The impact of lost time and disability management on healthcare service utilization and expenditure among Texas Workers' Compensation Commission claimants

The purpose of this study was to identify and examine relationships between disability management practices, lost time, and system expenditures related to workers’ compensation injury and disability. The study was conducted using primary event data provided by the Texas Workers’ Compensation Commission and short- and long-term data of successfully implemented disability management programs from other settings. Bivariate analyses determined if statistical and practical relationships existed between independent variables and variables reporting expenditure, medical service utilization (MSU), and time off work data. Regression models were developed to estimate likely expenditure, MSU, and time off work based on claimant characteristics. Finally, a costing model was developed to estimate long-term savings associated with implementing disease management programs in Texas. Results of the bivariate analyses showed statistically significant associations at p < 0.001 for most relationships between the independent variable and expenditure, MSU, and time off from work. Findings included significant differences in medical expenditure by practitioner type, MSU variation by the region of state in which care was provided, and differences in medical expenditure by gender. Regression analyses results indicated that there was little predictive value for any of the eight outcome variables assessed despite attaining statistical significance at p < 0.001. These models explained only 3.1% to 13.2% of the variance in each model. Results of the cost estimation model indicated that substantial savings may be obtained for treating injuries of at least 30 days and less than two years in length after implementing a disability management model in Texas. Specific savings depend on the type of disability management intervention, injury group targeted, and the intensity to which the interventions are integrated into the workers’ compensation care process. All models indicated that an increased penetration rate is associated with greater savings. However, incremental savings in all models gradually decrease over time as costs of the program begin to offset the benefits. Overall, the potential for disability management treatment planning to provide significant cost savings to Texas employers, as compared to continuing with the status quo, is substantial.