EAPs to the Rescue with Workers' Compensation Fraud?

One of my favorite subjects is business insurance. I like to watch news, press releases, and blogs reporting on the many aspects of this field. As I have often opined, business insurance is a stake holder of effective, core technology employee assistance programs. The only problem is, they don't know it. That's the fault of EAPs as a group.

Insurance protects businesses and producers sell insurance. Your bridge to meet these employers and establish yourself is one of following three professionals who know a business owner best: the lawyer, the accountant, or the insurance agent. Insurance agents are your best bet because of synergies associated with the their needs, business needs, and the purpose of EAPs are nicely melded. They must all be concerned about human behavior in the workplace that leads to risk and financial loss.

Who pays for the legal bills of employees sued for sexual harassment? Who pays for the workers' compensation costs associated with sexual harassment (yes, harassed workers have often collected money for sexual harassment) and who will lose money if lawsuits come for sexual harassment? The answer is business insurers. Of course, employers pay too, if insured, through high deductibles.

There are many types of business insurance and there are many behavioral risk exposures that business insurance is designed to address. EAPs interface with many of them.

So the logic is there to team up with this group. Get started. Start in Colorado, or at least follow this legislation to see where it goes an how much influence it carries. Here's the news.

One of the insurance writers I follow is Gary Boop. He writes for "About.com". Gary reported today on a piece of legislation working its way through the Statehouse in the Colorado. The politicians there are focused on prohibiting workers compensation insurers from spying on or doing clandestine surveillance of employees injured on workers' compensation. This technique of finding employees who are stealing money from employers by faking injuries and collecting fat paychecks has been used for decades to reduce workers' compensation costs. Do you know the ramification of such legislation? They are potentially great and it means news skills and capabilities are going to be important to reducing costs. That's where you come in.

Consider this New Colorado bill H.B. 1012

What does this have to do with EAPs? I hope you see the connection, but let me spell it out clearly for you. Limitation of an employer's ability to investigate fraud means there must be some other way to find it, but even better, a renewed interest in preventing it will obviously be on the horizon.

Instead of ignoring injured employees and then seeking to discover criminal malingering to collect benefits, heading these problems off at the pass will get more scrutiny.

I predict that someday a business service will emerge that will be funded by workers' compensation insurers, and that it will play the following role. It will operate confidentially and

• Meet with employees to assess the emotional impact of their injuries,
• Do a family assessment to determine likely areas of distress and conflict at risk for protracting an injury,
• Conduct an occupational alcoholism assessment,
• Help an employee remain motivated and anticipating a return to work,
• Resolve conflicts between an injured employee and the boss or coworkers back at the worksite,
• Offer support for the injured employee during the period of time they are off work,
• Offer guidance, tips, and support upon return to duty so employees experience reduced anxiety and conflict associated with return to light duty or full duty assignments.

I believe these activities would make a hell of a business opportunity to help reduce costs for workers' compensation managed care and employers. Specialists who would do such work would need the skills of employee assistance professionals. So, why can't EAPs get more involved now before such a service robs the field of an opportunity?

EAPs typically don't do these things now, but they could add these services to their continuum of activities and get enormous credit for doing so.

If you have entertained the idea of looking more at the EAP/Workers' Compensation interface, and you happen to service employees in Colorado, run don't walk, to develop your capabilities of servicing these employees with the goal of monitoring their care so they are less likely to fall prey to the temptation of malingering.

Of course, sometimes injuries are very real, except bogus injuries or injuries that were very real at the time become easy to lie about once their pain and debilitating symptoms disappear.

Any thoughts about this? See the drift?

Resolving Coworker Conflicts - Done

Resolving coworker conflicts is something many employee assistance professionals are well skilled at doing. However, many EAPs don't advertise or promote this service. You should think about doing so to improve your worth and perceived value. Providing education on resolving coworker conflicts can increase your visibility for this service and EAP utilization, but the really good news is that such help to the organization brings with it big returns that may help you stick around. You will notice that many of the products and services at WorkExcel.com are designed to help EAPs be more valuable. For example, doing Stress Management Secrets for Supervisors was not an accident. It was produced to get EAPs closer to the decision makers.

To offer a promotional and educational tool, available in five formats, I recently created new product on Resolving Coworker Conflicts. You can see it here. Feel free to give me a call if you have any questions. This program will elevate the visibility of your EAP and reduce risk to your host organization(s.)

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Are You Doing the Right Kind of Stress Management (link)

About a year and half a go, Watson Wyatt Worldwide, a leading global-wide consulting firm, surveyed employers and discovered that stress was the number one reason employees quit their jobs.

Watson Wyatt is a major benefits consulting firm, so their interest was in learning more about this workplace issue. They discovered that most employers weren't doing much about stress. Two surveys conducted by Watson Wyatt confirmed it.

The strange thing is that most employers did not cite stress as the key reason employees quit. Stress did not make it into the top five reasons. Most employers listed things like insufficient pay, lack of career development, or poor supervisor relationships as the reasons employees quit. Employees were saying it was other things.

The bottom line is that if you are doing stress management in companies and want to make the most impact, you must target the source of stress in your EAP interventions. According to the research from Watson Wyatt, the target sources of stress that increase the risk of employees leaving include the following, some of which you may be able to address, and others, perhaps not.

Note: The second number is the percentage of employers acting to help employees with this stress related issue.

Long hours, doing more with less - 48% of employees say this is a problem. (Only 5% of employers doing anything about it.)
Work/Life Balance - 32% (16%)
Technologies that expand work - 29% (6%)
Manager's inability to recognized stress - 24% (7%)
Manager's inability to find solutions for stress - 20% (14%)
Extra time, hassles related to security - 8% (2%)
Safety fears - 5% (27%)

The numbers give some clues. It may be easy to focus on dealing with security or saftey fears of employees, but there may be nothing employers can do to help employees who are forced to do more with less. The interesting set of numbers above is "Manager's Inability to Recognize Stress". It's rated high as an employee complaint, but it is low as a point of intervention from the employer's perspective.

There is appreciable room to help managers and supervisors understand stress better, its effects, the impact it has on employees, what to do about it, signs and symptoms in employees, and factors associated with supevisor-supervisee communiation that undoubtedly contributed to it.

When doing stress management consider laser targeted interventions to be more effective. Source: Press Release, "Few Employers Address Workplace Stress", contact Steven Arnoff at steven.arnoff@watsonwyatt.com

New EAP Professionals and Orientation to Alcoholism (Ouch!)

It is safe to say that discussing alcoholism with any professional in the treatment field, EAP field, or other helping industry will generate some argument and controversy. Just wait. If you are new to the field, you'll soon be indoctrinated with one of these cocktail conversations.

It's one of the "elephants in the living room" of the helping profession. One out of four people has an addict in their family, and myth and mythology over thousands of years keeps intervention, treatment, and recovery confusing and controversial.

From non-M.D. psychologists who are selected to be the U.S. Supreme Court consultants, who then push the idea that alcoholism is not a disease, to best selling authors telling us how alcoholics can drink safely, there is simply no shortage of information and "new thought" about alcoholism that continues to undermine the legitimacy of this disease and how it should be managed.

Of course, if you have worked directly with alcoholics in treatment, you are prized material for being hired as an EAP staffer. It means you have been in the trenches, faced the defense mechanisms, and hopefully have been mentored by recovering persons (if you are not recovering yourself) who adhere to abstinence principles and 12-step programming as the most effective way to manage this chronic disease.

(It is truly amazing that when I blog on this topic, I get rabid members of Rational Recovery threatening to turn off my free speech rights with their conspiracy theories about AA.)

If you are new to the EAP field, and have not been in the trenches of alcoholism, there are few things you need to know.

First, don't think that understanding alcoholism or writing about it as new EAP professional will be an easy scrabble. The economics and politics of alcoholism diagnosis, causation, treatment, and ongoing recovery are profound , convoluted, and continue unabated.

Before you get into a discussion about alcoholism, do a few things that are really critical to your edification and orientation.

1. Go to a dozen or so open AA meetings and get oriented to "recovery think". Know what recovering people read, and have your own library of this material. (Also purchase alternative and controversial materials that argue against AA so you can see their rationalization and desperation to avoid what AA is about.) Memorize the twelve steps. You don't want to be caught unable to converse about the 5th step, the 4th step, or the conflict in treatment programs that push patients to go to the 4th step instead sticking with only the first three. (See what I mean?)

Not having this information will also cause issues with your clients who will expect for you to know more than they do about recovery initially.

2. Visit the Web site of the American Society on Addiction Medicine at http://asam.org. There is a ton of stuff on this site. Read their position papers. This association represents about four thousand medical doctors who are the leading authorities on addictive disease, alcoholism, and its treatment. They don't get a lot of press. Probably because they get a lot of folks upset who would otherwise report on their opinions. There is a simple explanation: Science and research simply don't mix well with the popular culture, which has a 5000 year head start ahead of them.

It is popular culture that drives belief systems about the disease. You need to separate the wheat from the shaft if you are going to work in this field effectively.

There a lot of people making money off of alcoholics. Whether it's trying to do psychotherapy with them while they are still drinking or drugging, selling them gimmicks, pushing alternative group therapies and "not-necessarily-abstinence" groups, pop-psych ideas about how to drink normally, etc., there is no end to the influx of confusion and interference that keeps alcoholism from being accepted by everyone (like cancer) that it is an authentic, chronic disease that requires abstinence to arrest its progression.

3. Read "Under the Influence" by James Milam and Katherine Ketchum. Still about $5.95 a paperback copy, it is a fascinating book that explains alcoholism as a chronic, genetically based illness so well, it is hard to put it down. Not sure if the author's original, self-published book, 'The Emergent Comprehensive Concept of Alcoholism" is still around, but if you find it, it will blow your mind about the economics and the forces in our larger society that have a vested interest in your not believing that this is a true disease.

Okay that's enough to blog about today, don't you think!

Link Fixed

A link was broken on my last post. It's fixed, or you can click here.
Preventing Workplace Violence

Workplace Violence Video

I finished Video #3 in the Workplace Media Library 2010 series. This module is entitled Preventing Workplace Violence. It runs 12 minutes and I think it covers all of the bases.

While writing this program for EAP web sites and other workplace services, I took advantage of my experience as a victim of bullying when I was working for the CIA in 1978. (I eventually took a position in the CIA's occupational alcoholism program, but just prior, had a job in the Office of Logistics in Langley, VA doing various types of unclassified building work.)

I was able to stop the bullying permanently in a very satisfying manner. I zapped the perpetrator one day when he was arrested by a Federal police office for throwing lighted matches over the top of his head in an effort to hit me with them while I was walking down a hallway following behind. All for no reason. No reason at all. Just "fun". I was the chosen one--this guy's toy.

Luckily, it was all spotted by a Federal Police Officer guarding the hallway. She approached me and asked if I wanted to file a report. "Absolutely", I said. After numerous other events, it was the perfect opportunity.

The rest is a history of no more stress from this jerk, but the point of this story is that horseplay is illegal in Federal office buildings, and no matter where it is, it often turns violent. It frequently has victims, causes property damage, the clear example should encourage you to mentioned it in your training.

I have never seen horseplay mentioned in violence prevention materials, but this one does include it in one strong slide.

You will see other original content in this violence in the workplace prevention Power Point video. I also encourage employees to attend CISD debriefings offered by the organization after a violent incident, tips on avoiding assault, what the organization's EAP can do, how employees should be "change-agents" in promoting respect and avoid provoking a violent response from an employee who may not react rationally from picked on and bullied.

You can see the Preventing Violence at Work video here. Also, you may be interested in the Workplace Video Web Content Subscription as well. The program is designed to drive the cost down for these new products.

EAPs Can Do Managed Care and Increase Their Value

1. If you work for an internal EAP with a company that is self-insured, consider approaching your human resources and benefits management team to discuss the possibility of getting the mental health component of your EAP "carved out" so you can provide limited managed care services. If you are a very well trusted tenured pro, they just might consider it. Listen up. I am not recommending to you anything that I have not done myself, including this task.

2. If you can achieve this goal, it will increase utilization rates dramatically. Here is the selling angle: 1) The EAP can pre-screen and refer employees to appropriate mental health professionals based upon their clinical evaluations and guidance. This will save money by getting employees to the right provider the first time.

As an incentive, permit 80% coverage for mental health benefits versus 50% for those that don't go through the EAP. Self-insured companies can do this sort of thing. This will also allow the EAP to identify behavioral/medical problems that may underlie existing disorders contributing to the symptoms brought to the EAP session by the client.

3. Even a phone interview with an employee to discuss a referral -- in the event the employee does not perceive the need for a face-to-face interview, or refuses -- can go along way toward identifying primary health problems that can be more effectively treated by the referral source the EAP might suggest.

4. If you succeed in getting a carve-out, the primary services you will provide include: 1) approving therapists; 2) notifying the insurance company who they should approve payment for; 3) re-certifying regularly; 4) selecting providers when a specialist on the managed care panel doesn't exist; and, 5) deciding to pay higher fees than the managed care company is willing to do themselves. This is a good deal for employees and can increase confidentiality. Yes, it will save money for the company, too. That's right, many managed care companies will not require "outpatient treatment reports" and they will accept the EAP's approval of out-of-panel therapists. You decide. You have to be diligent, but remember, "its your money not managed care's money."

5. All of this can limit the amount of clinical information, other than a CPT code, that will go to the massive computer memory at the managed care company. This improves actual and perceived confidentiality. Survey other internal programs nationwide to identify strategies capable of adding this dimension to your EAP services.

If you are interested in seeing the new “Preventing Violence in the Workplace” program (five formats available), reply back here and I will make sure you are on my early release list to view it, and get the limited time discount. This is a reward for being nice enough to sign up for this blog. More to come in the future! The discount won't be as low as the Flash Video Subscription Service (you know about this product, right?) subscripton service, but it will be signficant. The program is in sound in Flash Video for your web site, DVD, PowerPoint, and a self-playing Flash CD.