It seems the workers’ compensation and health care industries are always changing – what might be ahead as both clinical and non-clinical best practice research continue to evolve? There are some significant opportunities on the horizon to identify and mitigate psychosocial risk factors and social determinants of health – considerations unique to a worker that compound needless work disability. These issues are often misunderstood or lumped together as though they are the same. They’re not, but both can influence whether or when an injured worker chooses to return to work – the gold standard outcome for a workers’ compensation claim.
In recent years, workers’ compensation insurers and employers have come to understand psychosocial issues that are most common to someone hurt on the job – fear and avoidance, catastrophic thinking, perceived injustice, and perceived disability – and have begun taking steps to address them. While more is needed, the historic fear among policyholders that acknowledging anything related to psychology will increase claim duration and costs has finally dissipated in many jurisdictions. In fact, many workers’ compensation payers are acknowledging and using certain “CPT” or billing codes that were developed by the American Psychological Association specifically to support the treatment of psychosocial issues without the need for a diagnosed psychiatric condition (and the labeling of a patient that comes with such a diagnosis). The CPT codes are used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies (including workers’ compensation regulators and insurers), and accreditation organizations.
So, what’s next? The workers’ compensation industry is just beginning to talk about social determinants of health (SDOHs) that can influence an injured worker’s recovery and return to work. These differ from psychosocial factors that occur or develop ‘between the worker’s ears’. SDOHs are more external; for example, inadequate housing, food insecurities, the availability of community resources, neighborhood crime, lack of family support, and education. But they can also include the threat of job loss, discord with the employer, and issues that can trigger or magnify psychosocial risk factors (catastrophic thinking or fear and avoidance, for example).
The more recent International Statistical Classification of Diseases and Related Health Problems (ICD) codes now include “Z” codes that allow medical professionals to flag SDOHs. ICD codes differ from CPT codes: the first identifies a problem that treatment or interventions should aim to resolve while the second refers to the treatment being given. Although Z codes are still rarely used, workers’ compensation industry leaders and technology solutions should prepare for future policy decisions that may include the need to accommodate these codes, related advancements, and ultimately design evidence-based system interventions. For example, there is already a website called Neighborhood Atlas that uses zip codes to create awareness of whether an injured worker’s address is in a disadvantaged neighborhood. Understanding this can allow a claim manager or other professional to have a more holistic picture of the worker’s environment and issues that can impact their individual resiliency, recovery, and decisions regarding return-to-work opportunities. In the future, workers’ compensation carriers may be using zip codes to flag a claim as at-risk for SDOHs, weak labor markets, or other factors needing early intervention to prevent work disability and the needless human harm and financial costs associated with it.