Improving Health Care Quality and Reducing Disability in Washington State Workers' Compensation

By Tom Wickizer
Professor, Department of Health Services

Tom Wickizer

The University of Washington has played an active role as a collaborative research partner with state and local government agencies. At the School of Public Health (SPH), there has been an important, ongoing collaboration between the Occupational Epidemiology and Health Outcomes Program, directed by Dr. Gary Franklin, and the Washington State Department of Labor and Industries (L&I), which administers the state’s workers’ compensation program. I have been fortunate to play a leading role in this collaboration over the past 10 years.

The L&I pays all medical costs (there are no deductibles or coinsurance) for injured workers and, in addition, makes payments to replace a portion of lost wages for workers who are temporarily disabled and out of work. In 2007, approximately 125,000 workers’ compensation claims were filed (and accepted) with the L&I. These claims resulted in over two million days—or 5,500 years—of aggregate disability lost work time. Once a worker is on disability and off work for more than two to three months, his or her chances of going back to work are greatly diminished.

Much of the disability (lost work days) incurred by injured workers could potentially be reduced through the delivery of effective and timely occupational health care. An important strategic objective of the L&I is to reduce worker disability, especially long-term disability, by improving the quality of care provided to injured workers in the workers’ compensation system. Toward that end, the L&I has contracted with the SPH’s Occupational Epidemiology and Health Outcomes Program to conduct applied studies and to evaluate pilots designed to reduce worker disability.

UW-L&I Collaboration
One of our early collaborative studies conducted by UW researchers was an evaluation of the L&I Managed Care Pilot (MCP). This evaluation, conducted over a four-year period from 1994 to 1998, showed the MCP was associated with decreased worker disability. It also documented the importance of organizing care around an occupational medicine model, which improved care coordination, enhanced provider-employer communication, and fostered the use of evidence-based guidelines.

The L&I then initiated an 18-month policy study, conducted by our SPH research team, to assess the feasibility of developing a community-based quality improvement project that would organize care around an occupational-medicine model. This led to the development of a major, ongoing quality improvement initiative known as the Occupational Health Services (OHS) project. Through the OHS project, Centers of Occupational Health and Education (COHEs) have been developed in two pilot sites, Renton and Spokane. To date, the COHEs have recruited over 700 physicians, who are eligible for enhanced payment for the performance of selected activities intended to improve quality and reduce worker disability. The COHEs use health service coordinators to coordinate care and foster communication among physicians, patients, employers, and claims managers. We have shown that the COHEs are associated with reduced disability days and decreased medical and disability costs. Largely on the basis of our research, the L&I is now considering options for expanding the OHS initiative on a statewide basis.

Future Collaborative Research
The UW SPH-L&I collaboration has produced important research; future collaboration will include evaluation of an innovative L&I pay-for-performance project involving neurosurgeons and orthopedic surgeons, evaluation of the Washington opiate use guidelines, and assessment of the feasibility of using a newly-designed tool in clinical settings to predict long-term disability among injured workers with back sprain.

Conducting collaborative research with the L&I to improve health care quality and outcomes for injured workers has been academically rewarding and productive. I encourage SPH faculty and students to consider opportunities for similar collaborative research. Such research can be personally rewarding; it also helps further the School’s mission to improve health and health care in the state of Washington.