States are testing innovative strategies to help at-risk workers stay employed | Urban Institute

Bipartisan federal and state policy innovations are laying the groundwork for new worker-based strategies, including a program that aims to help workers with new illnesses or injuries stay employed.

With the support of the Social Security Administration and the Office of Disability Employment Policy (ODEP) at the US Department of Labor, eight states have begun developing immediate intervention strategies for employees whose work has recently been disrupted by an illness or injury that puts them at risk of losing their jobs and permanently leaving the labor force. The Retaining Employment and Talent after Injury/Illness Network (RETAIN) demonstration project has the potential to expand our understanding of early intervention strategies to improve employment outcomes.

Proposed under the Trump administration and funded by Congress, RETAIN will evaluate how states can best deliver early intervention strategies to help at-risk workers stay employed. In September 2018, ODEP announced an initial round of grants of roughly $2.5 million each to eight states to develop their plans. The project has a multiyear budget of $100 million.

The key inspiration for the RETAIN project was a program developed by Washington State’s workers’ compensation program. The Centers for Occupational Health and Education (COHE) is a short-term program focused on the first 12 weeks after the occurrence of occupational (or work-related) injuries and illnesses.

The COHE program contends that, for the working population, getting back to work as quickly as is medically safe should be considered an important health care outcome. The program pays fees to physicians for best practices that trigger COHE involvement and clarify the worker’s current work ability. When necessary, COHE staff members proactively engage the key parties (worker, treating doctor, and employer) to resolve any kind of obstacles to return to work, such as educating and reassuring a hesitant worker or helping an employer understand how to temporarily adjust a job.

A recent eight-year follow-up evaluation of the COHE model found that relative to a comparable group of injured workers, those receiving COHE intervention had a 30 percent reduction in workplace-based disability and 30 percent lower rate of injured workers transitioning to Social Security Disability Insurance. In our new brief—the third in our disability policy series—we examine successful early intervention programs such as COHE and others in the US and abroad.

Even though Washington’s workers’ compensation system is unique and would not be easily replicated in other states, ODEP has asked states to learn from COHE’s accomplishments and propose ways to test key features of the program given their state’s circumstances. Here are noteworthy aspects of the proposals the eight states submitted:

• Most states are focused on early intervention services for workers experiencing musculoskeletal conditions resulting from both occupational and nonoccupational injuries. Musculoskeletal conditions—such as low back pain from a workplace injury or muscle damage from a car accident—are among the most common health conditions causing workers to leave the labor force. Kansas, Kentucky, Minnesota, Vermont, and Washington are considering additional health conditions.
• Kentucky’s proposal includes looking at how substance abuse disorders intersect with treatment for pain from musculoskeletal conditions. A study of the COHE program found that the program could also help combat the opioid crisis by detecting and addressing excess opioid prescriptions.
• Many states are proposing a range of private and public partnerships with health systems, hospital, insurers, and other providers to help identify at-risk workers and deliver early intervention services. Connecticut is partnering with The Hartford insurance company, while Minnesota is partnering with Mayo Clinic. Kansas is partnering with the Susan B Allen Hospital System, and Ohio is partnering with Mercy Health.
• States are exploring how state-funded temporary disability benefit programs could help identify and assist at-risk workers. California is looking at partnering with beneficiaries in its state disability insurance program, and Washington is targeting state employees who receive long-term disability insurance benefits.

Of the eight states receiving development grants in the first phase, ODEP will select four states to implement their plans during the second phase. Each of the four selected projects will be rigorously assessed by an independent evaluator funded by the Social Security Administration.

RETAIN is a major development in the movement to help disabled workers stay connected to the workforce, but it is only the beginning. Though musculoskeletal conditions are an important issue, many other health conditions, like mental illness, also cause workers to drop out of the workforce.

Some mental health–focused early intervention programs, such as the Individual Placement and Support (IPS) intervention, have been shown to help workers with serious mental illness, but funding to expand the IPS approach has been limited. Additional funding could provide states more opportunities to innovate early intervention strategies for a wider range of populations and health conditions.

The RETAIN effort shows how bipartisan cooperation could help workers overcome potentially disabling health conditions, stay in the labor force, and avoid the need for long-term assistance from programs like Social Security Disability Insurance.