Project Results

To see results of the Demonstration project done by Minnesota Health Partnership, click here .

Public Policy Goal:

To improve health care delivery and the resulting outcomes for patients by integrating the best elements of general health care and workers' compensation medical care for the treatment of both occupational and non-occupational conditions through: 1) providing patient choice of provider for all health care needs; 2) implementing common provider disability prevention practices for all conditions, including the use of an Activity Plan as a communication tool; 3) providing similar employer return to work accommodations for employees regardless of work-relatedness whenever possible. The Coordinated Health Care and Disability Prevention model would also decrease disability costs.

Project Objective:

Success of the project was evaluated based on an assessment of the impact of the model on employers, healthcare organizations, and health plans; what effect the model had on health care and disability costs; impact of the model on the functional status of the patients; and the patient's, provider's and employer's satisfaction with the care provided.

Project Description:

The Minnesota Health Partnership, a diverse group representing employers, health care provider organizations, labor, insurers, and state government agencies, developed a coordinated health care delivery model that blends the best components of workers' compensation and general health care. The model focuses on coordinated disability prevention activities for workers with both work-related and non-occupational conditions. The partnership spent several years actively planning for this form of "twenty-four hour" care and worked closely with primary care clinics in the Twin Cities area. This project had three stages: development, pilot site implementation, and then additional test site implementation. Research methods were developed to study the impact of this model on medical care quality, costs and participant satisfaction. [See the separate report of the MHP Demonstration Project ]

Key Findings or Accomplishments:

This model, Coordinated Health Care and Disability Prevention (CHCDP) was implemented in many clinics in the Minneapolis/St Paul area. It increased the awareness of the potential benefits of disability prevention and accelerated the movement of the Twin Cities marketplace toward integrated/coordinated health care.

Evaluation of the model's impact on patients, participating providers and employers revealed the following findings:

• Patients:
• The joint effects of disability prevention and a strong patient-provider relationship were associated with decreased risks of poor physical health; decreased restricted activity days; and overall satisfaction with their primary care provider.
• Results suggest that primary care providers with strong patient-provider relationships can successfully add disability prevention to their practice without a decrease in patient satisfaction.
• Patients who reported receiving Activity Plans rated their provider higher in relation to time spent with the provider, provider skills, and, overall clinic satisfaction.
  
  Providers:
• Providers showed a high level of agreement about the importance of disability prevention principles (i.e. discussing appropriate activity is useful for patients, prompt return to activity prevents de-conditioning and early return to work helps prevent disability); however, the actual implementation of these practices was neither widespread nor uniform. In particular, the use of a generic written activity plan was not widely accepted.
• Test clinic providers reported greater confidence in their disability prevention skills. This suggests that ongoing discussion and educational efforts relating to disability prevention strategies may continue to focus attention on the role of disability prevention strategies within primary care practice.
  
  Employers:
• Pilot employers reported having more formal stand-alone policies for non-work related conditions and reported greater success in accommodating non-work related conditions than controls.
• Seventy-eight percent of test and control front-line supervisors felt that an activity plan could aid an employee's early return to work and 67 percent felt it was very useful. As with the provider survey, there were areas of agreement among all employers, which suggests a common culture related to disability prevention principles. These include:
  • Agreement in the benefits of providing accommodations for both work and non-work related conditions
  • A high comfort level for discussing employee work restrictions for both work and non-work related conditions
  • The potential utility of an activity plan
  The organizational analysis, evaluating the impact of the model on employers, healthcare organizations, and health plans concluded the following main points regarding the implementation of the CHCDP model that could be used in understanding and to help identify strategies to transfer the model to other communities:
• Changing physician behavior is inherently difficult.
  
• The time-limited period for the intervention discouraged fundamental behavioral change.
  
• The small scale of the intervention made system changes impractical.
  
• Community based coalitions for health care reform is inherently fragile.
  
• Competing initiatives/research studies created pressures that competed against successful implementation.

• Although there was evidence of CHCDP's clinical implementation, ultimately, the experience underscored how difficult it is to carry out meaningful research projects in "real world" practice settings when the projects require physicians to change their interactions with patients and where there is not immediate positive feedback to physicians in the form of improved patient health outcomes, satisfaction, or reimbursement.
  
  
• Overall, the results suggest the importance of disability prevention principles as reported from providers, employers, and patients. Both provider and employer practices of implementing different principles may be varied, but the agreement of value is present. Most significantly perhaps, is that patients reported better mental and physical outcomes, along with greater satisfaction when disability prevention practices were used in the provider setting within the context of a strong patient-provider relationship.

Reports and Publications:

McGrail, M, Gorman, R, Lohman, W, Parker, D. "Disability Prevention: Assessing Appropriate Activity." Minnesota Physician XIV (14), no. 1 (2000).

McGrail, M, Gorman, R, Lohman, W. "Disability Prevention Principles in the Primary Care Office." American Family Physician 63, no. 4 (2001).

McGrail, Lohman, Calasanz, Christianson, Cortez, Gorman, Parker, Radosevich, Westman. "The Minnesota Health Partnership: Coordinated Health Care and Disability Prevention: The Implementation of an Integrated Benefits and Medical Care Model." Journal of Occupational Rehabilitation 12, no. 1 (2002): 43-54.

McGrail, M, Gorman R, Lohman, W. "Disability Prevention." Up To Date .

Radosevich, McGrail, Lohman, Gorman, Parker, Calasanz. "The Relationship of Disability Prevention with Patient Health Status and Satisfaction with Their Primary Care Provider." Journal of Occupational and Environmental Medicine 43, no. 8 (2001): 706-12.

Presentations:

William Lohman, MD, "Disability Management and Prevention: Implications from WC Research for General Clinical Care" Robert Wood Johnson Workers' Compensation Health Initiative Annual Meeting, September 6-7, 2001, Newport, RI.

Michael P. McGrail, Jr., MD, MPH, "Minnesota Health Partnership: Coordinated Health Care and Disability Prevention Lessons Learned and Applications for the future," Robert Wood Johnson Workers' Compensation Health Initiative Annual Meeting, September 6-7, 2001, Newport, RI.