RTW Trends: RETAIN Pilot Program

Tasha Patterson@Work

Federal Project Promotes Integrated Approach for WC, Non-Occupational Claims

RETAIN Pilot ProgramA new federal program is applying absence management best practices to workers’ compensation (WC) claims and non-occupational claims in an integrated approach.

The new Retaining Employment and Talent After Injury (RETAIN) demonstration project of the U.S. Department of Labor (DOL) drew inspiration from the Centers for Occupational Health and Education (COHE) model that Washington state developed for managing the early phase of WC claims. When a federal agency does a “demonstration” project like RETAIN, it is exploring a concept that may result in new programs, regulations, or legislation. It is a formal process with higher evidence requirements than a typical employer pilot program, and usually takes several years to complete.

In the COHE model that helped inspire RETAIN, a regional COHE group recruits physicians as members, and trains them to provide four specific services considered best practices in occupational health. The COHE pays physicians to deliver those services, and provides support by communications coordinators who facilitate information exchange among the parties during the stay-at-work and return-to-work (RTW) processes.

COHE has been very successful, said Jenny Haykin, Integrated Leaves & Accommodations Program Manager, Puget Sound Energy. “Providers participating in the COHE regional programs are the gold standard in injured worker care,” said Haykin. “I get paperwork quickly and filled out correctly, and my goal of keeping employees working and/or bringing them back as quickly as possible is shared.”

COHE was the primary model cited when the DOL invited states to apply for RETAIN grants. RETAIN is a five-year, $100 million demonstration project with initial grants totaling nearly $19 million to WC agencies in eight states: California, Connecticut, Kansas, Kentucky, Minnesota, Ohio, Vermont, and Washington state. The awards were announced on Sept. 27. In Phase 1, the states chosen will plan and implement pilots for 18 months. At the end of Phase 1, up to four states will be funded to expand their pilots for three and a half years in Phase 2.

Jennifer Christian, MD, a frequent DMEC presenter, was a key player in developing the RETAIN demonstration. While the COHE model is focused on WC claims, RETAIN will also address non-occupational disability claims.

Christian noted several significant aspects of RETAIN:

  • It is only a supplementary service; it doesn’t replace existing programs, Christian said. RETAIN funds won’t pay for medical care or wage-replacement benefits. It doesn’t replace any existing program.
  • The program focuses on the first three months after a worker is injured, and project assistance concludes six months after the injury.
  • To apply for the RETAIN grant, states had to assemble leadership teams including agencies that typically do not collaborate closely and do not focus primarily on injured or ill workers. Those players are: the state Workforce Agency, the state Department of Health, a healthcare delivery system, and the state Workforce Development Board. Participation by the state WC agency was not required. Among the RETAIN phase 1 grant recipients, three had more than 10 agencies on their leadership team.
  • RETAIN may be the first federal program to measure and seek to prevent job loss due to injury or illness. “This is a big shift,” said Christian. “We have always said ‘staying at work is good for you,’ but we didn’t say ‘job loss is bad for you; it’s a devastating outcome.’”

Christian points out that, although the Occupational Safety and Health Act (OSHA) 300 log requires many employers to track lost work days associated with recordable injuries, OSHA does not require employers to report job loss due to injury or illness. Attention to this metric may give providers and employers new urgency to keep employees attached to the workforce. While praising DMEC members as “activists” in promoting RTW, Christian said for many employers and insurers, “non-occupational episodes are still largely unmanaged during the critical early period.”

RTW metrics are especially useful for employers, insurance carriers, and third-party administrators in tracking performance of employer programs. A job-loss metric may be most useful in analyzing demand for social safety nets and focusing efforts on reducing need for and cost of unemployment insurance, Social Security Disability, and other social safety nets. A DOL analysis published in 2016 concluded that COHE participants were 26% less likely to receive Social Security disability benefits.

The Social Security Administration will also award a research contract to evaluate the performance of the RETAIN grant winners.

It’s too early to say what specific incentives the eight state RETAIN pilots might use to motivate healthcare providers to focus on job retention.

“For a long time the reformers of the U.S. health system have said we have got to stop paying for volume and start paying for outcomes,” said Paul Papanek, MD, a member of the American College of Occupational and Environmental Medicine (ACOEM) in California. “It’s a longer-term ACOEM goal to get a smarter set of fee schedules that aligns with this vision, both for WC and group health. RETAIN does not directly affect fee schedules, but may provide other incentives for providers to track functional status. RETAIN will give us new information about how provider incentives can affect health and employment outcomes.”

Washington state originated the COHE model, so its RETAIN pilot will be watched closely. They have a goal to collect a cohort of 400 workers with significant injuries that may cause disability claims and loss of contact with the workplace. These will be either workers with denied WC claims, or state employees, said Toby Olson, MPA, Executive Secretary of the Governor’s Committee on Disability Issues and Employment, and leader of the state’s RETAIN pilot. They want to compare the outcomes of this cohort to outcomes of a similar cohort that will not receive RETAIN services. “I am interested in connecting with interested employers and vendors and engaging their participation as we plan for a possible Phase 2 program,” Olson said.

To learn more about the eight state RETAIN pilots, including contact information for key personnel, visit https://www.dol.gov/odep/topics/SAW-RTW/grant-recipents.htm.