Tag Archives: legal

New Approach to Mental Health

In recent years, thought leaders in business, government and risk management have developed a sophisticated understanding of the bottom-line impacts of untreated mental illness in the workplace. For example, mental health and brain science dominated the agenda at the Davos World Economic Forum in 2015. And the National Business Group on Health held its first CEO Mental Health Summit in October 2015. Among the costs highlighted in these forums: worker productivity loss, high healthcare utilization rates, skyrocketing disability outlays and employment litigation.

To further advance mental wellness in the workplace, it’s essential for legal and human resources to be part of this collective effort. Here, we explore this disparity in approaches, and discuss why it is so harmful to the interests of all – employers, insurers, employees and their families.

See also: Language and Mental Health

What most thought leaders know about workplace mental health, in a nutshell, is this:

  1. Mental illness is common and treatable, with a 25% incidence rate and an 80% recovery rate, akin to chronic physical illnesses;
  2. Early detection and treatment are the most effective and inexpensive means of helping employees get well and return to full productivity quickly; and
  3. If an employee takes a leave of absence, the longer the absence, the less likely the employee is to return to work.

Thus, the organizational strategic imperative is to create workplace conditions designed to enhance early detection and treatment, restoring the status quo as efficiently as possible.

In stark contrast to this organizational imperative, legal and human resources professionals often advise supervisors, managers and EAP professionals to treat potential emotional and mental health issues exclusively as a performance matter. This advice is usually driven by a desire to “avoid an ADA claim.” However, this approach usually postpones the inevitable and makes a claim under the Americans with Disabilities Act more, not less, likely.

The result is often this pattern: a continuing decline in the employee’s condition and work performance, a severing of trust between employee and supervisor and isolation from others at work. Once a disciplinary action or performance improvement plan is imposed, both parties cut ties, and the result is a toxic cycle of leave of absence, disability claim, a request for accommodation, a failed interactive process, separation of employment and either litigation or a pay package. This is an expensive, disruptive and painful process that can often be avoided.

Employers would do well to consider this as an alternative approach:

Design a mental health policy that will unify executive leadership, legal counsel and human resources around the organization’s strategic approach to overall wellness.

  • This policy defines the vision, and the business case, for improving the mental health of the workforce and using the ADA interactive process as an effective means of achieving early detection and treatment of these impairments.
  • Training for supervisors, managers, legal counsel, HR, EAP staff and healthcare providers will highlight: A timely and collaborative exchange of information and interactive process maximizes success; the ADA does not require a fundamental alteration of any job; work teams and supervisors need to partner with HR on making accommodations work.
  • The policy will establish a confidential process for employees to obtain affordable, accessible treatment (either through existing vendors or through curated referrals).
  • Developing and implementing the mental health policy can stimulate and engage your organization in a discussion of the high incidence of emotional and mental health impairments and how these common, treatable conditions can be accommodated.
  • Mental Health 101 Training should be integrated into total wellness programs, including how to mitigate and address stressors in the workplace, how to respond to a colleague or supervisee who may be struggling and how to seek help confidentially.
  • Mental health champions should be designated, trained and made available as confidential resources to anyone at any point in the chain of command dealing with a mental health issue.

When executive leadership, legal counsel and human resources unify behind a strategic, business-savvy approach grounded in total wellness and ADA compliance, everybody wins.

See also: Why Mental Health Matters in Work Comp  

Insurance Thought Leadership’s continuing series of articles focused on suicide prevention is written by the Workplace Task Force of the National Action Alliance for Suicide Prevention, the public-private partnership championing suicide prevention as a national priority.

Implementing international medical providers into the U.S. workers' compensation system, Part 1

This is Part 1 of a multi-part series on legal barriers to implementing international providers into Medical Provider Networks for workers' compensation. Part 2 of the series can be found here, and Part 3 can be found here. Subsequent articles in the series will be forthcoming soon.

Introduction
Throughout the debate leading to the enactment of the 2010 Affordable Care Act (ACA), one area of health care has been relegated to the sidelines — the rising cost of workers' compensation claims. One major factor for the increase of workers' compensation claims costs is the rise of medical costs associated with those claims. The average medical cost per loss time claim in workers' compensation in 2008 was $26,000, and medical losses in that year represented 58% of all total losses.1 2 Since 2008, the average medical cost has risen steadily, increasing at a moderate rate3, as shown in Figure 1.

Figure 1 — WC Medical Claim Cost

WC Medical Claim Cost

20011p — Preliminary figure based on data valued 12/31/2011

In the past twenty years, from 1991 to 2010, the average medical cost per lost-time claim has gone from $8,100 to $26,900. In 2001 it increased to $15,900, and by 2005 it had gone up to $21,300. Given this trajectory, medical costs for workers' compensation will continue to rise, perhaps even reaching $50,000, if medical costs cannot be controlled. With all the workers' compensation system calls for reform, one possible solution has yet to catch on; implementing international medical providers into workers' compensation.

Implementing international medical providers into the U.S. workers' compensation system sounds far-fetched; however, globalization is rapidly changing many industries around the world, and health care and workers' compensation should not be an exception to that change. A rapidly emerging segment of the global healthcare industry is medical tourism.4 Medical tourism refers to patients going abroad to seek low-cost treatment. As international travel becomes more affordable and less complicated, and the technology and standards of care have improved, medical tourism has become very popular.5

This development has led to the creation of commercial ventures that facilitate the process of providing medical services to their clients. The facilitators’ role is to choose the best location, the best hospital and the best physicians to perform the treatment or procedures the patient requires. It began primarily as an individual practice.6 However, more group health plans are adding medical tourism into existing plans, or offering health plans that include medical tourism and implementing international provider networks into their plans.7

The desire to seek care abroad is motivated by a desire to seek health care that is lower cost, avoids long wait times, or provides services that are not available in one’s own country.8 The skyrocketing cost of U.S. health care due largely in part to exorbitant administrative costs, the practice of defensive medicine, and weak preventative care, is a potent argument for seeking medical tourism.9 10 Countries that serve as locations for medical tourism also have lower labor costs,11 and that translates into considerable savings for the patient.12

Just as many legal barriers exist to doing business overseas, the implementation of international medical providers into U.S. workers’ compensation medical provider networks also presents many barriers. This series will attempt to examine a few legal and regulatory barriers currently preventing foreign medical providers from treating patients abroad for injuries resulting from work-related accidents. It is not intended to be a definitive discussion of the subject, but rather a starting point for further discussion. Currently there is no literature available on the subject of medical tourism and workers’ compensation, but it is hoped that such literature will be forthcoming. At the conclusion, support for the hypothesis that the globalization of health care and the move towards medical tourism should include workers’ compensation will be offered.

1 Barry Llewellyn, (2009, September). Workers’ Compensation Medical Cost Issues. Casualty Loss Reserve Seminar (presented at the meeting of the Casualty Actuary Society (CAS), Chicago, Illinois, September 14, 2009).

2 Dennis C. Mealy, (2009, May). State of the Workers’ Compensation Line. (Presented at the meeting of the Annual Issues Symposium at the National Council on Compensation Insurance, Boca Raton, Florida, May 7, 2009). Figures shown in the 2009 report for 2008 were adjusted in later years, so that in the latest report, the average medical claim cost per lost-time claims in 2008 was $255,000, as shown in Figure 1.

3 Dennis C. Mealy, (2012, May), State of the Workers’ Compensation Line, (presented at the meeting of the Annual Issues Symposium at the National Council on Compensation Insurance, Boca Raton, Florida, May 10, 2012).

4 Laura Hopkins, Ronald Labonte, Vivien Runnels and Corinne Packer, “Medical tourism today: What is the state of existing knowledge?,” Journal of Public Health Policy, 31, no. 12 (2010): 185.

5 Kristen Boyle, “A Permanent Vacation: Evaluating Medical Tourism’s Place in the United States Healthcare System,” The Health Lawyer, 20, no. 5 (2008): 42.

6 Heather T. Williams, “Fighting Fire with Fire: Reforming the Health Care System Through a Market-Based Approach to Medical Tourism,” North Carolina Law Review, 29 (2011): 615.

7 Ibid, 616.

8 Hopkins, et al., 185.

9 Boyle, 42.

10 Williams, 613.

11 Ibid, 613.

12 Ibid, 613.

Note: This series would not have been possible without the inspiration, enthusiasm, encouragement, and guidance of Kristen E.B. Montez, Esq., the Director of Legal and Regulatory Services of Satori World Medical in San Diego, CA. It was Kristen who answered my call on LinkedIn.com for assistance with a topic to write for my Health Law class. Her knowledge and experience in the area of medical tourism as a published writer on the subject was not only very valuable, but also very much appreciated. Her desire to assist me in writing it, and in getting it published, is something that I did not expect, nor imagined when I placed the online posting. She is a remarkable individual, and it is my pleasure to have connected and collaborated with her on this project.