Doing right by injured workers

Authored by:
Jean Feldman, BSN, RN, Senior Director of Managed Care, Sentry Insurance
Tron Emptage, MA, RPh, Chief Clinical Officer, Optum Workers’ Comp and Auto No-Fault

As professionals who have been in the workers’ compensation industry for over 30 years, we’ve both seen the toll that a workplace injury can take on an individual and those who care for them.

One injury can trigger a series of hurdles that seem daunting and insurmountable—from physical pain to functional limitations, emotional turmoil, and financial uncertainty. These hurdles and their repercussions raise the question: How can we do more to help injured workers through their recovery journey?

To truly improve outcomes, we first need to improve the foundation of the support system, so it won’t be undermined during an extended recovery period. Achieving this goal requires cooperation among care providers, clinicians, claims professionals, the employer, and of course, the injured individual.

This collaborative, whole-person approach has been our focal point since we became colleagues years ago. We’ve shared countless conversations about the challenges faced by injured workers—and more importantly—opportunities to introduce better ways to drive positive change.

Today, those discussions shape the focus of Sentry and Optum’s partnership.

In our new co-authored white paper, “Right by You^®: The four principles of comprehensive care for injured workers,” we describe how Sentry and Optum work together — using data analytics, clinical intervention, and tailored therapies — to provide compassionate, timely injured worker care.

From the time of their accident, an injured worker may experience a wide variety of stressors beyond recovering from their injuries, including continued physical pain, social and family concerns, behavioral health disorders, financial anxiety, and difficulty performing daily activities. They may also feel confused and uncertain about their workers’ compensation claim, compounding the stress.

Sentry’s claims and managed care teams are trained to communicate often with injured workers. Representatives understand the importance of active listening and empathy to obtain information to help each injured worker feel comforted and supported.

However, even with direct interaction, we may not be alerted to every current or emerging issue. To help uncover crucial information and identify claim patterns, we use advanced models that comb through the data to pinpoint areas of risk and concern, therapeutically and economically. In just over a year since launching Sentry’s Injured Employee Complexity Factor (IECF) Models^™, we’ve helped provide greater access to behavioral health support for countless workers. And through positive, first-hand feedback from injured workers, this is just one example of how data can provide earlier, timely support.

By collaborating with Optum, Sentry also has access to the data specificity and clinical knowledge needed to make informed pharmacy care decisions.

A perfect example is an injured worker who is reporting a smooth recovery to their claims adjuster, but whose single Risk Score has dramatically escalated over a 3-month period. Claims professionals can easily recognize the disconnect when viewing this on the pharmacy portal and assign a nurse case manager to the claim.

By working closely with the Optum team and using the analytic and clinical expertise available through the partnership, Sentry can provide more intelligent, informed, and proactive care for injured workers.

We’re combining as much information as possible — using data models developed by both of our companies — to find better ways to optimize injured worker recovery.

Whole person care is critical. An injured worker shouldn’t be defined solely by their workplace injuries. Each person has different physical and mental needs that may affect their healing and ability to return to work. For individuals who would benefit from Sentry or Optum programs designed to address specific aspects of healing, we work with the claims professional and treating physician to enroll the injured worker.

We’re also collaborating to break new ground in care approaches for injured workers. As an example, we’re exploring innovative care therapies, such as virtual reality therapy (VRT) and virtual counseling, which have shown significant promise in improving injured worker outcomes.

There’s no one-size-fits-all approach in injured worker care. It takes a collective vision and shared purpose to build a better, more equitable support system for all injured workers.

The four principles of our “Right by You^®” approach are Right data, Right partners, Right programs, and Right treatments. When combined, these empower our approach to injured worker care and our ability to improve injured worker outcomes.

We’re seeing powerful results every day by actively choosing to take a more forward-thinking care approach and by continually using these results to fine-tune our models. Ultimately, what inspires us most is the ability to do the very best we can to help injured workers return to function and work.

For more information, including first-hand strategies and insights from both of us, download the white paper.

Carolyn Schamberger
Mobile: 715-315-9929
carolyn.schamberger@sentry.com

Avery Faehling
Mobile: 715-697-4590
avery.faehling@sentry.com