The News You Need for June 6

Using neuroscience to make the workplace better, understanding why COVID vaccination rules don't violate the ADA, Expert Analysis on urine testing, plus the happenings at Council Capital .

Embracing Humanity’s Goodness and Ingenuity: A Novel Concept for Workers’ Compensation?

Dr. Claire C. Muselman

Sarasota, FL (WorkersCompensation.com ) -- The traditional approach to workers' compensation, focusing on limitations, risks, and the darker aspects of human nature, has inadvertently fostered a culture of fear and suspicion. This fear-based strategy, while cautious, has overshadowed the potential for positive, innovative solutions. It is beyond time for a paradigm shift that acknowledges and harnesses humanity's inherent goodness and ingenuity. This shift from fear-based strategies can create an organizational environment where workers feel valued and inspired to contribute their best, ultimately leading to a more resilient and innovative workforce.?

The Need for Transformative Leadership?

Current leadership models in workers' compensation, often grounded in fear-based strategies, need a transformative shift. While risk management is crucial, these models usually overshadow the potential for positive, innovative solutions. To foster a healthier, more resilient workforce, we need leaders who can see beyond the limitations and recognize the vast potential within each individual, whose influence can permeate the organizations naysayers to improve the collective whole. Transformative leadership is more than just managing risks; it is about inspiring confidence and nurturing the belief that every worker possesses an intrinsic capacity for goodness and creativity. This kind of leadership improves morale and drives innovation and productivity.?

Understanding the Human Mind: A Shift in Perspective?

Our understanding of the human mind has traditionally highlighted its vulnerabilities and flaws. However, this perspective is incomplete. By focusing solely on the darker aspects of human nature, we miss out on the larger picture, including human resilience, compassion, and the drive to create and innovate. A new workers’ compensation paradigm, rooted in psychology and neuroscience, reveals the significant importance that humans need connection, empathy, and cooperation. The human experience has a fundamental need for belonging. These qualities are not mere add-ons to our nature but are central to our survival and flourishing. Leaders who embrace this understanding can transform their organizations by fostering environments where employees feel valued, understood, and motivated to contribute their best.?

Addressing Bias and Fraud in Workers' Compensation?

One of the significant issues plaguing the workers' compensation industry is the perception of widespread fraud. This perception often leads to a bias against injured workers, fostering an environment of distrust and scrutiny. However, data shows that dollar-for-dollar fraud is not predominantly at the hands of injured workers. Instead, it often stems from other sources, such as healthcare providers, employers, and other entities within the system. This bias against injured workers can have detrimental effects not only on those who are genuinely injured but also on the overall culture within organizations.?

Workers who feel unfairly judged or mistrusted are less likely to be engaged and productive. To address this, it is crucial to recognize and confront the biases that exist within the industry and take proactive steps to counteract them. Understanding biases involves training and education to help leaders and employees recognize and challenge their assumptions about injured workers. Implementing fair practices ensures that investigations into potential fraud are conducted fairly and without preconceived notions. This judgment includes using data and evidence-based approaches rather than relying on stereotypes or anecdotal evidence. Increasing transparency in the claims process builds trust. Workers who understand the process and feel fair and impartial are more likely to trust the system and comply with its requirements. Focusing on supporting legitimate claims and providing injured workers with the resources they need to recover and return to work helps the individual worker. It fosters a culture of care and support within the organization.?

Cultivating a Culture of Trust and Empowerment?

We must cultivate a culture of trust and empowerment to move away from fear-based leadership. Transparent communication is key; open, honest communication helps build confidence and ensures employees feel valued and heard. When workers know their leaders are transparent and authentic, they are more likely to reciprocate with loyalty and dedication. Recognition and appreciation also play a crucial role. Acknowledging employees' hard work and creativity boosts morale and encourages further innovation. Leaders should make it a point to celebrate successes, both big and small, to reinforce the belief in each individual's potential.?

It is crucial to create a supportive work environment where employees feel safe expressing their ideas and taking calculated risks. This organizational culture means providing the necessary resources, training, and emotional support to help workers thrive. Involving employees in decision-making processes fosters a sense of ownership and responsibility. Workers who feel their input matters are more likely to be engaged and committed to the organization's success. These practices collectively contribute to a culture of trust and empowerment, laying the groundwork for a more resilient and innovative workforce.?

The Benefits of Embracing Humanity's Goodness?

Adopting a leadership style that emphasizes humanity's inherent goodness and interconnectedness has numerous benefits. Enhanced employee well-being is one of the most significant advantages. Workers who feel trusted and valued are less likely to experience burnout and more likely to maintain their physical and mental health. Increased innovation is another benefit; a positive, supportive environment encourages creative thinking and problem-solving, leading to innovative solutions in the workplace. Stronger team dynamics also result from trust and mutual respect, strengthening team cohesion and improving collaboration and productivity. Organizations achieve sustainable success when they prioritize the well-being and development of their employees. This prioritization positions the organizations for long-term success, instilling a sense of hope and optimism in the potential of each individual and the collective.?

The Neuroscience of Humanity?

Treating people with humanity and respect profoundly affects the brain, fostering an environment where individuals can thrive personally and professionally. Neuroscience shows that when people feel valued and respected, their brains release oxytocin, often called the "love hormone." Oxytocin enhances feelings of trust and social bonding, which are crucial for creating a cohesive and collaborative work environment. This neurochemical boost helps reduce stress levels and promotes a sense of well-being, making employees more resilient to challenges.?

Positive social interactions and recognition activate the brain's reward system, releasing dopamine, which is associated with feelings of pleasure and motivation. This neurotransmitter release increases job satisfaction and drives employees to perform at their best. By fostering trust and appreciation, leaders can enhance neural pathways associated with creativity and problem-solving, leading to more innovative solutions and improved productivity. The brain's plasticity, or its ability to form new neural connections, means that these positive effects can build over time, resulting in lasting changes in behavior and mindset.?

When leaders treat their employees with humanity, they improve individual well-being and strengthen the organization. This approach nurtures a culture of empathy and cooperation, where employees feel connected and committed to the team's collective success. By understanding and leveraging the neuroscience behind human interactions, leaders can create a more positive, productive, and innovative workplace, ultimately driving the organization towards more remarkable achievements.?

Treating People with Compassion and Respect?

The future of workers' compensation lies in a leadership that moves beyond fear and taps into humanity's inherent goodness and ingenuity. We can create a more resilient and innovative workforce by fostering trust, empowerment, and appreciation. Addressing biases and promoting fair practices is crucial to building a system that genuinely supports and values its workers. It is time to embrace a new paradigm that recognizes and celebrates the interconnectedness and potential of every individual. By shifting our perspective and practices, we can transform workers' compensation from a system focused on limitations and suspicion to one that highlights humanity's best, driving a more positive and productive future for all.?

HR Homeroom: Employer’s COVID Vaccination Rule doesn’t Create ‘Record of’ ADA Claim

Frank Ferreri

New York, NY (WorkersCompensation.com ) -- Since Pfizer and Moderna rolled out their answers to the COVID-19 pandemic, there's been countless arguments offered for why requiring a workforce to get the jab is a wrong idea. But, as a recent case shows again, the possibility of discrimination under the Americans with Disabilities Act hasn't been a successful one of those reasons.

Case: Sharikov v. Philips Medical Systems MR Inc., 2024 WL 2820927 (2d Cir. 06/04/24).

What happened: In October of 2021, an employer that was a federal contractor advised its employees that the federal government had issued a mandate requiring federal workers and employees of federal contractors to be vaccinated against COVID-19. Employees who failed to comply with the required would be considered to have voluntarily quit.?

An employee of the company expressed that he would not comply with the vaccination rule and claimed that it violated his rights under the Americans with Disabilities Act.?

Later, when a court put the federal mandate on hold, the employer announced that it was continuing to require vaccination of all employees as a matter of company policy.

Because the employee refused to provide proof of vaccination or approval of an accommodation, the employer notified him that his employment had been terminated and that it would be recorded a voluntary resignation.

The employee sued under the ADA, claiming that the employer “made a record of disability by classifying” him as an “unvaccinated” employee.

The District Court rejected his argument, reasoning that accepting it would mean accepting that the employer recorded all its employees as having an impairment, an argument that other courts had also rejected.

The employee appealed to the 2d U.S. Circuit Court of Appeals .

Rule of law: The elements of an ADA claim are:

1. The employer is subject to the ADA.
2. The employee has a disability or is perceived to have one as defined by the ADA.
3. The employee is qualified to perform the essential functions of the job, with or without a reasonable accommodation.
4. The employee suffers an adverse employment action because of his disability.

The ADA protects not just those employees who have an actual disability but also those who are subjected to discrimination because they have a “record of” an impairment.

What the 2d Circuit said: The employee did not have a “record of” claim because he did not allege that he had a history of or has been misclassified as having a mental or physical impairment that substantially limited one or more major life activities.

“The Complaint alleges only that [the employer] recorded him as not being vaccinated and not having applied for an exemption,” the 2d Circuit wrote. “These allegations fail to plausibly state a claim for relief.”

Thus, the 2d Circuit upheld the District Court’s dismissal of the employee’s ADA claim.

The takeaway: A record that an employee is not vaccinated does not imply that the employee has “a history of an impairment that substantially limited one or more major life activities when compared to most people in the general population."

Who Should Receive Urine Drug Testing and How Often?

Christina Klemm, PharmD, BCACP Enlyte

Urine drug testing (UDT) plays an important role in workers’ compensation, serving as an essential tool for pharmacy benefit managers (PBMs) to ensure safe and effective use of medications by injured employees. UDT helps PBMs monitor adherence to prescribed medications and detect potential misuse by identifying the presence of prescribed, non-prescribed and illicit substances. This testing supports compliance with treatment plans while simultaneously assisting in preventing fraudulent claims.

The?Official Disability Guidelines ?(ODG) recommends testing at the onset of chronic opioid treatment and then at an ongoing frequency based on documented risk stratification for addiction and aberrant behavior. Specific risk stratification methods and testing instruments aren’t listed in the guidelines; however, there is mention of attributes that may warrant certain risk level. *

Low risk:

• None of the below risk factors are present?

Moderate risk:

• Opioid changes without success
• Stable addiction disorder
• Unstable and/or dysfunctional social situations
• Co-morbid psychiatric disorders

High risk:

• Active substance abuse disorder
• History of UDT positive for illicit substances

It’s recommended that injured employees considered low risk receive UDT once a year. The frequency increases to two to three times a year if the injured employee is considered moderate risk and as frequently as monthly for those considered high risk. It is important to note that the ODG explicitly states, “the frequency of urine drug testing may be dictated by state and local laws.”

UDT isn’t the only method for confirming compliance with opioid treatment. It’s only one tool and does not replace others such as pill counts,?Prescription Drug Monitoring Program ?(PDMP) checks, opioid contracts, etc. As with any tool, UDT isn’t without its limitations. There’s still the potential for false positive and false negative test results. However, with the ever-improving testing technology this is becoming less of a concern.

The information obtained by conducting UDT in the appropriate injured employee population at the recommended frequency helps to ensure safety and compliance. Inconsistent results such as a negative result for a prescribed drug or positive result for a non-prescribed drug or illicit substance can lead to timely intervention that otherwise may have gone unnoticed.

About the author

Christina Klemm graduated with her Doctor of Pharmacy degree from the University of Arizona in 2010 and became board certified in ambulatory care in 2015. She has 5 years’ experience in workers compensation focusing on clinical programs and formulary management. Prior experience includes inpatient psychiatric rehabilitation and community-based health clinics.

Christina is also a regular contributor to the Ask the Pharmacist Series where this article originally appeared.

www.enlyte.com/ask-the-pharmacist

References:

https://www.odgbymcg.com

*This isn’t a comprehensive list of risk factors, nor is this meant to be the only means of risk stratification

Council Capital Enters Strategic Partnership with Allegiant Managed Care

Nashville, Tenn. (June 5, 2024) --?Council Capital , a prominent healthcare-focused private equity firm, has partnered with?Allegiant Managed Care , a proactive nurse case management company providing services within workers’ compensation and other property & casualty insurance lines. Terms of the transaction, which closed on April 24, 2024, were not disclosed.

“We were attracted to Allegiant Managed Care’s culture of excellent client engagement, embodied by employees at all levels of the organization who do whatever it takes to provide quality outcomes,” said Grant Jackson, Managing Partner of Council Capital.?“Through strong customer relationships and superior service, Allegiant Managed Care has built a reputation for quality, white-glove services that stands out among competitors as a captain of advocacy for injured workers.”

Based in Pittsburgh, Pennsylvania, Allegiant Managed Care provides vocational and nurse case management services to insurance carriers and third-party administrators across 20 states east of the Mississippi. The company employs a deep bench of nurse and vocational case managers who provide field, vocational, catastrophic, telephonic, and specialty case management services to help injured workers navigate the complexities of the workers’ compensation system and contain payor costs.

“For decades, we’ve seen this approach produce excellent outcomes for injured workers and billions of dollars in cost savings for employers and their insurance carriers,” said Allegiant Managed Care President and Founder Dave Miller. “Our clients and their employees report high levels of satisfaction, and we are thrilled to collaborate with Council Capital on the next steps in our journey.”

Council Capital’s investment will be used to scale Allegiant Managed Care’s services and introduce the company into more states and lines of insurance business. “One of the reasons we decided to partner with Council Capital was to access the wealth of healthcare and workers’ comp industry knowledge and support found in its CEO Council,” Miller said.

ABOUT ALLEGIANT MANAGED CARE

Based in Pittsburgh, Pennsylvania, Allegiant Managed Care ?was founded in 1992 by?Dave Miller. Allegiant Managed Care?offers an array of workers’ compensation and injury benefit services that include medical case management, vocational case management and specialty services such as Life Care Plans, liability record reviews, medical cost projections and Medicare Set Asides. The company?delivers tailored solutions through a dedicated team of results-driven case managers with a commitment to providing the best possible services to injured workers.

ABOUT COUNCIL CAPITAL?

Council Capital is a healthcare-focused private equity firm based in Nashville, Tennessee. The firm invests in lower middle-market healthcare companies ($10-100M enterprise value) positioned on the “right side of change” in the healthcare industry, where growth aligns with increasing cost pressure and quality demands. Council Capital’s unique model supports management teams in business growth by leveraging the relationships and resources of its CEO Council, Strategic Healthcare Investors, and Value Creation Team.

The Council network, anchored by its CEO Council of 34 senior private and public sector executives who have personally invested over $140M in Council Capital funds, maintains direct relationships with payers, providers, and employers, representing more than 60% of the country’s managed care lives, numerous provider organizations, and millions of self-insured lives.