Ascellus Blog

Significant Results of Early Intervention CBT Success Study to be Presented at RIMS

January 23, 2018

podium_speech_pc_400_clr_1304We know that about 10 percent of workers’ compensation claims consume at least 80 percent of medical and indemnity resources, and the vast majority of these are injured workers with delayed recoveries are due to psychosocial risk factors. We also know that short term interventions, such as cognitive behavioral therapy (CBT) can mitigate these effects and get people back to function and work. Applying CBT to injured workers who are risk for delayed recoveries can be very effective in preventing these needless disabilities.

One of the most dramatic examples of this came recently from a California-based grocery chain. Albertson’s Safeway saw a 50 percent reduction in total claim costs after implementing a CBT-based identification and intervention program. We are very excited to have the opportunity to present the details of this program at this year’s RIMS conference.

Denise Zoe Algire, director of Risk Initiatives and national medical director of Corporate Risk Management at Albertsons Safeway and I will conduct the session Tuesday, April 17, from 11:00 a.m. – noon in San Antonio. Titled ‘Outcomes of a Workers Compensation Early Intervention for Delayed Recovery Program,’ our presentation will offer a step-by-step discussion of exactly how the program was implemented and the results measured.

The Company has 290,000 employees, both unionized and non-union at its more than 3,000 facilities. In 2013 the company was seeing increasing medical costs for the same reasons affecting many organizations:

• Increasing severity
• High facility costs
• Comorbidities
• Pharmacy expenses
• Utilization

But the top drivers of overall healthcare costs are stress and mental health issues. In fact, more workers miss work due to stress and anxiety than physical illness or injury combined. The World Health Organization puts the economic toll of these issues at 3 to 4 percent of the Gross National Product. For a company the size of Albertson’s Safeway the costs can be astronomical. In 2013 the company began a pilot program to address the challenge.

Delayed Recoveries
The latest research from workers’ compensation has found that psychosocial factors have a devastating effect on claims, possibly even more so than medical issues. Stress and anxiety are two of the major ones. The nature and severity of an injury doesn’t really come into play in the case of an injured worker with delayed recovery. It has more to do with his coping skills — or lack of them. These are the injured workers whose seemingly simple injuries turn into chronic pain, often leading to multiple, expensive medical procedures, a variety of medications — often including opioids, and lengthy disability durations. Understanding the brain’s role in pain helps explain how this can happen. In addition to physical stimuli, pain also consists of our thoughts, emotions and environmental factors. When an injury occurs, the pain signal goes to various parts of the brain, eventually landing in the thinking area, which dictates what action the body will take: fight, flight or freeze. This is a basic, primal process our bodies undergo to protect us from harm.

If there is no actual threat to the body, the thinking part of our brains should send that message to the body. But when psychosocial factors are present, the brain may act differently. The primal and emotional areas of the brain take over — literally growing and taking up more space. We can actually see these changes on MRIs.

When this happens to injured workers, their pain persists even after the physical injury has healed. Because they lack the tools to stop the pain cycle, their chronic pain can worsen.

Short-term CBT sessions help patients with chronic pain get their brains back on track, so they can get back to function and living. Adding an integrated approach to care, with the medical and claims management team coordinating the care via interdisciplinary treatment calls, fast tracks treatment for these patients. The best way to address this with injured workers is to identify those with psychosocial risk factors before their claims turn into delayed recoveries. The pilot claims management team coordinating the care via interdisciplinary treatment calls, fast tracks treatment for these patients. The best way to address this with injured workers is to identify those with psychosocial risk factors before their claims turn into delayed recoveries. The pilot program Albertson’s Safeway enabled us to identify and use CBT interventions to do just that.

Pilot Program:

We’ve found that the best way to distinguish injured workers with psychosocial risk factors is through a pain screening questionnaire. The Linton scale, which we use, asks a series of 21 questions aimed at the person’s attitudes, beliefs and perceptions about pain. Based on the answers, the patient’s risk level is determined as low, medium, high or very high.

From 2013 to February of 2017 more than 11,000 questionnaires were administered to injured workers at several of the company’s California facilities. Approximately 12 percent were categorized as ‘high’ or ‘very high’ risk for delayed recovery. Those injured workers were not forced, but given the opportunity to participate in CBT sessions. It should be noted that CBT for at-risk injured workers does not incur a psychiatric diagnosis. About half the company’s affected injured workers elected to undergo the CBT program.

After an average of 6 CBT sessions, the majority of these injured workers were able to return to work. To get an idea of how effective the interventions were, we had three comparison groups of injured workers identified as high or very high risk; those who participated in CBT; those who were told about, but did not choose to participate in CBT; and those who had not been informed about the program. The cost differences tell the story:

Group Total Paid _ Total Incurred
CBT participants $36,629 $51,317
CBT non-participants $44,356 $60,546
No CBT discussed $73,488 $84,230

The outcomes for this pilot program hold tremendous promise for the workers’ compensation industry. Injured workers who might have languished in the disability world indefinitely, instead were by and large back at work in short order, and the company was able to save tremendous amounts of money and get their employees back on the job.

We look forward to offering more details of this program. See you at RIMS!

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.