Disability Focus Could Improve Outcomes, Insurer Believes

Top officials at CIGNA Corporation speculated that the integration of disability and health care programs might be the “missing link” that employers seek “when it comes to total benefits cost control, productivity gains, meeting the workforce’s evolving benefits needs, and providing administrative simplicity.”

In “Disability and HealthCare Connection: How Strong Is the Link?,” W. Allen Schaffer, M.D., chief medical officer at CIGNA HealthCare, and Barton Margoshes, M.D., chief medical officer at CIGNA Group Insurance, reported on analysis of data from 156 client companies that offer CIGNA short-term disability benefits (STD) and CIGNA HealthCare as a core medical option. Those companies’ employees could select among medical providers.

Out of the 60,000 STD claims that were filed within those 156 companies in the study period of 2001-2003, approximately 13,000 were filed by employees who had selected CIGNA Healthcare, and 47,000 were filed by employees who had selected another carrier.

The authors found that more than half (56 percent) of STD-related medical costs were attributable to employees with chronic health issues, such as heart disease and diabetes.

However, those chronic conditions accounted for only about one-quarter (26 percent) of medical episodes. (A medical episode is a group of claims related to a single medical event, such as a broken leg.)

In other words, chronic conditions were approximately twice as expensive to employers as episodic conditions.

Steven Pflanz, M.D., told Psychiatric News that the data support other studies that have found “a small percentage of employees with significant illness use a disproportionate share of medical resources.”

Pflanz is chair of APA’s Corresponding Committee on Psychiatry in the Workplace.

Medical costs related to the average short-term disability dwarfed the cost of the STD payments alone.

The study found, on average, that the total direct disability and medical costs of an STD is $13,094. Of this total, $10,649 was attributable to medical costs, while only $2,444 was associated with STD benefit payments.

The authors noted that STD medical costs often continue after the employee returns to work.

Pflanz commented that it is clear that disability payments are just “the tip of the iceberg” when calculating the costs to an employer of a disabled employee.

Schaffer and Margoshes wrote, “It is not uncommon for an individual to have ‘shadow’ costs of mental health, which result when they become depressed from another condition like lower back problems or diabetes and need to be out of work.”

They reported that for patients in disease-management programs, depression is prevalent among 37 percent of those with low back pain, 11 percent of those with asthma, and 7 percent of those with cardiac disease and diabetes.

Depression is a secondary factor in other disabilities almost half the time, according to the study.

CIGNA officials recommend that health and disability professionals take a “more holistic view” of disability and recognize the likelihood of depression or other mental health factors as a hurdle in overcoming the disability.

In CIGNA client companies that have both STD and medical benefits, an employee with a disability is connected quickly by the disability nurse case manager to a mental health counselor, if the employee agrees.

The authors concluded that “disability and health care results can no longer be viewed in silos—they truly are linked.”

They contrast an “old paradigm” in which the disability event was considered to start when an employee filed a disability claim and ended when the employee returned to work with a “new paradigm.”

In the new paradigm, disability must be managed in phases: “before it occurs, through prevention; during the disability, to actively assist the employee back to work; and after the employee has returned to work, to ensure the employee has the support necessary to prevent recurrence of disability.”

According to the report, CIGNA is the only health benefits company with its own pharmacy, behavioral, dental, vision, and disability businesses, “so the company is able to provide industry-leading services that treat ‘the whole person.’ ”

The study, “Disability and Healthcare Connection: How Strong Is the Link?,” is posted online at www.cigna.com/health/producer/newsletter/mar2004/pdf/Disability_Healthcare.pdf. ▪