Disability Case Management

Disability Case
Management:
Managing for Wellness
75%
20%
12 weeks
1 year
The longer an employee is off
work, the less likely it is that he
or she will return. While three
quarters of workers return to
work after 12 weeks of absence,
only 20 per cent return after
an absence of a year.
Global Business and Economic
Roundtable on Addiction and Mental
Health, Roundtable Roadmap Disability
Management, 2004/2005
Disability Case Management:
Managing for Wellness
Efficient and Timely
Disability Claims Process
Sometimes health issues are unavoidable. In circumstances
where an employee is absent, Medavie Blue Cross
provides effective management approaches and supports
to facilitate a return to work as safely and quickly
as possible.
Over the past few decades rates of employee stress,
illness, injury and absenteeism have been steadily on
the rise. This growing trend is having a significant
impact on individuals and on organizations as a whole.
Medavie Blue Cross provides a well designed,
progressive absenteeism and disability management
program. Our products and services work to prevent
or shorten employee absences, reduce costs and
maintain productivity.
Medavie Blue Cross has been in the business of
electronic claims processing for more than 20 years.
We have sophisticated online adjudication systems with
the capability and flexibility to handle a wide variety
of program requirements.
Medavie Blue Cross Claims Processing Systems and
administration expertise provide our clients with a
streamlined process leading to timely, straight-forward
service delivery.
Our Claims Processing System functionality includes:
• Claims assessment/adjudication
• Ongoing case management
• Payment management
1
60-65 claims
per specialist
Medavie
Blue Cross
Specialist
80-85 claims
per specialist
Industry
Average
Medavie Blue Cross exceeds the ratio of Disability
Management Claims Specialists per claimant with
an average of 60-65 claims per specialist compared
to the industry average of 80-85.
Collaborative
Case Management
Disability Claims Team
Focused on the Individual
Medavie Blue Cross has assembled a multi-disciplinary
team of occupational therapists, kinesiologists, social
workers, accredited rehabilitation specialists and
registered nurses with a wide variety of experience
including psychiatry.
Medavie Blue Cross provides one-on-one claims
management. Our personal one-on-one management
approach includes:
This collaboration enables us to reach the best possible
decisions in case management. Our Disability Case
Management team and claims specialists provide a
number of disability support services including:
• Dedicated professionals assigned to each member
• Comprehensive short and long term claims
management
• Proactive case management
• Management of progressive return to work
• Access to:
– Prominent rehabilitation consultants
– Leading expert physicians
• Adjudication of applications based on contractual
eligibility and best practices guidelines
• Education for plan members on accessibility to
appropriate medical services to identify and
provide assistance to resolve workplace issues
• Maintaining open communications among plan
members, plan sponsors, unions and health care
providers
• Identification of barriers to attendance and work
with the plan member to overcome these issues
• Facilitation of direct intervention between treating
physicians and Medavie Blue Cross consulting
physicians
• Local service and expertise in the appropriate region
including managing access to medical services
• Identifcation and provision of assistance to resolve
psychological issues
• Referrals for plan members to resources to assist
with family problems
3
60 days
15 days earlier
$14,000
$
Save
$3,450
Each short term disability leave lasts about 60 days
and costs an employer about $14,000. Acting early by ensuring an affected worker has access to special
services - can get them back to work 15 days earlier,
or save $3,450 per episode.
Globe and Mail Report on Business, 2009
Rehabilitation
Management and Services
Rehabilitation services are a component of the Medavie
Blue Cross disability management solution. First, disability
claims specialists evaluate the potential benefit of
involving the expertise of our rehabilitation services for
claim resolution. Then our rehabilitation management
team works to identify the individual requirements of
the plan member and with the plan sponsor to address
return to work barriers.
The rehabilitation consultant:
• Designs and implements in a timely manner
comprehensive rehabilitation plans that respond
to plan member and plan sponsor needs.
• Develops strong working relationships with all
stakeholders through ongoing personal contact, home
and worksite visits, case conferences and meetings.
• Manages a proactive return-to-work process to
ensure plan progression and successful outcomes.
The return-to-work plan may include:
– ease-back
– modified work
– counselling and education
– vocational training
The rehabilitation services we offer our clients are
provided through effective partnerships developed
with external specialized service providers. This
approach promotes impartiality and objectivity while
allowing us to provide services and proven expertise
in all regions where we operate.
We believe personal contact and being acquainted with
the plan member and his or her situation are essential
elements in building a trusting relationship and optimal
conditions for an early and safe return to work.
Financial Protection
There are instances when an individual is unable to
return to work in any capacity due to illness or disability.
In these cases, Medavie Blue Cross will assess benefit
eligibility for the individual. Our disability plans are
comprehensive and provide for plan members when
they have no option but to leave the workforce.
Medavie Blue Cross provides, in these instances,
much needed personal and financial relief and security.
5
80%
40%
At least 80% of premature
heart disease, stroke and Type 2
diabetes and 40% of cancer
could be prevented through
healthy diet, regular physical
activity and avoidance of
tobacco products.
World Health Organization
Prevention and Intervention
inHealth Solutions®
inHealth Solutions is a line of organizational health
products designed to minimize disability and absenteeism
and promote healthy lifestyles. Products are available
separately or in any combination with other group
benefits. Most importantly, the inHealth Solutions line
of products is designed to actively address some of the
leading health and wellness issues faced by employers.
Optional Wellness Modules* provide employers with
the flexibility to offer employees enhanced coverage
for preventive health products and services focused
on addressing leading health issues including allergies,
obesity and heart disease. Flexible maximums and
cost-share options allow employers to offer additional
coverage without incurring significant additional costs.
*Not available in Quebec
My Good Health® is an interactive website featuring
comprehensive Canadian health and wellness
information. A Health Risk Assessment (HRA) tool also
offers an immediate snapshot of an employee’s health
risk profile. Employees can also use the site to set
goals, action plans and email reminders, and access
validated health tools and information. Together, these
insights empower employees to make healthier choices.
inConfidence® Employee and Family Assistance
Program offers employees valuable resources and
supports to address difficulties they may be facing
at work and in their personal lives that may impact
their overall job performance and provides employers
with information, coaching and resources to help
build a safe, productive workplace.
inConnection® Attendance Support Program
provides support to employees experiencing
difficulties attending work and offers solutions for
employers on how best to manage some of the
leading causes of absenteeism in their organization.
Second OpinionTM
As part of its overall health and wellness management
strategy for employers, Medavie Blue Cross is proud
to offer Second Opinion as an additional benefit to
those employees dealing with a serious illness.
Affiliated with one of North America’s leading medical
facilities, the McGill University Health Centre, Second
Opinion allows individuals to quickly obtain second
opinions from medical specialists upon diagnosis of a
serious medical condition.
Posaction Plus*
Posaction Plus is a management assistance program for
long term disability. It is offered by a national network
of specialists qualified in counselling. The program is
designed to provide concrete solutions to effectively
manage human resources and reduce the number and
length of absences due to illness or other qualifying
conditions.
*Available in Quebec only
7
Effective Benefit
Management
Conclusion
Medavie Blue Cross looks at disease states, drug,
extended health benefit, disability and wellness
product utilization to provide an overall picture of
each organization’s health. Our team analyzes the
health issues that impact workplaces and uses
this information to establish benchmarks, make
comparisons, track changes, develop targets and
prepare forecasts for our clients.
Through our proven health management expertise,
Medavie Blue Cross ensures benefit plans remain
cost effective and relevant in a constantly changing
health care climate. We provide employers with the
right data and information to assist in taking a proactive
approach to short and long term absenteeism which
helps in controlling escalating health care costs,
providing long term benefits for both employees
and their employers.
At Medavie Blue Cross disability management
services are more than just an income replacement
system. We believe by providing the right approaches
and supports we can optimize employee health and
improve return to work outcomes. By getting to know
you and your plan members we ensure strategies and
solutions are developed collaboratively and are the
right fit for your organization and its members.
9
To learn more about Medavie Blue Cross
and its Disability Case Management Solutions for
your organization visit www.medavie.bluecross.ca
or contact your Group Account Representative.
TM
The Blue Cross symbol and name are registered trademarks of the Canadian Association of Blue Cross Plans, used under licence by Medavie Blue Cross, an independent licensee of the Canadian Association of Blue Cross Plans.
BRO-122 E 09/13