The Heart of the Matter
Healthy Hearts for Healthy Claim Outcomes
Beth Detjens | March 2021
How much could your workers’ compensation claims benefit if you could identify and address a single health factor that touches approximately half of the entire U.S. workforce? What if you could help prevent chronic health conditions and unhealthy behaviors that contribute to massive employer costs? You can – by getting to the “heart” of the matter.
In examining the trends associated with comorbidities and overall claim costs, one common denominator rises to the surface – heart health. It is central to so many of the recommendations and medical interventions our nurses encourage, particularly for those claims with comorbidities.
According to the Centers for Disease Control and Prevention (CDC)1:
- Four of the 10 most costly health conditions for US employers—angina pectoris (chest pain), high blood pressure, diabetes, and heart attack—are related to heart disease and stroke.
- Work stress is the leading workplace health problem and a major occupational health risk, ranking above physical inactivity and obesity.
- Five chronic diseases or risk factors—high blood pressure, diabetes, smoking, physical inactivity, and obesity—cost US employers $36.4 billion a year because of employees missing days of work.
Impact on Co-Morbidities
Comorbidities in a claim – those pre-existing medical conditions and/or lifestyle factors that delay medical recovery and drive higher claim overall costs – commonly include diabetes, hypertension, obesity, and smoking. When managing a claim with any or all of these factors, our nurse case managers take special care to mitigate the negative impact by encouraging a smoking cessation program, healthy weight management, adhering to medical advice for the comorbid conditions and other actions.
While co-morbidities are not a direct component of a workers’ compensation claim, engaging a case manager on a claim with factors such as these can help mitigate the negative health impact of these risk factors. The case manager can actively engage the injured employee to discuss these conditions throughout the case manager’s day to day management of the claim and during the nurse's interaction with the employee and medical provider.
Impact on Injured Worker Morale
In EK Health’s experience, patient education and advocacy have proven to be huge motivators in injury/illness recovery and successful return to work. Working collaboratively with the claims examiner, our nurse case managers are fully present for the injured worker at the times they feel vulnerable, confused, and often scared. In addition to providing clinical expertise to support optimal recovery, a proficient nurse case manager bridges the gap between employer and employee to build a positive rapport for a mutually beneficial claim resolution. In most cases, the injured worker exits the claim process with a higher level of understanding, appreciation, and responsibility for their health, empowered by the clinical support and education they received during the claim resolution process.
Impact on Overall Claim Outcomes
Encouraging collaboration with the injured employee for their personal health and workers compensation injury can have several benefits:
- Assists in mitigating claims costs
- Helps improve the overall health of the injured worker
- Expedites and optimizes claim resolution
According to the American Heart Association's Heart Disease and Stroke Statistics – 2021 Update2, “heart disease continues to be the greatest health threat to Americans and is still the leading cause of death worldwide”.
As simple as the recommendations may seem, many injured workers benefit from consistent education and support from their nurse case manager to promote better heart health. In addition to support after a work-related injury or illness, employers can proactively support their employees’ health by encouraging education and healthy habits in the workplace, utilizing programs such as CDC’s Workplace Health Promotion3.
The Bottom Line
By empowering heart health in the injured workers we support, our nurse case managers are helping improve lives far beyond the claims they are managing. They are promoting a lifetime of healthy habits.