Integrated Absence Management: Early Return to Work

DMEC Staff@Work

Early RTW Can Help Control Healthcare Costs

Return to WorkBy Glenn Pransky, MD

Scientific Advisor
Liberty Mutual Group

By Kerry Brooks, VP

Distribution Service & Support
Liberty Mutual Group

Healthcare is by far the largest benefit expense, projected to grow more than 5% per year through 2024 at least.1 To mitigate this trend, employers are deploying a variety of strategies with mixed results and, according to research, sometimes adverse consequences.2 Scientific studies point to appropriate, early return to work (RTW) to help mitigate healthcare costs.

How well are current healthcare cost control strategies working? Nearly 66% of employers offer high-deductible health plans, higher premiums, or other measures to transfer costs to employees. This has led to at least a 200% increase in out-of-pocket expenses for workers over the last 10 years.3 To save money, more than 1 in 5 adults with health insurance are skipping doctors’ appointments or tests, or not taking prescribed medications. Short-term cost savings may lead to worse health and more long-term expense and disability, especially for workers with chronic illnesses.4 Workplace wellness is another strategy, but participation rates and long-term effectiveness are disappointing.5

Recent studies have shown surprising results: RTW programs can have a significant impact on overall healthcare costs, with additional reductions to indemnity costs. In partnership with academic institutions, Liberty Mutual conducted research on the impact of early RTW on medical costs. In one study, 140 volunteering employees with back pain who were at high risk for disability were identified early on. They were randomly placed into two groups; both groups received the usual medical care, but the intervention group, both the workers and their supervisors, also received problem-solving and RTW training. Overall, the intervention group had 72% less lost time.5

But the impact on medical care was notable, too. The intervention group had 70% less healthcare costs, with no negative impact on disability recurrence or future healthcare visits. These results should not be surprising. Work can be therapeutic, promoting recovery and rehabilitation, and can shift the focus from pain to becoming more active.

What’s needed to implement early RTW programs to help address healthcare and other costs? First, identify opportunities to improve RTW outcomes through scientifically proven strategies of early outreach and proactive, supportive employee communication before a work absence occurs. If an employee cannot return to full duty, evaluate the job and start to discuss potential modifications or temporary transitional employment options. Early referral to case management is key.

Getting RTW-focused medical care at the right time is important, too. Employees in high-deductible health plans may avoid care needed to facilitate RTW to gain short-term cost savings. Employers may want to target conditions early on where RTW can have the greatest impact, such as musculoskeletal and mental health disorders. They can support early, appropriate treatment by partnering with healthcare providers, plan administrators, and their disability insurer to ensure that healthcare cost containment strategies don’t interfere with appropriate access and timely, evidence-based care.

Controlling healthcare costs is challenging, and there is no panacea. Successful employers try several strategies, evaluate effectiveness, and adjust. Early RTW can provide better outcomes for employees and significant savings for employers.


  1. Keehan S, G Cuckler, et al. National Health Expenditure Projections, 2014–24: Spending Growth Faster Than Recent Trends. Health Affairs. 34:1407–1417. 2015.
  2. Brot-Goldberg ZC, A Chandra, et al. What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics. Quarterly Journal of Economics. 132(3): 1261-1318. 2017.
  3. Claxton G, L Levitt, M Long. Payments for Cost Sharing Increasing Rapidly over Time. Kaiser Family Foundation. 2016. Retrieved from
  4. High-Deductible Health Plans. Health Affairs Health Policy Brief. February 4, 2016.
  5. Linton SJ, K Boersma, et al. Early Workplace Communication and Problem Solving to Prevent Back Disability. Journal of Occupational Rehabilitation. 26(2):150-9. June 2016.