Claims involving comorbidities are often associated with highercosts and increased duration, but the latest research from HarborHealth Systems undeniably demonstrates the impact comorbiditieshave on claims outcomes. Based on this research analyzing more than7,000 workers’ compensation claims, claims associated with comorbidconditions experienced longer claims duration, higher medicalcosts, more temporary total disability (TTD) days and increasedlitigation and surgery rates. These findings were recentlypresented at the National Workers’ Compensation & DisabilityConference (NWCDC), in New Orleans, Louisiana.

The research study evaluated the following seven comorbiditiesin claims with an injury date between January 1, 2011, and December31, 2013: obesity, diabetes, hypertension, addiction, mentalhealth, tobacco use and multiple comorbidities.

Impact by the numbers

By examining these seven comorbidities, the research foundsignificant impacts on total claims costs, total medical costs,claim duration, TTD days, litigation rates, recidivism and surgeryrates:

• Claim duration is significantly longer for the claims involvingcomorbidities with the exception of tobacco claims. Claim durationincreased by 76 percent for claims involving multiplecomorbidities; 67 percent for claims involving addiction and 55percent for obesity-related claims.
• Incurred total costs increased 341 percent with multiplecomorbidities.
• Claims in all the comorbidity groups had significantly higherTTD days compared to the control group. TTD days increased by 285percent for multiple comorbidities claims and 274 percent foraddiction-related claims.
• Litigation rates also increased when claims involved multiplecomorbidities, mental health or addiction. Litigation rates forclaims with multiple comorbidities increased approximately 147percent; 224 percent for addiction-related claims and 248 percentfor mental health related claims.
• Surgery rates increased 123 percent for claims involvingmultiple comorbidities and 140 percent for claims involvingobesity.
• Tobacco use did not have a significant impact on the outcomescompared to the control group.

When evaluating the overall impact of various comorbidities onworkers’ compensation claims, the two that have the greatest impactare multiple comorbidities and obesity, followed by addiction,mental health and hypertension, with diabetes and tobacco havingthe lowest impact.

Links between comorbidities complicate risks

Relationships between comorbidities — such as the link betweenobesity and diabetes — can exacerbate complications and healthrisks. The age of the injured worker is another factor that isassociated with comorbidities and can complicate the management ofa claim.

Given these findings, the workers’ compensation industry needs amore comprehensive, system-wide approach to address the riskassociated with comorbidities. Prescriptive solutions ranging frommore complete intake data, to a system that incorporatescomorbidities into the utilization review process, to factoring incomorbidities in the treatment process should be all beconsidered.

By keeping these comorbid conditions top of mind in claimsmanagement, workers’ compensation professionals can minimize riskwhile providing more appropriate care to injured workers.

Linda Lane is president of Harbor HealthSystems, a One Call Care Management company. She can be reachedat [email protected].