The debate about when an ill or injured employee should rejoin the workforce has resulted in traditional medical methods being questioned. Helen Merfield explains
There is no doubt that the insurance industry is waking up to the benefits of rehabilitation and the importance of early intervention.
But equally, there is still a lot of work to be done. For rehabilitation to realise its true potential, insurers and rehabilitation providers need to increasingly measure the cost-benefits and results.
The industry needs to develop a better understanding of the social and psychological factors involved in the rehabilitation process and move away from applying the traditional medical model of rehabilitation.
The role of rehabilitation has always been to provide the injured person with the most appropriate and timely assistance to return to their pre-injury or pre-illness condition.
However, where traditionally, a medical model has been applied, experts are now calling for a more comprehensive approach. This is particularly important when dealing with the growing number of common health problems such as stress/anxiety, back pain and other musculoskeletal disorders where social and psychological factors play a key role.
Evolution
For the UK rehabilitation industry to evolve, insurers and healthcare professionals need to move away from automatically applying a medical-only based approach. This implies a cure, which unfortunately may not be a realistic goal. The psychological and social factors often have a higher influence over people's recovery than the medical problem in itself. Indeed, people's own beliefs in whether or not they will get back to work are more powerful than the medical diagnosis.
Speaking at HCML's annual rehabilitation conference in November last year, Professor Mansel Aylward, former chief medical officer at Department for Work and Pensions (DWP) and architect of the Government's Pathways to Work initiative, highlighted this need for change, saying: "Evidence has shown that how people think and feel about their health problem determines how they deal with it. The traditional bio-medical model doesn't work in this context so applying the bio-psychosocial model and using case management is the key."
More and better healthcare in itself is not the answer and will not prevent some people from drifting into long-term illness and disability.
As well as addressing the medical aspects of an injury or illness, the bio-psychosocial model identifies any obstacles to recovery including social and psychological issues such as anxiety and low job satisfaction.
Considering the wider context of people's injury and/or illness improves recovery rates and helps decrease potential long-term sickness.
In addition to introducing and implementing a new approach to rehabilitation, the industry faces the challenge of dispelling common health and work myths. To name one, many employers still insist that employees need to be 100% fit before returning to work. In reality, being out of work is in fact more detrimental to people's health than being at work, providing that the job is not physically harmful.
Harsh as it may sound, we cannot ignore the fact that people on incapacity benefits for more than six months are more likely to retire, or die than return to work.
But changing these deep-rooted beliefs is proving difficult. Insurers and individuals alike need to be educated about the benefits of work as opposed to sick leave. It will not happen overnight.
Recently, Professor Kim Burton, director at the Spinal Research Unit at the University of Huddersfield, put it like this: "In the rehabilitation process, all the players, including employers, healthcare professionals and workers, need to be onside - believing the same things and coordinating their actions to a common goal."
Wise words, but how will the industry get there?
Rehabilitation is high on the Government's agenda at the moment. The Government's 'Health, Work and Wellbeing Strategy' was launched on 19 October last year. Its main themes are engaging stakeholders and improving working lives and healthcare for working-age people.
In another initiative - 'Pathways to Work' (part of the DWP) - a key element is the case management-led 'condition management programmes'. The aim is to help people better understand and manage their conditions rather than search for a medical cure. Perhaps the most important element is that the goals of rehabilitation are owned by the person rather than imposed on them by the insurer or healthcare professionals.
One thing is proving the benefits to the injured person; another is demonstrating the financial benefits of rehabilitation to all parties involved.
It is therefore essential that rehabilitation providers can prove to insurers and employers alike that investing in rehabilitation upfront will ultimately save them money further down the line. But they cannot achieve this alone. Insurers and rehabilitation providers need to work together and share information to show the full cost savings and benefits of rehabilitation.
Insurers in particular should be encouraged to start measuring and publicising their results. At the moment, many insurers simply do not have the baseline figures or decent-sized pilots needed to measure success. Identifying and sharing this kind of data can help measure more precisely how big an impact rehabilitation case management has had on a claim.
Results
The industry as a whole needs to showcase the benefits of rehabilitation and start creating a more detailed picture of how rehabilitation can provide cost savings. It is a two-way partnership. The whole rehabilitation process needs to be results driven.
The results of a recent independent benchmark pilot between HCML and a major UK insurer are promising. The key figures showed that rehabilitation can provide a total reduction of 14% on the total average costs as well as a 44% reduction in the number of days it takes to settle a claim.
We need more of the same.
For rehabilitation to work, early intervention is essential. However, a lack of trust in the real intentions of the insurer can be a barrier. It is common for the injured person to assume the insurer is offering rehabilitation to avoid paying out.
So, how can this be addressed and how can a change of mindset be brought about?
One potential solution is to sell rehabilitation and its benefits upfront as part of the policy alongside income protection (IP).
The person would then expect to be offered rehabilitation and have a personal case manager if and when needed. They would not have to wait for the claim to be settled before accepting treatment.
This approach could facilitate early intervention and in turn will prevent long-term illness. It is a win-win situation for the injured person, who would have a better chance of returning to work with the insurer saving money on costly long-term claims and treatment.
For this to be successful rehab-ilitation case managers need to be involved before the limitation period on IP kicks in. It requires better education of both brokers and providers as to the benefits of rehabilitation and early intervention.
Helen Merfield is chief executive at HCMLCase studyA 36-year old bricklayer/foreman had an accident in the end of June 2006 when a beam landed on his back.
His recovery timeframe without rehabilitation was estimated to be 12 months. Post-discharge physiotherapy treatment through the NHS included exercises but did not provide any guidance on returning to work in a manual job.
HCML organised a face-to-face assessment in the client's home. It also liaised with the treating orthopaedic surgeon and organised private physiotherapy and a gym programme with personal training. Moreover, it liaised with the man's employer, and developed and monitored a return-to-work programme. Telephone support, monitoring support and advice were all provided throughout the programme.
As a result, the client regained function and returned to full pre-injury work duties and was later successful in obtaining a sedentary and higher-paid position with a new employer within six months.
This outcome was achieved for a total cost of £3,752.75 with an additional £648 for 10 physiotherapy sessions.
