Cancer Research Jobs

good afternoon and thank you for joining usin the washington dc office of mathematica policy reasearch and i want to thank everyoneattending webinar my name is henrick packet, here mathematica it's my pleasure to welcomeyou all here today for disability policy form on helping workers keep their jobs after experiencingan illness, injury or disability. this form is hosted by the centers for studydisability policy which was established in 20,007 to help build the evidence sound andeffective disability policy. finest on the sinners research are intendedto inform policies and programs are on the nation to help all americans with disabilities. phase form is sponsored by the stay-at-workreturn-to-work policy collaborative which

is a product on a by the office of disabilityemployment policy or or death at us department of labor. or death initiated the collaborative to explorepolicy options that might help doctors experience medical problems stay in the work force orreturn to work after recovering. in addition to supporting work these policiescan workers entreated the ssdi program for disability insurance program since 2013 thecleverness focus on earlier introduction that might help workers when they experiencingon set of medical problems in typically one before they apply for ssdi part over the lastyear the collaborative has focused especially on what states can do.

state staff are closer to the ground on theissue they can address them through a variety of state administrator programs. now to put extents of this problem in context,there will be familiar from many of the audience and perhaps those who attended past formslike this about 2.5 million workers per year leave the labor force and at least temporarilybecause of an injury or illness. and so this figure shows a rate of entry inthe ssdi program and we see that it is about 700,000 to 1,000,000 workers per year wereawarded ssdi benefits between 2002 and 2014. the fundamental truth is many workers withmedical conditions do not get the help they need to stay at work today must navigate acomplicated system of medical care and other

services and if they receive inadequate orinappropriate care, potentially treatable conditions can worsen in his results unavoidablework disability. and when that happens it's a tragedy for workersand families, and society loses a productive member. >> earlier this year the project team actuatedthe net benefits to successfully helping america remain employed after the onset of a medicalcondition assumes to take place at age 50. and so on a side now is a bar chart showingthe net benefits through the age of retirement and is calculated from several sectors i keeptake away here is that state work return-to-work investments have a win-win potential for stategovernments federal governments and employees.

and states would benefit from increased taxrevenues on workers earning in the jobs they retain. as well as lower medicaid cost and smallerpayouts through state assistance programs. the federal government would realize evenlarger increases in tax revenues and also larger savings on public assistance programsthat are funded at the national level. and the employee is the biggest winner hereand it makes sense because he or she can retain the job in the earnest that are associatedwith it. >> for employers, who are actually not shownon the graph it's more complicated story because they directly incurred the cost associatedwith workplace associate with workplace accommodations

as well as reduced worker output after aninjury or illness. unfortunately for many small employers, formany employers especially small and medium businesses, the net incentive to retain workersmay not be very strong..where the intent incentive is wrong to retain workers in typically forlarge shrubs employers may provide or directly fund state work in return-to-work services. and the private investments are already takingplace in the potential value of expanded public investment of this nature and public-privatecoordination to support individuals but faz work limiting medical conditions. day we will hear from the leaders of eachof the collaborative's policy workgroups to

present different ideas for addressing thisproblem. first here is an upstairs johnson associatedir. of human resources and mathematica will discuss promising behavioral interventionor nudges as they are called that could promote a job retention after the onset of a medicalcondition. next yen ascend venture loan a senior researcherproject record of the state work return-to-work policy collaborative were set states can pursueto help workers keep their jobs after injury illness or disability. then david stapleton director of mathematicacenter for study disability policy will discuss a coordinated community-based workers compensationprogram in washington state that and how to

be expanded to respond to the onset of offthe job medical conditions. the recommendations are outlined in threenew policy action papers which will be available along with companion to page fact sheet throughoutproject page on mathematica's website and there's a link for that at the end of theslide deck for today's form. however please note that today's presentationsand papers on which they are based do not necessarily reflect the user policies or avote pretty federal agency. on finally we are honored to have with ustoday jennifer sheehy and annette bourbonniere and they will discuss the recommendationsfrom the policy workgroup leaders and put them into context of current government policiesand initiatives.

mission he is the acting secretary assistantsec. of labor for disability employment policy and ms. bonaire is a party consultant specializedin healthcare outreach and employer engagement i like to thank both of them for supportingthe work presented at today's form. >> before we get started with the presentationi have a few housekeeping reminders for the audience prefers to our session today includesboth in person attendees and an online audience joining us via webcast. for the run to help ensure the highest possiblesound quality for a webinar participants, we use silent all of your electronic devices. in addition we are videorecording today'ssession and as a result we may capture images

of some of the end the recording will be postedon our website next week. also you may follow along with today's eventand submit your questions via twitter the event has taken is rtw policy. finally we will pray for questions from bothour in-house and 11 our audiences after yanni speaks and again after and it are bonaire'sspeech for those of you participating via webinar please submit your questions electronicallythrough the q&a panel on your screen at any time during today's form. will alternate your questions for the webinaraudience with those from our in-house audience. and with that, i am pleased to tony put themover to arbors presenter irma perez-johnson.

>> thank you, heinrich and thank you to everyonejoining us at the form here today i am delighted to have the opportunity to talk to about theconclusions and commendations that the policy workers back in behavioral intervention topromote job retention and after injury or illness. and before the end i do want to acknowledgethe many contributions of my colleague dr. karen contrary i health economist in our oaklandoffice. who could not be here today and as well asthose of our very helpful members of the expert panel who also contributed many importantinsights and ideas for the work that i will be presenting here today.

>> our policy workgroup examine the eventsand interactions that can help shape outcomes related to work for workers who experiencean injury or illness as as experienced both -- and we try to bring a behavioral to bothinteractions and by that i simply mean taking into account the many psychological behavioraland social factors that influence all of our decisions and actions on help us understand[ indiscernible - audio cutting in and out ] why we procrastinate -- and generally actin ways that may not be fully rational so there's many many examples of effort so withthat in mind we try to identify the key actors and interactions that may help shape stay-at-workin return outcomes and for example, clearly when a worker first experiences a work potentiallywork limiting condition, they will try to

seek information about the condition fromfrance colleagues coworkers, the internet and the like in the information they findwill help shape their decision about staying at work or returning to work. they will also seek care further conditionfrom a position and it's important to understand that positions are highly influential alsoauthoritative figures in the process whatever advice medical advise they provide and commendationswill carry a lot of weight with workers and will help shape their expectations for recoveryand their understanding of their prospects for returning to work. that point the worker may return to work,and [ indiscernible - audio cutting in and

out ] request temperately for some employmentat some point the employer will also become aware of their condition and how the employeramber response to the workers condition will also be influential in the worker's ultimateoutcome. finally the worker will also may apply forshort-term compensation, workers short-term disability worker's compensation or long-termdisability and the insurers will provide financial support while workers are not able to workthrough their actions and ultimately also intentionally or unintentionally shape thesework-related outcomes. >> as we examined these interactions, ourhope and our goal was to identify common pitfalls or factors that may unintentionally or unnecessarilybe contributing to workers leading the workforce.

so for example what were some of the potentialreasons why workers may not necessarily leave the workforce that considering first workers[ indiscernible - audio cutting in and out ] they may be struggling with decisions aboutremaining or returning to work just because of the stress they are under when first experiencinga new medical condition the answer to your financial and physical hardship that thereexperiencing under from their condition. obviously decisions about returning to workand bouncing their new health needs and work responsibilities are likely to be complexand that complexity may also contribute to workers not being able to make decisions aboutreturning or remaining at work. then they also underestimate their capacityto adapt or improve over time when first faced

with these conditions. and finally they may be painting themselvesand overly rosy picture of what life among disability might be like in underestimatethese many social psychological and financial benefits of remaining at work in the long-term. these are all attentional factors that maycontribute to workers unnecessarily leaving the workforce. focusing next on positions i think most ofus recognize that physicians have limited time and attention to focus on issues beyondthe worker's immediate health concerns when they praise a worker needing treatment.

and for many especially primary care providers,i think one of the themes that came strongly from our discussions with them is a many ofthem have never received treatment training dry-cleaning on the treatment of work limitingconditions and disabilities and are not only with evidence-based guidelines for time offfrom work or referral to specialist. finally focusing on employers, it seems manyof them underestimate the potential benefits of keeping the workers at their job and overestimatethe hassles and the cost of making accommodations. having identified these in potential barriersor so-called behavior bottlenecks we can then focus on strategies that may help addressthese issues and therefore help more workers remain and return at work and before i getinto this one i wanted to point out that in

our paper we also not only discussed beforeit is intervention strategies but also try to prioritize those that seem to have somepromising evidence of effectiveness that seems feasible in the sense that could identifypotential funder and administrator as well as a trigger for their deployment and finallythose that seem to have a potential to be implemented up to scale this is a problemthat we are really trying to effect on a large-scale. >> the intervention i want to highlight foryou multiparty dialogue is a intervention that was inspired by a mandatory program fornorwegian workers go on long-term extended leave on their job. in the idea here would be to bring togetherthe worker and an the representative and medical

proxy and insurance together to develop aplan and timeline for the worker to return to work if that is in fact feasible. to illustrate again our thinking on why wethought this would be promising, we envision that an intervention like this could be triggeredby the submission of a claim for workers compensation or short-term disability or the request forextended leave from work but could be an insurer a state or federal government and programlike this one could be administered through an insurer itself the employee assistanceprogram in employer resource networks or even our public 454 system so there's many differentoptions here. >> in addition [ indiscernible - audio cuttingin and out ] implementing in combination with

you multiparty dialogue or test on their ownfor example we seen desirable to make available to injured workers and workers to give themaccess to periodic sessions with job retention coach that may have special specialized trainingon the treatment of disability and returned work issues. and the goal of the sessions be to procurethe best most appropriate outcome for the worker so it is not an idea of always pushingfor work but pushing for work in helping the worker returned to work when it is in advantageousand as we consider this idea seemed feasible to model it worked to build it on a programlike washington state centers for occupational health and education or cody which you willhear more about the my colleague david stapleton.

in addition because people may be underestimatingthe benefits of remaining at work and overestimating the benefits of going on long-term disabilityseem desirable to provide financial counseling perhaps facilitated by some sort of structuredonline total that to again cultivate realistic expectation and interestingly there are examplesof such tolls and we found disability benefits when a one examples of such tolls and we founddisability benefits when a 1101 that illustrate the feasibility of this concept and finallywhen potentially offer bonuses or other incentive for workers to return to work and interviewthis was an intervention that could in fact be anchored or tied to milestones in a returnto work plan like one developed under multiparty dialogue through job search return for coachingand there are examples of these kind of programs.

from the unemployment insurance system. that have been tested in the past and shownpromising. finally, interventions based on electronichealth records seem promising as promising strategies to address some of the bottlenecksfound from their positions and here it seemed feasible to based on the diagnosis codes thatare entered into electronic health records, displayed guidelines or for treatment or timeoff of work and other information is particular relevant in that instance. and therefore help physicians make more appropriateaccommodations for workers. and i won't go into the details of this particularintervention.

in our paper we discussed several other strategiesand approaches that may be thomasine and helping address the behavioral bottlenecks identifiedincluding a broad information campaign modeled after one in australia that help address misconceptionsabout the proper treatment of lower back pain one of the leading causes of long-term disabilityhere in the united states, assistant education programs to help familiarize them with benefitsof keeping workers attach to work and finally including employment a quality metric forhealthcare systems and providers as a strategy to move better incentivized positions forwork focusing on work related issues and compensating them for the time they spend on such issues. and with that, there is the information formyself and karen and i look forward to your

comments and questions as well as discussing. >> thank you, kurt>> thank you very much -- thank you, irma >> flypaper is about thomasine early interventionoptions states and happy workers do their jobs after injury illness disability and wethink that states can take a variety of steps in some states already doing that to fillthe gaps in the system that high rate described earlier. so i had out group of policy worker backspaceand i won't list them and name the mall but they are listed here and also want to thanksome other people who engaged with me what the discussion over the phone.

very interesting discussions and suggestions. we focus on what sas can do because statesare closer to the ground as heinrich mentioned and we thank heaven array of tools to addresssome of these problems the regularly interact with employers and workers to the work forcedevelopment ber workers compensation help and other agencies and these agencies do havetwo goals to have better outcomes. as you will soon see some states have alreadytaken steps to help then some cases programs at least some what address the behavioralbottlenecks that irma mentioned. >> overstays this significant challenges thathinder their ability to -- benefit from them first and past for most general lack of awarenessand leadership in states regarding the problem

of job and illness -- large number of workersleave the labor force and interest sdi. stated could be tens of thousands of peopleevery year. several reasons for this the issue generallylacks visibility there's a lack of recognition of job loss and were forced as substantialnegative consequences and often preventable that and there's a misalignment of the costand benefits associated with the worker departure from the labor force as using the cost benefitanalysis the savings to the federal government are much larger than they are to the stateso the state doesn't have to much of an incentive compared to the federal government to do somethingabout it. another challenge is the relevant state agencieshave not traditionally focused on workers

at risk of losing their jobs if we think aboutstate workforce agency they're investing in helping unemployed people get back into thelabor force and state are mostly serve individuals with significant disabilities who either havenever worked for or been out of the labor force for some time and typically have limitedcapacity to serve those employed and i'll soon talk about some states that are addressingthose issues despite those challenges. finally some states have to make difficultfunding decisions regarding competing priorities and face considerable constraints in termsof recommendation of the state agency responsibility limited capacity to do more and infringementon the status quo in which various stakeholders or positions advocates often died were justpart of disability benefits rather than remaining

in the labor force. >> however despite the challenges we havefairly recent development that enhanced its ability to provide timely job retention servicesto workers or benefit from them -- we are committed to treat that outcomes for job retentionof current employees for specific services of equipment to maintain appointment regardlessof whether that state has an order of selection or if the person was formally of the our clientand second significant development is a revision to the rule implement section 503 of the rehabact in that role requires federal contractors and subcontractors to aspire to increase the7% of the percentage of their employees with disabilities and one way they could do thatis help workers who experienced disability

stale work so they might see an increase indemand for job retention services from employees and employers trying to achieve that 7% goal. other relevant the velvet is the expansionof the health insurance coverage under aca both in medicaid and easy exchanges statescould potential he is the leverage to promote letters they work their practices among physiciansand finally the concept of states and model employer with people disability sucking alot of traction with recent years with many states leading by example and hiring individualswith disabilities in this concept could also be applied to retention of workers with newlyacquired disabilities are today's presentations and i know that there are many in the privatesector and the audience today and i do want

to mention that many of these workers whoworked in the private sector are not covered by private disability insurance and many casestheir conditions are not worker's compensation so of their doing great work in some of thoseprograms need to realize there's a lot of workers who fall through the cracks and don'tactually see anybody who can help them apart from a position. position -- warehouse states intervene toprove to caused the two systems in which see this in the table shows for primary avenuesfor intervention and the respective party populations only had occasional need helpis relatively straightforward and worker's comp. workers with job-related injury or illnessare probably claim in the benefits include

both placement and medical care which givesa lot of leverage in both systems to help and we do see a lot of activity there. any five states presented for each work disabilityinsurance programs -- engagement is also easier because there is a claim however most of thestates don't do much in or get rhode island's of which is a state that is doing more thanothers are. and state-of-the-art -- another opportunitystate intervention and i mention that we'll up amendment that makes it easier to do howeverin the our there's no filing of claims to receive benefits that will trigger the provisionof services so they really need to rely on some kind of robust referral system.

finally states can intervene with their ownemployees with administration of health insurance disability insurance and other benefits statesemployee millions of workers most of them are not covered by disability insurance. >> though small pockets were states have intervenedto kim and reduce cost with varying degrees of scope and evidence of success upon examplesagain washington's records competitions as a material talk about soon as i mentionedin state short disability insurance through rhode island is purely state that has implementit changes really targeting improvements in work outcomes claimants after a task forcein 2005 they started a partial return to work program and work has been returned to workon a part-time basis is still received further

benefits and rhode island also requires aphysicians are evidence-based guidelines for the duration of time off work and after thetest was recommended these changes, these changes were implemented within a year. and that has been around since 2006. quite a few states operate the our programsthat are dedicated to helping retain employees who need assistance to stay at work and wemention alabama and arkansas here we had people from agencies on our policy worker for weknow a few other dvr agencies and alabama has the that retain valued and poison alabamasingle point of contact rapidly assesses individual's needs and arranges for assistance accordinglythat arkansas program avenue but it is important

to recognize that the programs help only afew hundred workers each year when the states or thousands of workers winter ssdi each yearand it's her room to do that more there. and the agencies want to do more but don'thave necessarily the funnier capacity for. finally the return to work program stood outto us in that it is a state that has disability insurance coverage for the employees and alsocoordinated program to help them return to work quickly there's a return to work learnedthat people know they can turn to in that court and works with the disability insurancecarrier to help get people back to work as soon as possible. >> the paper we present them menu of optionsfor specific steps it takes intake to increase

access to job retention services for workerswho need those services that are not currently receive them -- we think that the most appropriatecourse of action will value vary from state to state depending on the capabilities ofagencies in that state -- what do you recommend -- list are with the call class-based interventionswhether there's a claim that figures the services the three state public worker's compensationfonts north dakota ohio and wyoming can potential he from washington: program that they willtalk about but any state workers compensation system whether it is one of competitive testaccommodation subsidy programs such as oregon washington or follow ohio's workers compensationprogram for the provide training and incentives to encourage employees to develop and implementtraditional work programs and then we have

the states with the short-term disabilityinsurance programs they could learn from rhode island to sprint introducing partial returnto work program these states could also pilot test and behavioral intervention such as bothirma and have or will cover and then delaware in any other state government that providesthis employees with the eight std pilot test a variety of programs including partial returnto work case coordination implementing disability duration guidelines and behavioral interventions. as i mentioned most days do not offer privatedisability insurance coverage to be employed so you might want to consider offering thatand but they do need to be proactive about promoting a return to work for that to makesense.

>> these are accommodations for what we callreferral-based interventions where we don't have a claim to trigger the event and staywith pr agencies have provided job retention services but really need to think about howthey can do more to his referrals to services and increase the capacity to do more and meritsof protesting ike seeley g approach adopted for off the job cases within the healthcaresystems and some of the ideas mentioned that irma can fit in there to finally states alreadyprovide eabfive eab benefits to their employees and they can consider how to work with theeap provider and focus more on retention of workers including those mental illness andother states can consider the merits of offering the eap benefits to the employees to beginwith.

to conclude how do we move forward? the promising initiative recommend for statesthat are existing and private sector capabilities can be tested fairly rapidly by states, partnershipprivate sector, and while some states have acted on her own others could be encouragedto do so with the act of the federal government as shown in the cost-benefit analysis thefederal government is a one is danced again more than the states do and really could playa role here and we think multiple federal agencies will need to coordinate between thetwo make that happen and we also know there's some movement in that direction already withboth the president's budget for 20 17th and additional legislation proposing an integratedinteragency council on wordpress attachment

and i guess we'll wait and see. >> with that we will head into some questionsfor the first two presenters and a couple is going in one, please make sure that stateyour name and affiliation when asking a question and limit yourself to just one question ifyou could. for those in the room still be a microphonethat will come to you please speak into it so people knew webinar audience can hear you. and for those attending online please continuesending questions through q&a panel report of the q and a panel or do it using what the#rtw policy. we will start with the question in the room.

anybody raise your hand. >> dr. mary campbell with the dc departmentof behavioral health and i am idea iea quarter and modified duty return to work officer youmention the 504 but you left out the ada and i used it a lot to help and keep workers onthe job or getting them back to the job modifying their job duties that without intentionalwas that intentional? but no it was not intentional i think youmake a good point you're talking about a new development that ada has been around for awhile -- >> [ indiscernible - participant too far frommic ] >> we have a paper from last year where wetouch on ada the role of 88 more directly

like to move see if i touched on it on mypaper and focusing on new opportunity -- it is worth three derating but i do want to makea point it has been around for 25 years now. and we need to think about ways to enforceit i guess. >> i didn't say we should change it. >> baby take a question from the webinar>> sure this question is from linette henderson from vanderbilt university, the question is-- have you given any thought to invisible or progressive genetic conditions that makeit difficult to know what days you might be feeling well enough to work or is just likeme where i struggle and a full-time status faculty position even with fmla and disabilitystatus?

>> i think it's a great question. for so much heterogeneity with conditionsand in my presentation we talked about what could trigger the help and the claim is theeasy case where there's an obvious trigger these other cases where else invisible notsometimes it takes time for the workers themselves to know that down the line this might be aproblem in its user to address etc. but for person who has an invisible disability, itis really i think that's one reason why information like irma talked about makes is to raise awarenessthat there are many people who have some conditions that are not that we might know about themove some of discloses that even then the question is how do you handle the issues withit.

>> i agree with everything ianni said andthey get the example about the multiparty dialyzed may be particularly in helping educatethe employer as to the specifics of that condition so they can bash in help achieve a more satisfactoryarrangement for the worker or perhaps are given more flexibility, and come to an agreeablesolution but i think again it just information and that sharing and joint learning is reallycritical. >> my name is lauren gilbert with georgetown'sglobal social enterprise initiative and my question is to ms. perez johnson you mentionedvery briefly and australian information campaign and i was wondering if you could go into moredetail about it. >> sure.

the campaign i was referring to, i don't rememberthe exact timing of it, but it was within the last 10 years. it aims to educate both the broad generalpublic and position positions and individuals involved in treatment and individuals withlower back pain as to what were appropriate treatments and for example that it is illadvised to tell a person to rest a lot and not move and that in fact sort of what practicescould actually worsen the condition. the campaign was also paired with direct informationfor positions on treatment options and guidelines so again more detailed information that wouldbe particularly relevant for the position and interestingly in following up with positionsin the survey of the general public they found

a significant shift in attitudes toward lowerback pain changes an actual knowledge about what was appropriate treatment and what werecounter indicated strategies for as well as lower medical claims, lower medical expenses,with the condition and there's a couple of interesting papers that we reference an hourpaper, it project if implemented in the united states the potential savings health savingsand medical savings and reductions in long-term disability and the numbers are actually quiteimpressive so i would welcome when reading the paper please get in touch if you haveany further questions for >> it would be released later today for laterthis week and -- today. ill be available online in the link is inthe slides.

>> this question from lee koslow from rochesterworks in rochester new york and the question is is there anything available on individualswho leave the workforce and begin to receive ssdi segmented by industry? >> who looked at incidence of -->> there's been studies on that but i cannot -- gulf studies using thesip on the website they sent an email by more specific reference -->> entry into ssdi by certain employer characteristics but>> industry is not one of them >>>> has adopted david stapleton will talk about a promising workers compensation model ininteresting ways it could be scaled up.

>> i get to talk about c ohe early interventionhas proven to be successful in workers compensation and the question that i'm asking is can itwork outside workers compensation and short answer is we really don't know but it wouldbe well worth conducting a pilot to figure that out there but the first question i wantto answer is working to find a cody and here it is. the other washington cohe stand for centerfor occupational health and education and irma mentioned earlier part and i will talkabout what cody is a minute and its success of workers compensation but first let me givesome credit to the important people we had a policy workgroup that provided a lot ofexpertise on coes and what eventually could

be done outside of workers compensation andwant to give a shout out to a couple people jennifer christian is working sitting in thefront row she's the co-author of the paper that will be out later this week and not todaybut hopefully by friday and she also accompany on a visit to the state of washington or retypedlots of interested people -- >> [ silence ]>> [ no audio ] what is a cody? try to avoid saying that why enough -- a codyis a private sector organization that is designed to address some of the behavioral bottlenecksthat firm is described it works with all authorities involved in the workers compensation claim-- first the worker injured worker at the bottom providers starting with the positionand other types of rehabilitation providers

certainly the employer employer has a verystrong interest and getting worker back to work and then labor and industry itself theworkers compensation agency so because he works with all of them to try to ensure thatthe outcome of the case is off optimal in the sense of optimal return function optimalreturn to work how do they do that well they could buy two sorts of activities and i willtell you the first one which i often forget if i second is they really try to identifywhat best practices are pitched the stakeholders about best practices and make sure that theyare being used when there is new things coming along their the ones for helping stakeholdersimplement them that's kind of a community service activity for all stakeholders in thecommunity for the other one in the one they

spend most of their time on is monitoringindividual cases prepare professionals who have been trained to monitor individual workerscompensation cases from day one and they do this mostly electronically by management informationsystem that they've got and when they see a problem, they identify a problem in somecases progress of more slowly something is not getting them they can call up one of thestakeholders and say what is going on and they can with the people involved to devisea plan to address what the issue is primarily they are trying to stop and do those behavioralbottlenecks they can result in data comes when there is a perfectly reasonable treatmentthat [ indiscernible] getting back to work timely and as they do it's important to recognizethey are doing this and said workers compensation

and that means that they are embedded in whatis relatively an integrated care system a single pair has paid for everything the workerscomp insurer and also has case managers were following each claim in a different way theworkers are also getting if they miss substantial work or getting wage replacement or indemnitypayments and also paid by the same worker's comp. chair and there and is built into thesystem for employers to cooperate with return-to-work probably because the insurance industry recognizesthat getting the person back to work is going to save the money, and that is also pr serviceswhich agency itself provides the workers compensation agency and that is how they are so were coheis working and that's the stem and it's important to recognize that if any one of the stakeholderorganizations that's involved in cohe did

not support it, cody would not exist for there'sthe workers the labor ministry and providers and also the workers comp agency are all reallyinstrumental and that reflects what happened with how cody was developed in the first placewas developed by the stakeholders because they recognize there were significant problemswith medical care and other services in workers not getting back to work timely and a testof the in they had a very successful pilot nearly 2000 and after that it was implementedstatewide so here's a result from the pilot and summary and this is great it's a successfulpilot because all of the outcomes are negative for. at the end of 12 months at a 21% reductionin the number of workers were not working

-- so 21% went back to work instead. for lower back spring cases it was 37% reductionin that is huge. the medical cost were reduced by 7% for bothtypes and all cases of lower back spring cases and that's after taking into account the extracost of paying the doctors to work with the cohes and they communicate with other stakeholdersand for the cohe services themselves and the disability cost savings were much larger andthis is the wage compensation payments they lost workdays were also much larger and there'sa lot of savings in those 12 months and those under state the total savings because thesabres to worker's comp. continued after a month because ere had more people back towork at the mark and in addition, savings

occur outside of workers compensation andafter eight years, the workers compensation people in washington think that they actuallyreduce the number of claimants who went on to enter ssdi by 8% by 2b5 percent on sorrydad and that is an estimate and its plenary is consistent with the 21% reduction in notemployment after all months were actually pursuing a project to affirm that number appearedso the question that we post is what see opportunities to use cohe services elsewhere and we aredimension that other public workers compensation insurers that seems odd obviously it privatewas potentially large employers with employers paid for disability benefits and health insurancebenefits would be in their interest if they are already doing something to do something-- that could include state and federal governments,

we were focused on other workers workers whohave conditions that are not compensable under workers compensation, they don't have privatedisability insurance many of them work for small employers or medium-sized employersand relatively low skills low levels of education loads of low wages because of workers thatdisproportionally get onto ssdi after leaving the labor force. and there's many challenges of doing thisoutside of workers compensation in the first is that there is tremendous pregnant pageand in the service delivery system they creates reinforce of the bottlenecks that occur withinsaid workers compensation workers have to navigate this healthcare system by itselfrehabilitation and return to work services

are available sometimes but they have no guidanceon how to get them, institutions don't support collaborating with each other in fact therecertain there is like hipaa the privacy rules for help information it makes it difficultto connecticut across stakeholders -- and so that's a challenge for cohe but it alsoreal promising opportunity because it's exactly those sorts of bottlenecks that cohe has beendesigned to get rid of to identify and figure out how to get around. in addition outside of workers compensationfinancing is much more limited in its health is highly fragmented substantial funding isavailable for health insurers but they often don't pay for the sorts of things that wouldhelp a person get back to work more quickly

and there's also vocational rehabilitationfunding and medicaid funny but those are separate programs not integrated in they have limitedfunding out-of-pocket expenses for the worker can be high so there can be a substantialburden on the worker and it's at a time when the worker outside of worker's comp. may notreceiving any sort of compensation. wage replacement spirit and in addition andimportantly, it said is for employers outside workers compensation or much weaker than withinside within workers compensation because we don't have the sorts of systems in placethat workers compensation have to make it in the employer's interest to help the workerwith after but despite all these challenges, we do think it would be feasible to test acohe system outside of workers compensation

in washington state. there is substantial support among leadersthat we talk to among the stakeholder organizations in washington, we think and they think thatthey could follow the path of conducting a pilot like they did inside workers compensationand we had a design for the pilot and also rigorous evaluation to go along with it butit would take 4 to 5 years to get that thing up and running from the point at which a decisionis made to go forward. sorry to get it up and running and completedit would take 4 to 5 years however it will not happen for several other things happeningfirst and one is state leaders need to step up and say we want to do this and i thinkright now there is probably interest in doing

that but they see too many other obstaclesand the other obstacles are they see they need federal support and they need to typesof federal support in first is just administrative support because some republicans that wouldbe involved in the past are put himself on a by federal agencies and over which federalagencies have regulatory authority. the second is financial support as ianni saida lot of the benefits of the system would accrue to federal government particularlysocial security programs and medicare and the states have no way to benefit from thosesaving so they really need support it would make it in their fiscal interest to go forwardwith a pilot like this which i think we need to come from the federal agency or maybe potentiallya foundation for that is it.

i think there is an opportunity here to doa pilot but it will take getting over some barest doing a pilot before we can naturallyget it done. thank you,. >>'s back thank you, dave. in a moment jennifer sheehy will give us herthoughts on recommendations on the recommendations we heard and how they might inform federalreturn to work policies and then we will hear from annette purvin and on how today's presentationsrelate to current state and local return to work policies and after that we will haveanother round of questions and answers that will address your questions for david stapletonms. sheedy and ms. prevent hair and we will

then open up the general q&a and as reminderfor webinar audience, we would love to hear from you still so please keep submitting yourquestions now on the q&a pan on your screen. and what that i will passings off to jennifersheehy >> thank you so much and thank you to mathematicafor hosting this form is nice to see you all here i am jennifer sheehy and the office ofdisability employment policy like to recognize two of my expert collies paired up and michaelreardon as well so all questions can be referred to vampiric and funding request -- let metell you a little bit about odep first we are a small nonregulatory federal agency thatfocuses exclusively on policy that will help support people with disabilities to stay inthe workforce or return-to-work and so it

is natural for us to look at this issue andthis topic mathematica has been our colleague the last three years studying this and alsooperating i community of practice. because we're a small federal agency and becausepolicy is not done just at the federal level, it has to work for everybody. we often engage in what's called communityof practice and we bring together physicians and researchers policy experts, disabilityinsurers employers, and professionals in disability management to talk to and listen to and giveus feedback on what might be a policy solution. and frankly these days policy has to workharder than ever before your kit not only has to show before policy is recommended thatthere might be evidence for a policy to work,

it has to not have unintentional consequences. we all live with policies now that i've hadunintentional consequences and certainly social security is trying to address those and finallyit has to save money or policy has to save money. it cannot cost beyond the money that goesinto the policies. so what does that mean exactly? that means we need to look at things likeirma was talking about -- behavioral nudges where people do things that are for theirbenefit whether they have a natural resistance to them or not.

we've done that with georgetown is the schooland with gordon did the school looking at employer behavior and what will copy employerbehavior to higher retain people with disabilities where the natural instinct may be biased onconscious or conscious bias may be causing them to resist that something that is goodfor their bottom line. so what is the federal role? we often look at what the federal role isin this space and it is really too look at policy levers or those nudges that will promotethe private sector to take on and sustain something like employment for people withdisabilities where there is a benefit for all party's involved.

federal employment that federal agencies oftensee demonstrations where there might not be in incentive or maybe a very high cost totest policies, and then we also try to look at convene all the different stakeholdersinvolved to make sure the policies are benefiting or that all the players involved that needto be involved have some kind of benefit or at least those significant cost that theycannot sustain. and we do work very very closely with socialsecurity, with hhs health and human services, research institutes department of educationbecause they are all integral full to addressing these issues. there have not been recent for all these agenciesbefore to coordinate because not one of those

agencies as you've heard has a direct goalin accountability for keeping people at work and getting them before they apply for socialsecurity disability insurance in all depth has a nonregulatory agency is perfect organizationto convene those numbers and bring them to the table. so some interesting things that have comeout of this and we hope to carry forward are putting together based on everything wherelearning ideas for demonstration that his fellow agencies that might be able to partnerto fund and also to recommend to our office of management and budget and budget justification. we -- a lot of what we heard today means weneed to have a little bit more data where

are people coming from who will ultimatelygo into or apply for ssdi and can we reach them early. we've heard -- you know the research out therethat supports almost a 12 week sweet spot where we have to intervene or those folkswho can use all services to stay at work or return-to-work will be lost and they willapply for ssdi and then once on those benefits, have very little chance and reason to getoff of those benefits. so perhaps short-term disability there aresome promising practice their. ssdi as a short-term bridge that was my personalcase and that's how i used ssdi. i had to have it work i had to have medicaid.

i needed a two-year window to finish schooland then establish myself at the workplace so i could earn enough to support all my newmedical and personal assistance needs. but without that, i would not be able to sustainwork. other promising practices their. we don't have a lot of time today to talkabout those, but we encourage you to engage with us further after the webinar and pleasefeel that we are happy to feel more questions as you look at those papers that are wonderfulresearchers and policy groups have put together and thank you so much for the opportunityto serve you as taxpayers and hopefully make a difference in your field.

>> i am excited to participate in this becausei'm excited to see that we are looking now at prevention rather than fixing. it is much easier to stop somebody from fallinginto the well bed to try to pull them out. and that's what i always think of what socialsecurity disability. and for test this is good not only for theindividual, but for the system and when we are focusing on the individual, we are helpingthe system and that is the opposite of what has been happening in the past so this isreally good. one of the irma and her papers talked aboutinformation being key. and i can tell you that the information thatis generally provided is so far from what

is reality. there is not only a financial loss by losingyour job, but there's a career loss and there's no way you're going to go back and step intoyour career where you left off. and there's the loss of social context foreverything around you has changed. from the people that i've counseled doingjob development it has been -- i can sum up their comments with have nothing to do withand no money to do it with. and that is what being on disability is fora lot of people and it is not where we want things to be. the role of the affordable care act i thinkit is time i could place for it to be right

now -- those extraordinary visibility relatedcost that are beyond the cost the capability of individuals could be covered possibly througha medicaid wraparound so the individual can go to work, by traditional health insurance,and have medicaid hopefully cover those extraordinary cost without penalty. i know that my story was the opposite of jennifer's. i actually did work for 20 years i had theself venture because i was unable to buy health insurance and finally just had to give upand go on disability so i could get coverage for these costs. so this is an important thing to have in place.

yanni talked about the re-tiling program andwe are looking at that now and rhode island was a first date in the country to have apaper disability insurance and we are looking at the past five years of their use of thepartial benefits and partial return to work benefits and i can tell you that for thosewho participate in the partial return to work benefits, their average time out of work is7.78 weeks versus those who did not participate in it whose average out of work is 15.04 weekswhich is a really significant difference. this is after removing attorney which is aseparate disability case there so there's room for such things as this in policy tolook at ways to help -- i look at it more as a transition been waiting for recovery.

somebody with a disability i mean we're nottalking about those were cold and go back to work but somebody with an ongoing disability,where there may not be a medical recovery, if you try to go from not working to working,it may be an impossible task theatergoing from not working to working full time andis like oh my gosh this is way more than i can handle and it may discourage them fromgoing on further. where with a transition and they offer a transitionof up to eight weeks, where you can get partial benefits while you are working up to yournormal work schedule and i think that that makes a tremendous difference in the abilityof people to reach their employment goals. and i think other incentives are talking abouthave the same potential and they should be

tested. i think it's a really exciting time to belooking at these things. one of the things we've talked about and iwant to be careful however this, so we should be looking at this also as a way of movingaway from the medical model of disability not to get rid of doctors, we need them andplease don't take them away -- but we don't want to focus on the diagnosis or the expectationof recovery. when you do that, i mean a diagnosis doesn'tmean a disability -- there's people with lots of diagnoses that you can have two peoplewere present diagnoses and one will work in one will not and that is not really the wherethe focus should be.

recovery or even medical improvement is neithera necessary nor sufficient condition for return to work. there are people with long-term disabilitiesthat had never are going to change medically that do return to work. and they're able to return to work so we needto find the way looking possibly using the functional model of disability for examplethe jews by the wheelhouse organization -- the incorporate technology and other aspect tothe definition of disability so that we are not focusing just on what you cannot do, buthow you can do it and i think that it is time to start really pleasing that into the wholeissue of demonstration projects, and where

we're going with disability policy and i thinkit will help people have their lives back as opposed to losing all that they can losethrough not returning to work part peer mentor's, who have been through it and grab that giventhe training can help people navigate the system and get to it i think these demonstrationprojects all have that potential if we look at -- from that functional model. >> thank you, telenet plein air -- annettebourbonniere >> we will put them now the questions fordiscussion and david stapleton and reminders when us could question please state your nameand affiliation and limit yourself to one question and those in the room for the miketo come to and those online, using the q&a

pad on the screen or twitter using rtw policy#-- >> i like to make a contribution dr. jenniferchristian and i think there's an idea that's really important to get out into the roomwhich is that more access to medical care is not what made the difference in cohe andis now is making the difference in a lot of these programs it is access to new kinds ofservices and most of which have to do with communication problem solving etc. part sothe solution that's particularly important in washington state because they are all theworkers have complete access to health care services -- but the outcomes are improvingbecause of these unusual services and the other interesting part of the cohe is aigare being paid to do those new services.

and with guard to what annette was talkingabout, is really do have a vocabulary problem with the word disability that i've been tryingto encourage us to start using the word work disability for people who are either not workingor not in a test because of health problems and the impairment is really the other wordhere is do you have some difficulty functioning. as you were saying there's no necessary connectionbetween having a difficulty with some function and working but if he uses a word we giveeach other confused and that's the only point i am trying to make. >> this question is from lisa: an attorney-- are you aware of in on program to educate physicians on pda fmla or rehab act to enablethem to better assist employers in remaining

at work or returning to work? >> i've been involved in physician educationfor the last 10 years and they're probably is an occasional session at a professionalconference on the aba and ada -- my companies involved with trying to encourage employersand payers and agencies to institute systematic education and position and basically havebeen reluctant to do it not been able to speak with one voice to them medical professionthat we needed to know some stuff and you haven't been doing -- one of the flaws inphysician education programs as they are taught by people with an administrative or legalfocus turned to the doctors off and part of what it has to be as position center and sensitiveto the medical culture.

>> if i could add and agree completely withyou jennifer but i think again it's important to recognize all of the other pressures anddemands positions time -- many of these encounters focusing specifically on individual torquelimiting conditions were disabilities for many positions can be relatively low incidenceof that so maybe they will encounter a patient with these needs once every six months orsomething like that so relative to all the other commands of their time, it is somethingclaiming relatively limiting attention and again it is -- what is incentive for positionsto focus on these issues and absent some external broker or someone facilitating these discussionsagain, again the incentives are not aligned for it to work.

>> dale brown independent disability policyconsultant want to ask if anything at looked at in terms of office of personnel managementand disability retirement system and that seems like an area very ripe for savings iwas hundred of cohe wanted to have cohe adapt if there's been studies or what's going onwith that thank you, >> i thought about that. several years actually. one interesting thing about federal government,as an employer, it is for all health and disability benefits and the leave the labor force orthrough federal pension -- argument most fellow employees [ indiscernible - poor audio ] somesort of federal health employee plan that

federal government as an employer it's alreadyincurring cost providing these services. and workers compensation agency which is thedepartment of labor does do some things to coordinate care and they have is to some initiatives,but outside of that agency at all that there has been and is something i think the programshould be doing for there are programs in place to provide assistive technology that'sthe defense department but there isn't a concerted effort i'm aware of to provide coordinationto individual cases or two address what i think can be sometimes adverse incentivesbecause of multiple types of benefits that are eligible for staying in the work forceand to my mind easiest way the federal government to increase the number of employed workerswith disabilities to keep the ones they already

have for jennifer you may want to weigh inon this one. >> actually i think the federal workers compensationsystem does a pretty good job at returning employees to federal ways to work and there'sless is there that if we can look at also that a lot of these questions especially theposition education question talk about communications and messaging and raising their expectationsthat part of what we are doing in our office is trying to get that to employers and helpthe employers build a culture where people are ready to talk about what they need whenthey need it -- not about disability -- it might not have to do with disability the factof the language -- if you have a non-apparent disability, then you may not identify as aperson with a disability, but you know that

you might need some flexibility in your scheduleand you may need some leave or use the fmla or some type of equipment that will help youwith your workstation or your computer but you might not identify as a person with adisability. so we are doing a couple of things -- we aretry to help employers institute flexibility and benefits across all their employee population-- not just for individuals with disabilities to but also to get that education -- to peoplewith a come onboard when they are first tired that their accommodations that could be requested. the company is supportive of employees andall sorts of health and life experiences. so that hopefully will help raise expectationsof employees, employers, hiring managers and

disability insurers and ultimately wants togo to a position they say how quickly can i go back to work, not just take care my painand sent me home because i just can't get through the next 15 minutes. so that is all part of intervening earlierand earlier and earlier to show people their options. >> ^ billet for david stapleton who selectsthe cohe and who absorbs the cost of the cohe? >> -- the cohe organizations and their sixof them and they are part of the healthcare system what is [ indiscernible - low volume] with a larger healthcare systems the industry's worker's comp. agency contracts with the cohesand plays them and pay them on a case-by-case

basis and they also pay the physicians forthe time they spent talking to the cohe and representatives as well as time for reportingforms that are required -- i think the selection process is a contractual want rather thanwhere it agency which is contracted with these organizations in response [ indiscernible- low volume ] if the questions concerning more pics the particular individual who workswith a particular claimant, i think that's pretty [ indiscernible] people working ina room and working cases and cases come up -- there may be specialization but i'm notaware of it >> my name is christopher clarin off of thenational academy of social insurance, and i would actually is adjusted in the cohesas well and i was wondering it seems like

it was also touched upon in earnest paperwith the job retention -- i was hundred after specific aspects of these cohes that you foundto be more effective than others or was it the coordinated effort or was it certain aspects? >> that's really hard to know. we know their overall effectiveness and weknow they think everything they do is really important and it's really not possible i thinkto breakout individuals -- i guess observing them i spent some time observing these healthcareservice coordinators working. the impressed about how routine it was whatthey were doing and just spending most of their time monitoring individual cases throughelectronic records and looking for problems

and going through checklist to sleep if problemsat arisen and in those cases most cases they don't the only intervene and maybe 20 or 5%of the cases per and that shortly 5% of the case -- and they have things they can do ifthey see things going wrong and they do but it is not really high technology they obviouslyhaven't trained and they learned through experience about what things to do. >> to follow up would you say that almostlike expert claims adjusters kind of what would you say their specialty would be? >> i will let the doctor answer that. >> i traveled with him and after followingcohe for the last decade, actually washington

state when they talk about the program thatthink they are emphasizing is that physicians are doing best practices and communicatedwith their patients. is david and i would we went we started tohear how important of all of these people they call the health service quarters areso it is really both for you have a doctor at the front into his been trained in thesebest practices and is being incentivized to do them and not only that, but actually theyhave a relationship with certain health care coordinator who get some feedback once a yearabout whether they have actually been doing the best practices and accounting up how manyof your cases did you do them in and by the way you left one on the table because youdidn't do the services for which you would

of been paid. so it's a relationship or so the three elementsthat i would say they have is one is the teaching of best practices and incentivizing has practicesand the second one is the coordination by the health secure service quarters to do tendto be trained with about 20 years experience a lot of times they are working with the employerto teach the employer about return to work to facilitate problems and also to upgradethe performance of the doctor so they are doing really well for the third one is theyreally are establishing sort of a infrastructure in the community of a web of relationshipsbecause all the doctors in the state of washington are not in the cohe they sign-up and promiseto do the best practices, and then an exchange

they get the help of this healthcare service. >> healthcare service coordinator. >> this is from christine schmidt what canbe done to change the employer view that people with disabilities returning to work are anincrease liability and increased benefits expense and thus employers might actuallywork to the incentivized people with disabilities returning to work. >> i will take a couple things about that. i think the lessons are that if you interveneearly enough, you do reduce of medical cost where it will not cost any more went you bringsomeone back to work in there are lots and

lots of costume cost to employers for replacingsomeone who has a lifetime with the company as training skills and equipment and a historyand knowledge -- you cannot look at it simply as one individual that what will it cost mefrom here on out and then not like of the whole context of the person the help insurancefor the company that supports the services and in the context of what they do for allthe other employees as well and what the front and cost are per job recruitment and training-- so we try to put that in context and one of the things we do with our office with employersis we have a technical assistance center for employers is to try to put all this in contextso that we are really eliminating some of those mental attitude barriers to bringingemployees back to work.

>> i agree with jennifer. ethics is important that i think it's important-- depends very much on individual circumstances. if somebody with skills that can be replacedeasily it's easy to hire somebody new and train them to the same point. that might be from a pure profit perspectiveand more attractive to the employer than retaining the worker and waiting for them to come backafter six weeks for 12 weeks or whatever it takes. and the reason i say that is partly becausei think we have to be realistic about what we can expect employers to do.

they are in a for-profit competitive labormarket passion cannot afford to be -- [ indiscernible] -- they are looking at a carefully and a lotof the benefits through a crew to the workers as well as to federal programs that don'thave to pay benefits is reasonable -- i think it's an important lesson from the work thatyacht east on the cost benefits that we need to look carefully in the employer's interestto retain the worker and realize cases were snotty employers interest out not just theconvincing is the right thing to do -- there's other things that can be done to>> to add more detail in my paper and we also have a handout with an example from differencesin oregon washington do provide employment subsidy or workers and workers compensationbecause they realize that the reason the time

to incentivize the employer for the perceived[ indiscernible] hiring the person back -- >> i have to say -- this is jennifer -- wehave lots of examples where employers have taken their high turnover low skill jobs anddone lots of recruitment for people with disabilities and then looked after several years like theywere finding just profit oriented bottom lines savings and benefits. so it is sometimes those low skilled if yourlevel jobs that people with disabilities to make sense from a financial perspective. >> on that -- -- this is on that could i hadone resource for employers the us position of leadership net worth that provides informationand information on best practices for employers

and they do a really good job in many stateshave their individual chapters as well. >> and they are employer to employer -- talkto a colleague rather than that they are good for that -- we are not monitoring you -- atthe risk of putting my foot in this is jennifer christian in the commercial world, years agowhen i was in my first toe into the water in managing, episode to try and reduce workdisability disability said to me dr. christian the only cases that come to our cases forthere's trouble in the worker in the supervisor and most times if there's good relationships,the employer will make more of an effort to help somebody stay-at-work per car recentlywrote on the plane next week i was ehr head operations for very large company timor-lestesaid the exact same thing he said that if

somebody has been a good employee and hasa good attitude, they will really work to try and provide them alternative work in thefor the somebody they would just as rather be rid of, they are going to let them takethe disability route as a mutual sort of conspiracy between the employing the point of resolveand interpersonal problem pixel as long as family surface and we work on our gettingright medical care and are we doing right by the ada we are not actually addressingwhatever public solving interpersonal relationships exist we will continue to see people followthat? so i think part of what we're talking aboutin terms of preventing work disability is less managerial issues if we can resolve itand i think this multiparty dialogue is of

the solutions that can be manageable if youget a good facilitator. versace>> i think the topic of employee engagement is -- context of [ indiscernible - poor audio] a form on this in a future like to thank our speakers once again for being here andjust as reminder for you there are comment cards in your packets please let us know howwe're doing five between the mouth and for online on users and laconic survey comingyour way. maq over being here and have a good afternoon. >> [ event concluded ]