This article was produced in partnership with AmTrust Financial Services.
Bethan Moorcraft of Insurance Business sat down with Dr. Melissa Burke VP, head of managed care and clinical for AmTrust Financial Services to discuss behavioral health in workers’ compensation.
Behavioral health is fast becoming a key focus area for workers’ compensation insurers and employers.
As a discipline, behavioral health encompasses both physical and mental health, looking at how daily cognitive habits impact overall wellbeing, emotions, biology, and behavior. Typical behavioral health services include mental health counseling, treatment for addiction, and support from psychiatrists, neurologists and physicians.
Behavioral health is a big focus for workers’ compensation insurers and employers because mental and physical wellbeing is inextricably linked to the outcome of bodily injury and workers’ compensation claims, especially if an injured worker is experiencing chronic pain.
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In recent years, AmTrust Financial Services has embraced the concept of holistic care and pain management, investing in behavioral health services and additional things like telehealth, psychiatry, and cognitive-behavioral therapy to provide every injured worker with a personalized path to recovery.
This is a landmark change to how the wider workers’ compensation industry viewed behavioral health a decade ago, according to Dr. Melissa Burke (pictured), vice president, head of managed care and clinical, for AmTrust Financial Services.
“When I first entered the workers’ compensation industry, it was very taboo and stereotyped,” she said. “There was a stigma around behavioral health that we don’t want to ‘buy the psyche claim!’ But, as the industry has grown and learned to take a more holistic approach to care and pain management, like we do here at AmTrust, we see the value in investing in mental and behavioral health.
“At AmTrust, we tend to focus a lot on the cognitive-behavioral therapy in workers’ compensation, because that’s really about changing the injured worker’s behavior, their actions, and their approach to recovery. I like to think of it as changing their life policies. How do you react to something? What steps will you take to keep yourself on the right track during recovery?
“We know that if we can get an injured worker’s mind set on the right track, if we can have them focus on what they can do as opposed to what they can’t do, and the improvements in their quality of life, that helps them get back into the workforce, stop identifying themselves as an injured employee, and return them to the prior health and baseline they had before their injury.”
In the past, employers have shown some resistance to supporting and ultimately paying for workers’ compensation insurance that covers behavioral health services for injured employees. In a similar vein, many were opposed to services like aquatherapy and acupuncture – really, anything with additional cost beyond traditional treatment and medication.
“We’ve slowly seen that the more you personalize the care and pain management approach, the better the return-to-work scenario, the more optimal the situation, and the less likely employees are to fall back out of work. So, we can decrease recidivism with that holistic care and wellbeing approach,” Burke told Insurance Business. “Sometimes employers are still resistant, but that’s where we bring in the data and show them how much we’ve improved outcomes by addressing behavioral health.”
Behavioral health services can significantly reduce the severity of workers’ compensation claims. Burke gave the example of using behavioral health strategies to help workers with post-traumatic stress disorder (PTSD). For example, if they have personally experienced or witnessed violence or trauma in the workplace, the right therapy can help to mitigate any fear of returning to the workplace. The same goes for if a worker has a sustained injury and is anxious about working differently or utilizing pain medication.
AmTrust has internal nurse case managers trained to engage with injured workers to provide ongoing support, information, and resources throughout their recovery.
Burke explained: “Our nurses and claim adjusters are very well trained about how to have empathetic communication, how to ensure that an injured employee is communicating with them, letting them know their full story, what’s going on, and what other issues are potentially driving their pain, or their desire to be out of work, or their inability to heal and get back to baseline.
“And our nurses are always thinking about that holistic approach and that holistic view of the injured employee. Do they have outside home or life pressures that are causing other reasons for their emotional wellbeing to decline? And we try to address them, because, if we don’t, just treating an injured worker’s knee injury is not going to bring them back to work. We have to look at their whole person, and they have to be ready to go back to work.”
Behavioral health will continue to be an area of focus for AmTrust moving forward, Burke stressed. “That’s why we’ve in-sourced our nurses and we’re building our nurse team for telephonic nurse case management, utilization review, and pharmacy. Those three pieces together enable us to take that holistic approach, ensuring we provide the right medications and the right treatments for that whole-body approach to wellness and mental health.”
