Mental and Behavioral Healthcare Assessment Program for Medicare and Workers' Comp
Detecting and addressing mental and behavioral health conditions can help reduce the length and costs of a claim.
The comorbidity of chronic pain and behavioral health are inextricably linked to determining the successful outcome of a claim. The relationship between chronic pain and depression is complex and bidirectional, meaning one condition can exacerbate the other.
The potential negative impact of these conditions on a claim directly affects adjusters, case managers, and defense attorneys. The challenge for insurers has been how to integrate behavioral health assessments into a claim effectively.
How BRE Benefits Insurers
Behavioral Response Evaluation (BRE) is a proactive program for payors to gain valuable insights into how a workers' comp beneficiary's behavioral and mental health affects their ability to recover. BRE's clinical staff calls the beneficiary monthly and administers clinically valid and CMS-approved assessments that measure depression, anxiety, cognition, medication abuse/misuse, PTSD, and suicidality.
The scores can be compared over time to improve risk stratification. The assessments can also give case managers valuable insights into discovering underlying problems that may affect the outcome and recovery process, which can delay the claim.
Identify Appropriate Treatment
BRE can help identify the specific mental health condition an injured worker is experiencing. This allows insurers to recommend and approve the most suitable and effective treatment options, reducing the likelihood of unnecessary or inappropriate treatments.
Facilitate Timely Intervention
Early identification of mental health problems through assessments enables insurers to intervene promptly. Timely access to mental health support can prevent the condition from worsening, promoting faster recovery and return to work.
Mitigate Long-term Costs
By identifying and addressing mental health issues early on, insurers can reduce the risk of long-term disability and ongoing medical expenses. This proactive approach can help control costs associated with extended treatment and rehabilitation.
Improve Claim Outcomes
When mental health issues are accurately assessed and addressed, injured workers are more likely to experience improved mental well-being, leading to better overall claim outcomes and a higher likelihood of successful return-to-work outcomes.
Foster Positive Employer-Employee Relationships
Insurers who prioritize mental health assessments show concern for the well-being of injured workers. This can enhance the relationship between the employer, employee, and insurer, leading to better cooperation and communication throughout the claims process.
Compliance With Legal and Ethical Standards
Providing appropriate mental and behavioral health assessments is essential for insurers to comply with legal and ethical guidelines related to workers' compensation. It ensures fair and equitable treatment of injured workers, regardless of the nature of their injuries.
Suicide Prevention
The CDC reported that, from 1999 to 2016, injured worker suicide rates increased by 30%, substantial enough to contribute to a decline in overall U.S. life expectancy. BRE has alerted physicians to thousands of potential suicide threats among patients, allowing for proactive intervention before someone took their life.
Accurate Claim Assessment
BRE assessments help insurers determine the validity and extent of a claim related to mental health issues. This ensures that only legitimate claims are approved, preventing potential fraud or false claims.
Data Collection and Analysis
Insurers can use aggregated data from BRE mental and behavioral health assessments to identify patterns and trends related to workplace mental health. This information can help in developing targeted prevention programs and policies to improve overall employee well-being and reduce the likelihood of future claims.
Risk Mitigation
New research has shown that injuries severe enough to keep an employee home for at least a week almost tripled the combined risk of suicide and drug overdose death and increased the risk by 50 percent among men. BRE assessments alert physicians and insurers of potential suicide risks and provide consistent documentation that the claimant’s mental and behavioral health were factored into their physical treatment plan, thus reducing the exposure to tort liability for failure to diagnose. The use of opioids during treatment significantly exacerbates the problem.
