causes and work environments that lead to workplace fatigue vary, there is no single solution for addressing fatigue, but there are multiple strategies that can be employed.

IMPROVING EMPLOYEE BREAKS

Though most workplaces provide time and spaces for brief rests, the nature of work may require more accommodations to improve the quality of rest an employee can enjoy.

Calm, quiet environments can be helpful. One study found that allowing for 30-40 minute naps during night shifts decreased fatigue burden.16 While this may not be suitable for all workplaces, other research finds that letting workers rest from repetitive tasks by switching duties can help them maintain alertness, decreasing fatigue.21

ADJUSTING SHIFT SCHEDULING

By strategically scheduling shifts to allow employees 10 hours between shifts so they can get enough sleep, employers can reduce the likelihood of fatigue.20 Staying on a shift pattern for a few weeks before rotating can allow employees to grow used to different sleep schedules, and scheduling consecutive days off allows workers to better enjoy their time off.

EQUIPMENT CONSIDERATIONS

Though this depends significantly on work environments, investing in certain equipment or other resources can ease employees’ work burdens. For example, anti-fatigue mats, shoe inserts, and sit and stand stations have been proven to reduce fatigue for retail workers.20 Utilizing similar occupation-specific countermeasures could help reduce fatigue.

CREATING A FATIGUE RISK MANAGEMENT SYSTEM

It is important to have policies and practices in place to minimize, document, and address fatigue head on. The first step is to create awareness of the risks of fatigue in the workplace, especially as employees are less likely to think of fatigue as a safety issue when compared to employers.21

Simple five-minute safety dialogues between managers and employees can be effective in helping identify fatigue,21 and the resulting conversations can help establish causes and potential solutions for fatigue. Furthermore, documenting injuries, near misses, and other information surrounding fatigue can reveal larger patterns, which can also lead to potential solutions.

STRESS AND MENTAL HEALTH

Like fatigue, excessive workplace stress may cause workers to develop mental health burdens that impact their wellbeing over time. According to the Centers for Disease Control and Prevention (CDC), poor mental health and stress can negatively impact employee:22

Job performance and productivity
Engagement with one’s work
Communication with coworkers
Physical capability and daily functioning

The CDC also claims even after taking other health risks into account – like smoking and obesity – employees at high risk of depression had the highest healthcare costs during a three-year period after an initial health risk assessment.22

Furthermore, mental health issues such as anxiety, depression, catastrophizing (assuming the worst of things) and fear avoidance can impact injured worker care.

MENTAL HEALTH’S IMPACT ON WORKERS’ COMP CLAIMS

A patient’s mental state can severely impact the effects of managed care, keeping them from effectively recovering and returning to work and other routines. Clinical research has found:

Psychosocial factors

can be more detrimental to claims outcomes than physiologic factors in patients following surgery for occupational hand injury23

Depression

was the foremost inhibitor of restored function in patients with minor injuries24

Fear avoidance

can lead to higher pain and disability levels and lower return-to-work rates25

MENTAL HEALTH DIVERSITY FACTORS

Diverse populations face different mental health risks. Clinical research has found:

Women
2x
as likely to be diagnosed with depression26
MILLENNIALS
Higher average stress levels than other generations27
BLACK AND LATINO POPULATIONS
3x
Likely to experience serious psychological distress than white populations28

PREVALENCE OF MENTAL HEALTH CONCERNS IN THE WORKPLACE

While workers may be predisposed to develop mental illness or come into the workplace with pre-existing emotional problems, the workplace itself can be very stressful. Approximately 72% of people have daily workplace stress and anxiety that interferes with their lives moderately.29

While some stress is normal and even beneficial, in some cases workplace stress can contribute to declines in mental health. For example:30,31,29

49
% of employers
agree that the reporting of mental health issues increased in the last five years
48
% of workers
have cried at work due to stress
28
% of employees
have experienced an anxiety or panic attack on the job

STRATEGIES TO ADDRESS MENTAL HEALTH IN THE WORKPLACE

While mental health in the workplace is a serious concern, there is considerable hope. An estimated 50% of workers are more likely to seek help for mental illness now than they were five years ago,31 and there are a wide assortment of clinical modalities to address mental health.

Some ways employers and insurers can promote mental wellness are as follows.

ELIMINATING STIGMA

Employees may be worried about discrimination, labeling, or other prejudices when coming forward with mental health concerns. Roughly 59% of businesses believe the stigma of mental health issues prevents employees from seeking help,30 and so it is clear that proactively discussing mental health in a positive light can help employees.

Having conversations throughout a business organization and establishing confidential programs can encourage employees to address mental issues more readily, allowing employers to guide them to available resources. However, this only helps if employees are given the appropriate resources to utilize.

CREATING OR AUGMENTING PROGRAMS TO PROMOTE MENTAL HEALTH

Only 41% of businesses have a strategy in place to address employee mental health issues,30 and while creating or improving such programs could be costly, if successful in improving mental health they could yield a significant return on investment.

Such programs could involve talks from managers and leaders to employees that encourage self-care. Currently, 53% of managers do not feel adequately trained to spot mental health issues, and 50% of companies don’t provide training to managers on how to identify mental health issues.30 Providing such training could help detect issues early, creating intervention opportunities.

Strategies for different businesses will vary but promoting mental health resources across all appropriate channels can benefit employee wellness.

In the face of intervention opportunities, it is paramount to offer benefit and wellness plans that help employees improve their mental health. Not only is it undeniable that counseling and appropriate drug therapy can help fight mental illness, but telemedicine therapy programs can also improve mental health.

And finally, 66% of organizations do not track or analyze the prevalence of mental health issues in their work environments.30 By documenting such incidents, trends could be deciphered, allowing for larger initiatives that may bolster mental wellness.

PROMOTING EXISTING MENTAL HEALTH PROGRAMS

While mental health resources may be available in many wellness programs, oftentimes these resources need more promotion. Among employers offering mental health services:30

55% only promoted services reactively or on a oneoff basis as issues arise
43% promoted services proactively via company communications
48% promoted services via company portals or intranet
19% did not actively promote such services

RETURN-TO-WORK ACCOMMODATIONS

In the event a worker is physically injured on the job, when their doctor clears them to return to work they may often have clear orders on physical limitations, such as not to lift heavy materials, stand for too long, etc. However, if a worker is returning to work due to mental health issues, such limitations may not be clear.

An estimated 68% of employers do not have specific return-to-work strategies for employees on leave due to mental health issues.30 Reintroducing employees to certain mental stressors could cause them to, for lack of a better word, mentally reinjure themselves.

RETURN-TO-WORK STRATEGIES

When an employee is returning to work following an injury that involves mental health, it is important to engage the injured worker in various ways. This can include:

Workplace reintegration support, which involves sitting with employees to establish arrangements that best suit them
Guiding employees to wellness program resources that can benefit them
Alternative or reduced duties, or job description revisions
Alternative work schedules, including work from home, flex time, and exceptions to time-off policies
Understanding how drug regimens interplay with duties, in order to best support adherence to therapy and avoid situations that can conflict with treatment

References

  1. Healthesystems analysis.
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  3. Stephanek M, Jahanshani K, Millard F. Individual, workplace, and combined effects modeling of employee productivity loss. Journal of Occupational and Environmental Medicine. June 2019. doi: 10.1097/JOM.0000000000001573
  4. National diabetes statistics report 2020: estimates of diabetes and its burden in the United States. Centers for Disease Control and Prevention. 2019. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
  5. More than 100 million Americans have high blood pressure, AHA says. American Heart Association. Jan 31, 2018. https://www.heart.org/en/news/2018/05/01/more-than-100-million-americans-havehigh-blood-pressure-aha-says
  6. Laws C, Colon D. Comorbidities in Workers’ Compensation. NCCI. Oct 2012. https://www.ncci.com/Articles/Pages/II_research-brief-comorbidities-inworkers-compensation-2012.pdf
  7. Asthma and Hispanic Americans. U.S. Department of Health and Human Services Office of Minority Health. March 13, 2017. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=60
  8. Hispanic Health – CDC Vital Signs. Centers for Disease Control and Prevention. May 2015. https://www.cdc.gov/vitalsigns/hispanic-health
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  10. Percent of U.S. adults 55 and over with chronic conditions. Centers for Disease Control and Prevention National Center for Health Statistics. Nov 6, 2015. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm
  11. Mattke S, Liu H, Caloyeras JP, et al. Workplace wellness programs study. RAND Corporation. 2013. https://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.pdf
  12. Song Z, Baicker K. Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial. JAMA. 2019;321(15):14911501. doi:10.1001/jama.2019.3307
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  16. Fatigue in the workplace: risky employer practices – part two of a three part series. National Safety Council. 2018. https://safety.nsc.org/fatigue-in-the-workplacerisky-employer-practices-report
  17. Long work hours, extended or irregular shifts, and worker fatigue. Occupational Safety and Health Administration (OSHA). https://www.osha.gov/SLTC/workerfatigue/index.html. Visited on April 13, 2020.
  18. Fatigue in the workplace: causes & consequences of employee fatigue – part one of a three-part series. National Safety Council. 2018. https://safety.nsc.org/fatigue-report
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  20. Pfirman D, Collins S. Reducing fatigue and stress in the retail industry: workplace solutions. Centers for Disease Control and Prevention – NIOSH Science Blog. Sept 16, 2019. https://blogs-origin.cdc.gov/niosh-science-blog/2019/09/16/retailfatigue/
  21. Fatigue in safety-critical industries: impact, risks & recommendations – final report of a three-part series. National Safety Council. 2018. https://safety.nsc.org/fatigue-insafety-critical-industries-report
  22. Mental health in the workplace: mental health disorders and stress affect working-age Americans. Centers for Disease Control and Prevention. July 2018. https://www.cdc.gov/workplacehealthpromotion/toolsresources/workplace-health/mentalhealth
  23. Roesler ML, Glendon AI, O’Callaghan FV. Recovering from traumatic occupational hand injury following surgery: a biopsychosocial perspective. J Occup Rehabil. 2013;23:536-46. doi: 10.1007/ s10926-013-9422-4
  24. Richmond TS, Amsterdam JD, Guo W, et al. The effect of post-injury depression on return to pre-injury function: a prospective cohort study. Psychol Med. 2009;39:1709-20. doi: 10.1017/ S0033291709005376
  25. Wertli MM, Rasmussen-Barr E, Held U, et al. Fear-avoidance beliefs – a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14:2658-78. doi: 10.1016/j. spinee.2014.02.033
  26. Depression in women: understanding the gender gap. Mayo Clinic. Jan 2016. http://www.mayoclinic.org/diseasesconditions/depression/in-depth/depression/art-20047725
  27. Twenge JM, Gentile B, DeWall CN, et al. Birth cohort increases in psychopathology among young Americans, 1938-2007: a cross-temporal meta-analysis of the MMPI. Clinical Psychology Review. 2010. doi: 10.1016/j.cpr.2009.10.005
  28. Mental and behavioral health – African Americans. U.S. Department of Health and Human Services Office of Minority Health. Last updated Sept 25, 2019. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24#1
  29. Highlights: workplace stress & anxiety disorders survey. Anxiety and Depression Association of America. Accessed April 13, 2020. https://adaa.org/workplace-stressanxiety-disorders-survey
  30. 2019 DMEC mental health pulse survey. Disability Management Employer Coalition (DMEC). 2019. http://dmec.org/wpcontent/uploads/2019-DMEC-MentalHealth-Pulse-Survey-Results.pdf
  31. 2019 Workforce attitudes toward behavioral health: annual report. Ginger. 2019. https://go.ginger.io/final-reportworkforce-behavioral-health-2019

RxInformer

Since 2010, the semi-annual RxInformer clinical journal has been a trusted source of timely information and guidance for workers’ comp payers on how best to manage the care of injured worker claimants and plan for the challenges that lay ahead. The publication is an important part of Healthesystems’ proactive approach to advocating for quality care of injured workers while managing the costs associated with treatment.