Disabled may soon get a ticket to work

Early claims assessment encouraged

A new integrated disability program to close long-term disability (LTD) and Social Security Disability Income (SSDI) claims was developed by the federal government and a public/private partnership. Called Ticket to Work, the program targets two areas: existing/maintenance claims and early intervention claims. It is based in the Social Security Administration (SSA) but research is being undertaken by the San Diego-based Disability Management Employer Coalition (DMEC). DMEC, formed in 1992, has 19 chapters nationwide and about 1,300 paying members (employers and vendors that serve employers).

"It’s not unusual for employers to be self-insured for STD [short-term disability] but insured for LTD [long-term disability]," says Peter Mead, chair of the DMEC Supported Employment Committee (SECom). "Also, in workers’ comp, there's no such thing as short-term and long-term disability; it’s all workers’ comp. So as a management tool, claims are triaged and some are put on a quick return-to-work track and some on a slow track."

It’s not unusual, he continues, for some employers to say it does not make sense with nonoccupational injuries to spend too much money on aggressive triage up front to identify potential LTD claims and begin treating them even before they are LTD claims, because often it is the insurance company’s responsibility to do that. "It’s only natural that employers will be hesitant to invest in STD claims until it is very clear they will be LTD claims," he notes.

In other words, if an injury is treated as if it is relatively simple, it may not be until six, eight, or 10 weeks have passed that it becomes clear the worker is not progressing as he or she should. "At that point, you could say there may be other factors involved, such as psychosocial factors," says Mead. "It’s possible that Ticket to Work may encourage organizations to do an earlier claim assessment and ask themselves up front if it will become an SSDI case. The program may create enough resources and incentives to do that."

Where things stand

The first phase of Ticket to Work focuses on the existing 9 million SSDI and SSI claims, providing new resources to help close them. Ticket to Work’s program for existing claims can be described as a new federal integrated disability management program. It provides medical care, disability benefits, vocational rehab, and associated case management, as well as incentives to win buy-in from employers and claimants, Mead explains. However, Mead adds, it is struggling because "SSA doesn’t know how to sell Ticket to Work to its disability beneficiaries, and the other challenges that can be addressed through improved intake."

However, he notes, DMEC’s may have a solution to these problems. DMEC currently is involved in research to develop an efficient model for using Ticket to Work to help LTD/SSDI claimants return to employment and to test this model based on outcomes. The model is aimed at addressing marketing and intake needs.

"We have the benefit of some software we will use as part of the process that will help us standardize our data gathering," says Mead. "It was developed by a consultant to SSA, a disability researcher named Dave Vandergoot. He played a key role in developing such a program for Pepsico."

The Pepsico program, he notes, involves early triage. "It’s not so much that they’re looking for fraud, but rather at how the incentives are lined up," Mead explains. "In other words, Is this person lined up in such a way that he does not have incentives to try hard to get back to work?’"

The program being developed for DMEC will have some similarities to the Pepsico program, but differences as well, Mead notes. "Although we will continue to fine-tune the model, it is now robust enough to begin seeking research partners for tests."

DMEC currently is talking with employers, carriers and third-party administrators (TPAs) about putting the model to the test to help close their claims. "As a result of the research, we want to gather good robust database to answer question, Does Ticket to Work pencil out for insurers, employers, and TPAs?’" Mead poses. "We anticipate that within two years we should have enough data to begin to get a halfway reliable answer to that question."

The SSA also is doing research to explore another phase, which they call early intervention. It would provide new resources to help prevent significant claims from going to SSDI by helping people find alternate careers. However, says Mead, any real progress still is years away. "Perhaps we will have a national demonstration in early 2005," he says.

"The SSA has only committed to research the possibility [of such a program]," says Mead. "If the research shows that early intervention can reduce SSA disability costs by preventing claims, the Ticket program sends a favorable report to Congress, which presumably would be eager to pass a law authorizing and funding such a program. The early intervention research is a nationwide demonstration to gather 5,000 claims for a conclusive test. If all goes well, this could become a permanent program, and our very best opportunity for changing one of the very worst features of SSDI — the ghastly application process."

From an altruistic perspective, says Mead, the goal is to help people with disabilities become self-sufficient and achieve their potential. "Also, from the perspective of SSA, they need to learn how to prevent or minimize claims," he adds. "Their disability trust fund continues to require new funds, and to some degree we should at least wonder, "Are we helping people with disabilities or creating them?’"

A total of about 9 million people currently receive benefits from the SSA; 5.5 million of whom receive SSDI benefits, notes Mead, so the current research projects "could cast a long shadow and affect the way many claims are handled."

[DMEC still is looking for research partners. For more information, visit the web site, www.yourtickettowork.com, or contact Peter Mead, 725 Louis St., Eugene OR 97402. Telephone/fax: (541) 434-9029. E-mail: PeterMead1@comcast.net.]