Stakeholders within the nation's health care system have long understood what is becoming increasingly obvious to the workers' compensation industry: Social Determinants of Health (SDoH) have an enormous impact on health outcomes and injured workers are no exception. In fact, research suggests that medical care accounts for only 10 to 20 percent of health outcomes while the other 80 to 90 percent are attributed to demographic, environmental and socioeconomic factors.

As SDoH take center stage in the discussion surrounding treatment of workplace injuries, these nonclinical issues, including socioeconomic status, transportation barriers, housing problems, food insecurity and other basic human needs–including loneliness–play a significant role in patient engagement, recovery and return-to-work. It is important to consider the worker's overall situation and prevent seemingly minor non-clinical issues from creeping into catastrophic claims. Claims that initially seem routine may become complex when SDoH factors are involved.

While it's tempting to think that the impact of these issues is focused within certain financially challenged or at-risk populations, several studies challenge this concept:

68 percent of patients have at least one social determinant of health challenge, according to a study of 500 random patients.
A national study commissioned by Kaiser Permanente found 68 percent of adults had at least one unmet social need, and these needs span all income levels.

With the majority of adults reporting social needs, it is likely that a significant percentage of injured workers will also face these challenges. Therefore, communicating with injured workers at the beginning of a claim, identifying the SDoH and resolving the circumstances that could impact recovery are key to speeding recovery and driving down costs.

It is an approach that will pay dividends for plan sponsors, since injured workers can put significant strain on financial and clinical resources. Specifically, three to five percent of complex claims drive roughly 50 to 60 percent of overall workers' comp costs. Because on-the-job injuries often represent the potential risk for catastrophic, complex and large loss cases, the opportunity to address SDoH early on enhances health outcomes while mitigating financial risk.

This is especially important when an injured worker has a history of depression or a substance use disorder, is obese, or lives alone. These vulnerable individuals often lack a strong support system and the impact of SDoH may be exponentially higher, resulting in fragmented care or delays that can interrupt the injured worker's journey to physical recovery.

Understanding SDoH

No injury exists in a vacuum, and recovery is never simply a matter of healing a broken body part. The most innovative approaches to treating an injured worker focus on both physical and mental health, offering workers' comp plan sponsors a significant opportunity to address SDoH throughout the continuum of care.

SDoH factors to consider on behalf of an injured worker fall into multiple categories:

Economics – Stable income, enough money to meet the ongoing needs of daily living for themselves and their families.
Environment – Safe home environment, safe neighborhood
Transportation – Transportation to and from work, medical appointments, ability to drive or access to public transportation
Nutrition – Access to quality food and clean water
Support – Network of family and friends, and community connections to prevent social isolation and likelihood of hospital readmission
Culture – Discrimination where they live or within the medical community
Understanding – Basic understanding of what they can do to facilitate their recovery, including medication adherence and management of chronic conditions that might impede recovery

All these and other factors influence how well an injured worker recovers and how quickly they return to full productivity. While these issues may not be the direct responsibility of an employer or plan sponsor, addressing them can vastly improve the recovery process. The case examples below illustrate how effective these programs are:

Solving transportation issues for injured workers

For many of the 2.8 million injured workers nationwide who missed or were late to medical appointments due to a lack of cost-effective, reliable transportation, the relationship between Carisk Partners, a specialty risk transfer and care coordination company, and Uber Health represents a meaningful solution. This relationship leads to timely care while minimizing chances for travel complications. It also results in quicker recovery and a faster return to work for the patient. Uber Health offers convenience, clarity and certainty about when transportation will arrive.

Since getting to and from medical appointments can be stressful and expensive, with transportation delays posing a barrier to care that can compromise patient outcomes and impose higher health care costs, this relationship is significant. It's a solution that offers a level of convenience, comfort and reduced stress for not only the injured worker, but also claims staff who are tasked to reschedule missed appointments or make alternate transportation arrangements.

Cleaning up the water supply

An injured worker had a malfunctioning well, leaving him without an adequate supply of clean, accessible water. International Paper considered the problem and ended up paying $3,000 for a new well pump. While such a purchase falls outside the bounds of normal workers compensation expenditures, the company reasoned it would allow the worker to stay in his home and recover rather than having to go to a rehabilitation facility at an estimated cost of $30,000. The employee healed and returned to work, which showed the company how considering SDoH factors can impact a claim and make it a win for everyone involved.

That is just one example of how SDoH factors can impact a claim and how paying for something on the front end saves suffering, time and money for the worker and employer.

Behavioral health approach to care coordination

A biopsychosocial approach to care provides a full understanding of the injured worker's social environment, history of illness and/or injury and ability to access resources to better address issues, including SDoH. By placing the patient at the center of the process, it is possible to resolve many of these issues so that what started as a minor injury doesn't turn into a costly delay in recovery.

The integration of all behavior profiles with clinical and evidence-based medicine enables the care coordination team to offer all necessary tools to maximize improvement. Such a complex approach carves out financial risk in a way the industry needs, representing an important shift for the workers' comp industry. Traditionally, there was minimal awareness or recognition of the behavioral health factors that impact recovery and how these issues must be treated early to avoid health issues down the road. As plan sponsors increasingly recognize the impact of SDoH and behavioral health, this mindset is changing.

Many sponsors are discovering that the optimal solution is to partner with a specialty risk transfer care coordination partner that has the resources and capabilities of providing a biopsychosocial approach that:

Addresses SDoH
Takes a 360-degree view of the patient
Considers all the biopsychosocial factors impacting their outcome
Coordinates care to achieve high patient satisfaction
Integrates medical/surgical expertise with behavioral health care for catastrophic and complex cases
Turns insights and understanding of SDoH in actionable solutions

Getting started

Industry observers recommend that a good way to begin addressing SDoH issues related to workers' comp is to start with small steps. Once there is awareness of the areas of everyday living that may be affected, companies can look at individual items on a claim, such as obesity and food, and identify appropriate resources.

Social isolation should not be overlooked, and may be addressed by family members, friends or a home-health caregiver. When transportation problems pose barriers to keeping medical appointments or getting to the pharmacy to fill a prescription, services such as Uber or others provide a solution – with costs that can be underwritten by the employer or the risk transfer partner. While these may seem like small gestures, plan sponsors will see a positive reflection in related claims.

When sponsors need assistance to identify or assess SDoH or other non-clinical issues, they can access forms such as those available on the American Academy of Family Physicians' website. The Centers for Disease Control (CDC) also has a toolkit, "Tools for Putting Social Determinants of Health into Action" that includes many recommendations. David Vittoria, LCSW, MCAP, ICADC, NCAC II, is vice president, clinical services for Carisk Partners.

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Social determinants of health: Turning awareness into action for injured workers

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