Rubio’s Case StudyOutcomes from an Early Injury Reporting and 24/7 Delivery Model
California Coalition on Workers’ Compensation Annual Conference
Sarah Cato, Claims Manager, Rubio’s Restaurants
Peter P. Greaney, M.D., President, CEO and Medical Director, WorkCare, Inc.
Introductions
Sarah Cato, Claims ManagerRubio’s Restaurants
Overseeing all workers’ compensation and general liability claims
Rubio’s has over 4,000 employees and operates more than 200
restaurants in California, Arizona, Colorado, Utah, Nevada and Florida
Introductions
Peter P. Greaney, M.D.President, CEO and Medical Director, WorkCare, Inc.
Consulting occupational physician, Rubios
WorkCare is a physician-directed occupational health
company providing integrated workforce health management
solutions to employers in the U.S. and abroad
About this Session
Rubio's Restaurants collaborates with
occupational health specialists to:
• Promote employee well-being
• Effectively manage injuries at onset
• Reduce medical costs and workers’ comp claim rates
• Facilitate safe return to work after an injury
• Decrease the likelihood of lost work time and disability
Key Employer-based Interventions
• Senior management commitment to
workforce health and safety.
• Supervisor-employee collaboration and advocacy.
• Reporting injury, illness or physical discomfort at onset.
• Providing immediate, appropriate care guidance.
• Using work to promote recovery and sustain livelihoods.
• Monitoring progress during recovery.
Healthy Workplace
• Company culture facilitates
engagement and trust
• Employees have positive sense
of well-being and self-efficacy
• Supervisors are educated
about the process
Workplace Culture
• Engender trust and communication
• Create non-punitive climate for injury
reporting and early intervention
• Educate employees so they can
make informed safety- and
health-related decisions
“It Pays to be Nice”
4.3
3.8 3.8
4.2
3.1 3.1
4.3
2.8 2.9
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Doctor Employer Main Supervisor
Rating
Durable RTW Non-durable RTW No RTW
What We Know About Injuries
• Most work-related injuries are relatively minor
• Injury assessment typically notwithin supervisors’ skill set
• Reporting and intervention at injuryonset facilitates return to work
• “Simple” care guidance preventsunnecessary complexity
• Working during recovery promotes healing
Using Work to Promote Recovery
“...long-term worklessness is one of thegreatest risks to health in our society. It ismore dangerous than the most dangerousjobs...and too often we not only fail to protectour patients from worklessness, we sometimes actually push them into it, inadvertently…”
- Professor Gordon Waddell, “Is work goodfor your health and well-being?”
Value of Work
•There are physical and psychosocial
benefits associated with working
•Working through pain is better
for health than not working
•Advocacy means creating a culture
where employees feel comfortable about
reporting an injury or discomfort
‘Worklessness’ and Health Risks
Increased risk of:
• Dying (20% excess deaths)
• Heart disease and other chronic conditions
• Poorer self-reports of general health and well-being
• Poorer mental health (2-3 times risk of mental illness)
• Higher rates of medical utilization, hospital admissions
and suicide attempts
Acute
Subacute
Chronic
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 10 20 30 40 50Time (Weeks Since Pain Onset)
Percentage of Claimants Still Off Work
I
II III
3 to 4
weeks
12
weeks
By 12 weeks, injured workers had only a 25%
chance of ever returning to work.
Time is of the Essence
186 municipal workers with acute Low Back Strain
Initial medical evaluation within 1-2 days of going off work
Random Assignment
2 days complete bed
rest
1 Hr PT instruction &
vigorous HEP
Minimalist Treatment“carry on with usual duties
as much as possible”
Best outcomes at 3 wks & 12 wks:
Improvement in pain & functional status, substantially less lost time
Overtreatment: Helsinki Study
Injury Management Philosophy: The SPICE Model
We help prevent routine injuries from becoming complex, costly claims.
We understand that staying at work
promotes good health and healing.
We promote early intervention – optimally
during the "golden hour” – for best results.
We collaborate with all parties to effectively manage every case.
We provide reassurance and establish reasonable expectations for recovery.
The SPICE model provides the foundation for WorkCare’s approach to injury assessment and care guidance.The concept originated with the medical management of WWI soldiers suffering from post-traumatic stress disorders.
Right Care, Right Time, Right Setting
• 24/7 telephonic access to occupational clinicians
• Clinical guidance to support self-care/first aid
• Provider referral management to improve outcomes
• Physician peer consultation on return-to-work pathways
Benefits for Employees
Alleviate anxiety, provide reassurance
Encourage prompt reporting
Empower self-directed care
Support return to function, livelihood
Reduce likelihood of disability
Benefits for Employers
• Demonstrate caring, progressive approach
to workforce health management
• Identify and correct hazards enterprise-wide
– before more injuries can occur
• Gain insights to determine work-relatedness
Benefits for Employers
Reduce:•Lost work time
•OSHA-recordable rates
•Medical costs
•Workers’ comp claim rates
•Potential for disability
•Litigation
Rubio’s Challenges
• Connecting with mono-lingual, Spanish-speaking Team Members
• Showing we care in a fast-paced environment
• Preventing escalation of claims and out-of-MPN treatment
• Understanding injury causation
• Lack of trust to report injury due
to over-elevated medical treatment
• Comorbid conditions
• Return-to-work management
Triage Gaps
Re-establish trust for timely injury reporting
So….Now what?
Follow up and close the injury loop
The Data
49.60% 51%
63% 64%68%
50.40% 49% 37% 36% 32%
2013 Prior NT 2014 Prior NT 2015 WorkCare 2016 WorkCare 2017 WorkCare
Self-care Clinic Visit
How Does It Work?
WorkCare poster• All incidents called in regardless of severity
Report to nurse triage by end of shift• Occupationally trained nurses ensure
correct line of questioning
Demographic feed • Triggered by employee ID
• Reduces call times
How Does It Work?
Email notification is sent to GM, DM,
People Services, Ops, Risk & Safety ✓ Team Member investigation form
✓ DWC-1 (CA)
✓ Medical release form
✓ First fill pharmacy card
✓ Provide modified duty, as feasible
✓ Check in with Team Member to ensure he/she has needs
met throughout the recovery process
©2018 WorkCare - All Rights Reserved.
Incident Intervention ProgramSuccess measured through timely injury reporting
• Reduced disability days with improved
return- to-work communication
• Re-established trust with proper medical
referral based on severity of injury
• Self-care injuries have follow-up and resolution plan
• More precise injury causation determination
• Occupationally trained nurses make a difference
• Triage time is reduced
• Doctors are available when needed
©2018 WorkCare - All Rights Reserved.
Incident Intervention ProgramRubio’s Restaurants, 3/1/2017 to 2/28/2018
Total P2Ps*% of P2Ps
Possible
% Successful
P2Ps
128 88% 90%
Regular
Duty
Activity
RestrictionsOff Work
32% 55% 14%
First Aid Maintained Above First Aid
12% 88%
*P2P = Occupational physician peer-to-peer
engagement with treating provider
Discussion
Sarah Cato
Peter P. Greaney, M.D.
Top Related