New AMA Classification of Obesity: How it Affects Workers Compensation and Mandatory Reporting CLM016

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2 New AMA Classification of Obesity: How it Affects Workers Compensation and Mandatory Reporting CLM016 Michael Davis, Sr. VP Risk Control Services Lockton MaryRose Reaston, Ph.D. CSO Founder Emerge Diagnostics

3 Learning Objectives Ø Ø Ø Ø Why unhealthy employees have more frequent and costly on the job injuries Best in class safety results will require a combined approach How to prevent Obesity as a work-related condition Impact of court decisions of AMA reclassification of Obesity on your business

4 Emerging Business Trends Ø Lack of top line revenue growth Ø Customer driven standards for safety results Best in class safety results Ø New employer challenges: Shrinking available workforce Aging workforce Increasing health care costs Obesity as a disease

5 Emerging Trends in Work Comp Ø How many of your companies practice Behavior Based Safety? Ø How many of your companies have health and wellness biometrics or educational programs? Ø How many of your companies have financial wellness educational programs? Ø Do you see increasing percentage of injury costs result from the lack of wellness or poor financial health of your employees?

6 Interrelationship of Life Wellness Factors WorkPlace Health & Safety Health & Wellness Financial Health

7 Interrelationship of Life Wellness Factors WorkPlace Health & Safety Health & Wellness Financial Health

8 Obesity in America Ø 20% of the population BMI <25 = Healthy BMI Ø 50% of the population BMI = Overweight Ø 30% of the population BMI >30 = Obese Obesity has doubled in the past 15 years National Institute of Health; Journal of Occupational & Environmental Medicine. May 2012

9 Johns Hopkins Study: N=7,690 Ø 4-year study Ø 85 percent of the injured workers were classified as overweight or obese. Johns Hopkins University Bloomberg School of Public Health: May 16, 2007

10 Duke University Study: N=11,728 Ø BMI greater than claims per 100 workers Average lwd s per 100 workers Average claim costs were $51,019 Ø BMI less than claims per 100 in workers Averaged 14.2 lwd s per 100 in workers Average claim costs were $7,503 Duke University Study: Archives of Internal Medicine. April Research Grant NIOSH

11 Obesity as a Predictor of on the Job Injuries: National Institute of Health: Cross sectional study - N=42,000: Ø Baseline BMI <25 Ø BMI 25 < 30 = 15% increase, Ø BMI >30 = 48% increase National Institute of Health; Journal of Occupational & Environmental Medicine. May 2013

12 Obesity as a Predictor of on the Job Injuries: National Institute of Health Fire Fighters - N=433: Ø Baseline BMI <30 Ø With BMI >30 = 289% increase Clear association between obesity and occupational injuries in high stress jobs National Institute of Health; Journal of Occupational & Environmental Medicine. May 2013

13 Obesity as a Predictor of on the Job Injury: Finland N= 69,515 Academy of Finland, the Medical Research Council Kouvonen A, Kivimäki M, Oksanen T, PenC J, De Vogli R, et al. (2013) Obesity and OccupaQonal Injury: A ProspecQve Cohort Study of 69,515 Public Sector Employees. PLoS ONE 8(10): e doi: /journal.pone February 14, 2013

14 Bureau of Labor Statistics: Demographics Projections Ø The labor force will increase by 12.8 million Ø The number and percent of workers between ages 16 and 24 years will decline from 14% Ø The number of workers ages will increase by 1.9%, share of the labor force will decline from 68.4% to 64.6% Ø The number of workers 55 and older is projected to grow by 28% or 5.5 times the rate of growth in the overall labor force Johns Hopkins University Bloomberg School of Public Health: May 16, 2007

15 Bureau of Labor Statistics: Workforce Totals* All Workers 128, , , ,450 Age - 16 to 24 21,617 22,366 21,285 18,462 Age - 25 to 54 91, , , ,195 Age - 55 and older 15,060 20,777 32,437 41,793 *Times 1,000 Bureau of Labor Statistics; Labor Force Projections December 2013

16 Bureau of Labor Statistics: Labor Force Projections Bureau of Labor Statistics; Labor Force Projections December 2013

17 Obesity vs on the Job Injuries Type of Treatment Required Normal BMI <24.9 Overweight BMI Obese BMI >30 ER visit 6.7% 10.1% 10.3% PCP visit 16.3% 20.1% 19.1% Specialist visit 12.5% 20.1% 33.8% Physical therapy 10.6% 14.2% 16.1% Surgery 3.8% 4.2% 4.4% National Institute of Health; Journal of Occupational & Environmental Medicine. May 2012

18 Obesity vs Type of on the Job Injuries Body Part Normal BMI <24.9 Overweight BMI Obese BMI >30 Neck 3.8% 4.6% 4.5% Shoulder 3.8% 5.5% 10.3% Back 11.5% 16.4% 17.6% Elbow / hand 0.8% 3.7% 5.9% Hip / leg / knee 7.7% 8.7% 11.8% Foot / ankle 6.7% 6.4% 5.5% National Institute of Health; Journal of Occupational & Environmental Medicine. May 2012

19 Disease Management Comorbidities Costs

20 Retirement Planning Predicts Employee Health Ø 76% of eligible employees contribute to 401k s Ø 24% of eligible employees do not contribute to 401k s Ø When people are informed of their situation, they begin to act rationally and capture spillover benefits in other domains*. Employee Benefits Research Institute *Drexel University: Wesley Gray PhD. Finance Professor

21 Financial Well-being: Taboo in the Workplace? Ø 69% of employers believe that employees feel that their organization is concerned about their financial wellbeing Ø 10% of employees actually believe this Ø 17% of employees said they would value more guidance from their employer with managing their finances Barclays December, 2013 study

22 Washington University Study; Pierce & Gubler Ø Retirement planning predicts employee health improvements Ø It s all about taking care of your future Ø Workers who save take better care of their health Ø Employees who invest in 401k showed improvements in blood tests and health behaviors 27% more often than non-contributors Washington University Study: Lamar Pierce PhD. and Timothy Gubler

23 Financial Health Categories Ø Comfortable, Coasting, Balancing and Slipping Ø 59% of employees are in the balancing category, focusing on managing their current financial situation rather than saving for the future. Ø 11% employees fall into the slipping category they have no savings and are regularly spending more than they earn. Barclays December, 2013 study

24 Impact of Obesity on Workplace Injuries & Disability Ø Duke University Study: ROI for wellness plans = 165% Reduced sick days, improved productivity, reduced disability days Lack of wellness increases the severity of workplace injuries and increases recovery/disability period Disability costs associated with obesity are 7-times higher than those with BMI under 30 Duke University Study

25 Value of Wellness Coaching $1.00 invested returns $1.65 in healthcare cost reduction: Ø 21% > eating habits Ø 15% > physical activity Ø 20% < sick leave Ø 59% < health care costs Duke University Study

26 Results of Wellness Coaching: Successes: Ø 42% Reduction in Work Comp Claims Ø 62% Reduction in the number of Lost Time Claims Ø $120,000 claim cost reduction per 100 employees International Association of Fire Fighters: BMI Predicts Work Comp Claims. Oregon Health & Science University, Journal of Occupational Medicine. National Institutes of Health. May 2013

27 Lockton Study - Infolock

28 Chronic Disease Untreated Treat underlying conditions: Ø Ø Ø Ø Biometrics screening less than 39% participate Treat high blood pressure less than 27% manage the condition Treat Diabetics less than 13% manage the condition Treat high cholesterol less than 26% manage the condition Lockton Benefits N= 1,000,000+ Infolock study, February 2015

29 Maslow Safety is the Second Need

30 What Factors Influence Employee Decisions in the Workplace? Ø Poor decisions don t start in the workplace Ø Life long pattern of risk taking Liberty Mutual Study: Low credit scores predict future claims Ø Life goals Ø Immediate goals

31 Influential Factors - Life Goals Ø Vision of one s future self = Life Goals Financial health Health and wellness Workplace health and safety Ø Life goals drive perception of consequences What do I have to lose? In the moment decisions Personal goals Family dependency

32 Life Goals: Essential Elements of Wellbeing Gallup Study: Ø Career Wellbeing: liking what you do every day Ø Social Wellbeing: having strong relationships and love in your life Ø Financial Wellbeing: managing your economic life Ø Physical Wellbeing: having good health and enough energy to get things done on a daily basis Ø Community Wellbeing: the sense of engagement you have with the area where you live Strengths Finder essential elements of wellbeing: Tom Rath & Jim Harter Phd. 2008

33 Wellness Initiatives Employers Tools Ø Biometrics - Health Risk Assessments Ø Health Coaching Ø Preventive Medication Paid Ø Increased Medical Contributions Nonengaged Ø Financial Planning Ø Automatic enrollment in 401k

34 Achieving World Class Injury Reduction Ø Provide coaching on health and wellness for your staff Ø Provide coaching on the financial wellness for your staff Ø Recognize the limitations of an aging workforce Ø Design job physical demands within the capabilities of your aging workforce

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36 AMA Reclassification of Obesity June 16, 2013, the American Medical Association voted to declare obesity a disease rather than a comorbidity factor. Ø This will affect 78 Million Adults Ø The U.S. Department of Health and Human Services said the costs to U.S. businesses related to obesity exceed $13 billion each year.

37 The Future Back Pain Knee Injuries $ Obesity $ Cumulative Trauma Shoulder Injuries

38 Obesity and the ADA Ø The American Disability Act Amendment of 2008 allows for a broader scope of protection for disabilities Ø The classification of obesity as a disease means that an employer needs to be cognizant is now considered protected under the American Disability Act Amendment

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40 Obesity and the ADA Litigation Ø A federal district court ruled in April 2014 that obesity itself may be a disability and will allow, Joseph Whittaker v. America s Car-Mart, in the federal district court for the Eastern District of Missouri to move forward under ADA. - Severe obesity is a physical impairment Car dealership and company regarding his as disabled in the essential function of walking so he was terminated without reasonable accommodation. - Impact: Once obesity is accepted as a valid disability, injured workers could more easily argue that their obesity is a permanent condition that impedes their ability to return to work, as opposed to a temporary life-choice that can be reversed.

41 Whittaker v America s Car Mart Ø A federal district court ruled in April 2014 that obesity itself may be a disability and will allow, Joseph Whittaker v. America s Car-Mart, in the federal district court for the Eastern District of Missouri to move forward under ADA. - Severe obesity is a physical impairment Car dealership and company regarding his as disabled in the essential function of walking so he was terminated without reasonable accommodation. - Impact: Once obesity is accepted as a valid disability, injured workers could more easily argue that their obesity is a permanent condition that impedes their ability to return to work, as opposed to a temporary lifechoice that can be reversed.

42 Obesity and the EEOC Ø EEOC excluded being overweight as definition of Impairment Ø EEOC and Obesity: - Severe [or morbid] obesity - Body weight more than 100% over the norm - Qualifies as an impairment under the ADA without proof of an underlying physiological disorder. Ø Rising number of EEOC-driven obesity-related lawsuits - Federal district support the EEOC s position that an employee does not have to prove an underlying condition, especially in cases in which there is evidence that the employer perceived the employee s obesity as a disability or otherwise expressed prejudice against the employee for being obese.

43 Mandatory Reporting

44 Mandatory Reporting Ø Medicare reporting to CMS in electronic format Ø No statute of limitations compliance Ø Paying twice + Ø MSA Re Review Process

45 Are You Prepared for the Consequences of Accepting a False Claim?

46 AOECOE Only Ø What if you could perform a simple baseline test to compare current status with pre-injury status? Ø What if the baseline test was objective, without subjective influence? Ø What if this baseline test can prevent a claim, prevent Mandatory reporting and prevent an OSHA recordable? Ø What if this test can give back control of medical care even in states that don t allow it? Ø What if it no longer matters if Obesity has been re classified?

47 Why Baseline Testing Ø Good Baseline Testing = Non Discrimination Ø Fewer OSHA Recordable injuries Ø Only Accept AOECOE work related injuries Ø Compliance with Federal Mandates Ø Obesity becomes an non issue in Comp and ADA

48 Baseline Testing Ø Proactive risk management process for objective diagnosis for work-related injuries Ø How does it work? Develop testing protocols based on the essential functions of the position as outlined in the job description provided by client Test new hires and store the unread data as a baseline Test appropriate groups of existing workforce with a fitness-forduty evaluation and store as a baseline Post-injury: perform EFA test; compare with baseline

49 A Example of Baseline Testing Ø Electrodiagnostic Functional Assessment- EFA - EMG, ROM, FCE Proprietary equipment and service protocol for diagnosing and assessing soft tissue injuries Ø FDA Cleared Definitive Intended use section - Measure, monitor and assess any muscle group, including cardiac - Distinguish between acute vs. chronic pathology - Objectively quantify effort (patient compliance) - Baseline Testing - Evidenced based medicine

50 Case Study: Baseline Testing Results Ø 48-year-old driver BMI in excess of 30 felt a sharp pain in his back after lifting at work. When he reported the incident, he stated that he was injured before his EFA baseline evaluation and that even no change from the baseline still meant he had a work-related injury. Ø Scenario A Without Baseline Ø Scenario B With Baselilne Obesity - Non issue

51 Baseline Testing Results Ø 15,000 baselines conducted Ø 0.18% had claimed a soft tissue injury Ø 0.03% resulted in a change of condition. Ø 3 litigated - Less costly because the objective evidence provided by the EFA post-loss test leads to more rapid, accurate and favorable results.

52 Action Required! AOECOE Only!

53 Questions Michael Davis CSP., ARM. Senior Vice President Risk Control Services Lockton Mary Reaston, Ph.D Chief Science Officer, Founder Emerge Diagnostics