Proven Ways to Improve Workers Compensation Health

📰 Curated Industry Article

This is a summary of a full article from a trusted insurance publication. Click “Read Full Article” below to read the complete story.

The workers’ compensation industry has long operated under a familiar model: an injury occurs, a claim is opened, and treatment focuses on the specific body part or diagnosis that caused the disability. But this narrow lens is proving insufficient. Rising rates of diabetes, obesity, and cardiovascular disease, paired with expanding presumptive claim laws and greater attention to behavioral health, are prompting a fundamental shift in how claims are managed. Payers, employers, and claims professionals are recognizing that treating the injury alone often fails to address the real barriers standing between an injured worker and a full recovery.

“We have patients with comorbid conditions that affect how they recover and the speed with which they recover,” said Julie Black, R.Ph., Director of Product Development at MyMatrixx by Evernorth.

“So, it’s necessary for us to treat the patient as they come to us, beyond their injury and as a whole person.”

Rethinking the Traditional Claim Model

The “whole person” approach represents a departure from decades of injury-first thinking in workers’ compensation.

“Our challenge today is to break the mold and think about patient care in a new way,” said Sarah Randolph, Pharm.D., Product Development Senior Advisor at MyMatrixx by Evernorth. “Things are different today, so the way we provide care for patients and their workers’ comp injuries should be different, too.”

“That difference is significant,” added Kimberly Di Scala, Pharm.D., Product Development Senior Advisor at MyMatrixx by Evernorth. “Under a traditional model, a worker with a back injury receives treatment aimed at the injury. But with a “whole person” approach, the back injury treatment is coordinated by a care team who also considers whether the patient is dealing with depression, has transportation to appointments, understands their treatment plan, is adhering to medications, or even faces a language barrier that limits their engagement with providers.”

“Exactly,” adds Randolph, “The injury might be the reason a claim exists, but it’s not the only thing influencing how the patient responds to treatment or recovers. If we focus only on a specific diagnosis, we may miss the real reason someone isn’t progressing in their journey for healing.”

In workers’ compensation, there are common injury types – including back injuries – and with those there are often standard medications and treatment plans that come with them. But patient populations are not standard and two workers with the same injury may need very different combinations of support based on their individual circumstances. Treatment plans need to reflect the patient as they are.

“For example,” Black explains, “a woman going through menopause, may recover differently than a 30-year-old woman with the same injury. Or an obese man with diabetes and depression may heal slower than a fit coworker. If these factors and conditions are left unaddressed within a treatment plan, you are likely looking at extended disability and claim durations and increased claim costs.”

The Power of Coaching, Education, and Care Coordination

The heart of the “whole person” approach is a simple but powerful idea: better questions lead to better outcomes. That’s where health coaches, patient education, and care coordination come in.

An injured worker often faces a bewildering array of stakeholders — HR representatives, employers, adjusters, providers, pharmacists, and specialists. Add to that digital health tools, telemedicine, behavioral health services, and support for chronic conditions, and the experience can become overwhelming.

“A health coach can be incredibly valuable in a patient’s care plan,” Randolph said. “It’s important to note that a health coach doesn’t replace a provider, adjuster or a case manager. The role of a health coach is to build trust with the patient by being a consistent point of contact and helping them by supporting a behavior change, providing education, and ultimately connecting them with resources available to aid in recovery.”

“Many work-related injuries involve some sort of pain management and often that means an opioid, which come with their own set of challenges,” said Di Scala.

A patient might leave the pharmacy with questions about the risks and side effects of opioids and with fear and uncertainty about a potential surgery or the financial impact of being off work.  “The psychological toll can be significant,” continued Di Scala, “and that’s why a health coach could be beneficial.”

Black added, “The earlier we can intervene with a patient who is on opioids, the better chance we have that person won’t become a chronic opioid user. Plus, it gives us an opportunity to identify any potential issues that might be at play.”

The whole-health model uses risk stratification and screening tools to help identify the claims that may benefit from more intensive intervention; whether that’s pain management, women’s health support, diabetes management, GLP-1 support, or behavioral health resources for underlying depression or anxiety.

Randolph emphasized that the whole-health model isn’t about applying every available service to every claim as that would just inflate costs without improving outcomes.

“The goal is getting the right support to the right person at the right time,” she said.

Pharmacy Benefit Management’s New Mandate

For MyMatrixx by Evernorth, the “whole person” approach represents a natural evolution of care for our injured workers.

That evolution reflects a growing recognition that pharmacy benefit management, while foundational, is only one piece of a larger care puzzle. By integrating health coaching, care coordination, behavioral health resources, and targeted support for chronic conditions, the organization is building a model designed to meet injured workers wherever they are in their recovery journey.

Black connects this with a broader philosophy shared across Cigna, the MyMatrixx parent organization, which places the patient at the center of every decision.

“The patient is our primary goal using appropriate resources to get them on the road to recovery,” she stressed.

A Simple Approach to a Complex Situation

The workers’ compensation industry will continue to grapple with rising comorbidities, expanding presumptive claim laws, and the growing complexity of injured worker populations. Organizations that adapt by asking better questions, listening carefully, and coordinating care around the whole person stand to deliver improved outcomes while managing costs more effectively.

“Complex situations don’t always require complicated solutions,” Randolph said. “Asking better questions leads to better patient insights, which help us connect those patients with the care they need to recover.”

To learn more, visit https://www.mymatrixx.com/.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with MyMatrixx by Evernorth. The editorial staff of Risk & Insurance had no role in its preparation.

The post Beyond the Injury: Reshaping Workers’ Compensation with a Whole Person Health Approach appeared first on Risk & Insurance.

Read Full Article on Source →

💡 What This Means For You

Insurance markets shift for many reasons, and those shifts eventually reach everyday policyholders. If this raises questions about your own coverage, we’re happy to help you understand where you stand, with no pressure and no jargon.

SECURELIFE INSURANCE

Secure Peace of Mind for You and Your Loved Ones

We provide comprehensive solutions including life insurance, mortgage protection, and annuities tailored to your needs.

Get a Free Consultation →