Science and Innovation in Workplace Disability Management Programs
By Liz R. Scott, PhD
Emerging innovations in medicine and psychology are driving the evolution of disability management.
Two of the most inspiring and exciting recent innovations, that are showing real results and practical application in return to work (RTW): pharmacogenetics and cognitive behavioral therapy with an RTW focus. Increasingly, measured research results are showing that each has a real and lasting impact on reducing costs and an employee’s time away from work.1
More effective interventions are badly needed by American employers and employees. The Gallup-Healthways Well-Being Index surveyed 94,000 U.S. workers across 14 major occupations, finding that 77% of workers fit the survey’s definition of having a chronic health condition (asthma, cancer, depression, diabetes, heart attack, high blood pressure, high cholesterol, or obesity). The total annual costs related to lost productivity total $84 billion2 Adverse drug reactions, due at least in part to inter-individual variability in drug response, rank between the fourth and sixth leading causes of death in the United States.3 At the level of the individual workplace, this means that an employee who has an adverse drug reaction may be absent, resulting in the need to replace that employee or increase the workload on other employees, affecting productivity and morale.
An employee with a mental health condition such as depression may end up on short-term disability (STD). If the condition has the potential for successful pharmacological treatment, then the doctor or psychiatrist has to find the drug that will have the intended effect on the person. For mental health conditions, the symptoms are often experienced subjectively, including good and bad periods, which means that testing medications for the condition can often take months or even years.
Help is being found in the growing field of genetics. In recent years, disability management professionals have been introducing employers to the benefits of pharmacogenetic testing to better manage medical conditions and reduce time away from work. Wendy Jackson, manager of Canadian benefit programs at Magna International, is an employer championing the value of pharmacogenetic testing within the workplace. “In our U.S. divisions, we do pay for the testing on some of the drugs that qualify. This is cost-effective for us in the long term,” she says.4
The pharmacogenetic testing process is simple. It is based on the concept of individualized drug treatment, in which the choice of drug is influenced by a patient’s own genes.5 It begins with a person taking a simple cheek swab to capture saliva and sending the sample to a laboratory. A report is sent back to the person, and often to their doctor, outlining a large number of medications and how the person is likely to react to each of them. When an employee takes a new drug for the first time there will either be no reaction, a toxic reaction, or the drug will have the intended effect. A pharmacogenetic test shows which drug will have which effect, both now and in the future, because a person’s genes do not change.
Pharmacogenetics can greatly reduce the time needed for experimentation with drugs and dosages, since lab tests show the doctor and the patient which medications would have the intended effect. The doctor and the patient are the only two people with access to the information, ensuring compliance with the Genetic Information Nondiscrimination Act.
Cost and insurance coverage of pharmacogenetic testing may vary. Health plans may cover some tests if requested by physicians. Cost of the tests may vary from $100 to $2,000 per test, and response time may be up to several months. Even so, the process is still faster than trial-and-error on psychotropic medications, with the employee off work until the right medication in the right dosage begins to alleviate symptoms and the employee begins to enjoy restored function.
In our experience working with Canadian testing firms, the cost for the mental health-related tests we most often use is in the range of $400 to $450. Costs are more than twice that in the U.S., with an average response time of about four weeks, due in part to regulatory overhead created by the Genetic Information Non-discrimination Act.
Managing the condition faster means less time away from work and often a more timely return to work, producing a positive experience for both employee and employer. Pharmacogenetic studies are rapidly shining light on the inherited nature of medical differences in each person; the enhanced drug discovery of pharmacogenetics provides a stronger scientific basis for better drug therapy on the basis of each patient’s genetic make-up.6 Ensuring a drug does not have a toxic effect means healthier employees, fewer complications during time away, and more timely return to work.
But some mental health conditions require a second line of treatment to complement medication. To that end, cognitive behavioral therapy (CBT) with an RTW focus is often combined with pharmacogenetic testing.
CBT has emerged over the past several decades as a particularly powerful tool in treating depression, anxiety, and posttraumatic stress disorders. The treating psychologist uses a range of proven talk-therapy tools including reframing, mindfulness, and resilience building to address problems the employee faces in daily life. This approach can include homework with progressive treatment, usually over six to eight weeks. CBT has shown superior efficacy in treating social phobias as well, conditions that can produce significant durations in disability claims. Adding CBT to disability management strategies is proving to be particularly effective, as it can greatly increase the effectiveness of resilience building in RTW and transitional RTW. A series of coping skills are progressively introduced by the psychologist to build this resilience.
The disability management process works concurrently with a CBT program, introducing the employee back into work as early as possible in the process. A study in Canada tested the effect of combined CBT and disability management in a manufacturing workplace. Over two years, the program produced a 56% reduction in the incidence of serious mental health claims, and a 52% reduction in duration.7
Disability management professionals should be consistently examining the tremendous strides being made in the medical and behavioral sciences. Professionals should mine best practices that can be successfully applied in disability management programs and workplaces.
Pharmacogenetics and CBT are only two examples of techniques that are producing very encouraging results. Many more emerging best practices are waiting to be explored and implemented. Video conferencing can bring doctors and medical professionals closer to patients in isolated or rural communities, and as this technology develops, it may be possible to incorporate virtual reality to dramatically enhance that experience in the near future. An employee may be able to receive CBT treatment from a psychologist, in that psychologist’s office, without making a journey to a remote location. A psychologist on the East Coast could treat a patient on the West Coast as easily as if they were located in their own town. This is already being leveraged by technology companies such as “Doctor On Demand” and others.8
Choosing New Directions
Disability management professionals can incorporate the leading edge of technology and research to increase their impact on employee care, engagement, and return-to-work outcomes. As pharmacogenetics and CBT show, when new and emerging research is successfully used in disability management programs, the results are healthier employees, more productive workplaces, and reduced economic impact on employers.
It also shows why the discipline of disability management continues to be enormously beneficial for both employers and for society as a whole. This is most apparent in the experience of the employee. When the unfortunate happens, disability management helps employees restore meaning to their lives. It benefits workplaces. It makes society healthier and more productive. It changes lives.9
- Plöthner M, D Ribbentrop, JP Hartman, M Frank. Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany. Advances in Therapy. Sept. 2016, 33(9): 1461–1480. Retrieved from: https://link.springer.com/article/10.1007/s12325-016-0376-8
- Witters D, D Liu. In U.S., Poor Health Tied to Big Losses for All Job Types. Gallup-Healthways Well-Being Index. May 7, 2013. Retrieved from http://news.gallup.com/poll/162344/poor-health-tied-big-losses-job-types.aspx
- WHO Drug Information Vol. 17, No. 2, 2003. Retrieved from http://apps.who.int/medicinedocs/en/d/Js4954e/2.html
- A Sharrat. Is Personalized Medicine the Future of Benefits Plans? Benefits Canada. Apr. 16, 2015. Retrieved from: http://www.benefitscanada.com/benefits/health-benefits/personalized-medicine-the-future-of-benefits-plans-64771
- 5. Gong L, M Whirl-Carrillo, TE Klein. The Role of Pharmacogenetics in Precision Medicine. Pharmacy Times. July 22, 2016. Retrieved from: http://www.pharmacytimes.com/publications/issue/2016/july2016/the-role-of-pharmacogenetics-in-precision-medicine?p=2
- Rajiv S, S Santosh, RS Sugandha. Pharmacogenetics: The Future Medicine. Journal of Advanced Pharmaceutical Technology and Research. 2010. Oct-Dec; 1(4): 423–424. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255401/
- Scott LR, C Dalton. (2016) Rethinking Mental Health Disability Claim Management. Ontario Occupational Health Nurses Journal. Fall/Winter 2016. Retrieved from http://www.orgsoln.com/pdf/OOHNA-Fall-Winter-2016.pdf
- See https://www.doctorondemand.com/
- Special Committee on Health, Productivity, and Disability Management, American College of Occupational and Environmental Medicine. Healthy Workforce/Healthy Economy: The Role of Health, Productivity, and Disability Management in Addressing the Nation’s Health Care Crisis: Why an emphasis on the Health of the Workforce is Vital to the Health of the Economy. Journal of Occupational and Environmental Medicine. 51(1):114-119, Jan. 2009. Retrieved from: https://journals.lww.com/joem/Fulltext/2009/01000/Healthy_Workforce_Health