A hospital's integration evolution

Risk & Insurance, Oct 1, 2004 by Marybeth Stevens

Allina Hospitals & Clinics targets cost controls and injury prevention through integrated disability management by eliminating silos--pockets of knowledge and experience--in its programs. The result is that Allina has been able to leverage expertise and enhance the benefits of its initiatives.

Allina Hospitals & Clinics, which owns or manages 12 hospitals and 44 clinics, brings a dual perspective to its integrated disability management program. First, as an employer, Allina began implementing strategies in its workers' compensation program nearly 20 years ago to reduce costs and improve employee satisfaction, an approach that it has expanded over the years to other disability programs. Second, as a health care provider, Allina knows the value of helping individuals get the right care they need in order to return to wellness and productivity as soon as possible.

Today, Allina, with 23,000 employees, is putting these dual perspectives to work in an integrated disability management program that covers employees with both occupational and non-occupational illnesses and injuries. Allina's strategies include return-to-work and remain-at work programs that place employees in transitional or modified work duties, either in their regular departments or elsewhere in the facility or hospital. If employees are unable to return to their jobs because of permanent medical restrictions, Allina has an internal placement specialist who helps find new positions within the system.

In 2003, Allina's integrated disability management program was honored with the Quality Leadership Award from the Certification of Disability Management Specialists Commission (CDMSC).

By eliminating silos--pockets of knowledge and experience in its programs, Allina's approach to disability management has become integrated, which enables the company to leverage expertise and enhance the benefits of its initiatives. For example, Allina's Employee Assistance Program (EAP), which offers counseling and resource referrals to employees on a variety issues, is integrated in its Health & Safety Department. This allows internal and external EAP counselors, who work primarily by telephone, to offer assistance to support case management initiatives within its disability and wage-replacement programs. Integrating this assistance is particularly helpful for employees who are dealing with multiple issues such as depression and physical disabilities.

Allina, which is based in Minneapolis/St. Paul, attributes much of the success of its disability management program to an individualized approach that focuses on the needs of each employee, the demands of the person's job, and his or her ability to perform specific required tasks. "This means really understanding and facilitating the person's return to work, and then making sure that the processes work well each time. This is a critical success factor for us," says Marsha Studer, director of employee health and safety at Allina. In addition, Allina stresses outcomes that hold the organization and people accountable. "We hold ourselves accountable to provide employee health and safety, and we measure it," says Mike Howe, executive vice president, human resources and culture, at Allina. "The first has to do with how well we do once people are injured, and for us that's our injury care and return-to-work program including the claim cost of injury and the internal expense of returning people to work. The second area, and possibly most important, is avoiding injuries all together."

These two key measures--controlling costs once a disability occurs and reducing lost workdays through injury prevention--are tracked throughout the organization, and become part of the results that are reported to top management and Allina's board of directors. "As an organization becomes more robust, it creates a more robust set of measures," Howe says. "We find setting standards and measuring our progress has really made a difference in creating a health and safety culture because you are holding people accountable."

STRATEGY DEVELOPED OVER TIME

Like many companies, Allina developed and implemented its disability management program over time. The first step was in 1985, when Allina launched a case management process for workers' comp. The purpose was to assist employees with navigating the system by offering assistance such as facilitating communication and easing the process for returning to work.

As a result of its workers' comp initiative, Allina realized a significant reduction in its indemnity costs. For every $1 spent, it reaped approximately a $3 to $4 return, Studer says. Then, as Allina grew, savings were realized as the workers' comp program was expanded. "Every time we added another hospital to our system, we would see another dramatic reduction in indemnity costs following case management implementation," Studer says.

Given the success of the workers' comp program, Allina began looking at how the same approach might benefit other disability programs. Allina has a short-term income replacement program, which is internally funded and is used in lieu of short-term disability benefits for non-union employees and a funded program for a few of the unions. It also offers long-term disability benefits through its insurance carrier, Cigna.