Beyond the Claim
Beyond the Claim

Episode 8 · 4 months ago

How Well Does Your Organization Respond to Behavioral Health? w/ Terry Smith


It’s a cliché at this point to note the silver linings of COVID-19…

But if you’re in the claims management space, there is one upside that is hard to deny:

Employers are finally understanding why mental health matters — both for their bottom line and their concern for employee well-being.

Today’s guest, Terry Smith, First Vice President at American Benefits Consulting, is one of the pioneers of the Modified Duty and Return-to-Work movements. He joins the show to discuss the evolution of employer attitudes towards mental health.

In this episode, we discuss:

  • The history of return-to-work programs
  • How to approach modified duty with empathy and understanding
  • The difficulties faced by employees when it comes to behavioral health treatment 

Need more claims strategy in your life? Check us out on Apple Podcasts, Spotify, or on our website.

Listening on a desktop & can’t see the links? Just search for Beyond the Claim on your favorite podcast player.

All right. Think that we've done a decent job of destigmatizing behavioral help. I think we're we're still falling down. where I think it was tremendous opportunity is for employers to recognize the fact that there's are, in some cases, coherent barriers to letting employees seek treatment. You're listening to beyond the claim, the show for forward thinking risk and claims professionals curious about the latest industry trends, winning strategies and stories from influential leaders. Let's dive in. Hello everyone, welcome to this episode of beyond the claim. I'm Mark Cunningham, chief sales and marketing officer for broadspar. Thank you for joining us today. Today I have the pleasure of being joined by Terry Smith, first VP consultant with American benefits consulting. Terry's a legend. Terry's been in industry a while and he's seen everything. Terry spent twenty nine years with Mercer, operating at all levels. I know you're graduate from Villa Nova, Terry. Terry, thank you for joining us. Thank you for the opportunity, mark, I really appreciate it. No, Terry, I don't think I've ever told you this when I joined the industry. Mean you were one of the first names that I heard in the space, you know. So when I say legend, I truly mean it that this is probably something that even before I knew a podcast is ever going to exist, it was a conversation that I've been looking forward to throughout my career. So I really appreciate you taking a time to sit down with us today. It's part pleasure to Terry you have. You've seen a lot in this industry over a period of time, you know. I know you have. I think you graduated and went directly into which early after when Tom Mercer and spent most of your career to this point in that consulting space, and then now you're with ABC and Terry, I think you even have lineage with your father being in the space as well. So I'm so intrigued, insted in hearing your journey, hearing your story. So I'm going to stop talking and ask you to share your story with the world. Arm Yeah, I'd be happy to a little background. So I graduated develop of university in one thousand nine hundred and eighty four with a degree in finance and and they lap of a business school back then into this day, is really a pipeline for accounting and financial grads to go to Wall Street and the plan was to go to Wall Street. And we're a couple of opportunities, but that I looked at that I ultimately turned down. As I continued the interviewing process, my father, who was an executive at pronial, said why don't you come to work at prue for a while as you continue to interview? And here thirty five years later I'm still in the industry. So in the early days that prue I was a medical underwriter and then after only a year at pre duncial I decided to joining the company called US healthcare, which was one of the countries first HMOS, was one of the first HMO on to writers ever, and after a couple of years there I decided I wanted to give in the consultant so I joined Mercer in Atlanta. It was a...

...a premier practice for mercer back then, really really dominant in the healthcare space, and so I joined Mercer in eighty seven in Atlanta and I was I was on the healthcare consulting team and one day I was invited to a client meeting and the instructions to me at that time were say hello, say goodbye and no say anything in between. It was a really Marquy very large client, very large audience, and the CEO of this company came to speak and he talked a little bit, a lot about technology, a lot about logistics, a lot about competition, unization, etc. And then he went down a path where he started talking about the need to have as many people show up for work on any given day as possible and he posed a hypothetical question. He said, why is it that that we have a group of employees who are out of work to a disability they're unable to perform any work of any kind? And then something happened is one night and the very next day these employees are able to go back to work full time. And he said that he didn't believe that people would go from totally incapacitated to totally capable of work in a one day period. So what he did is he really planted to see for modified duty return to work opportunities and, long story short, he asked Mercer to help build the first ever full scale modified duty return to work program that was staffed with corporate employees and the number of corporate employees. At its height, greutle about sixty people whose full time job was to support employees who had a condition that prevented full time return to work but enabled them to work on a part time basis as they continue to recover. So at that point in my career I pivoted from the healthcare consulting practice into a newly developed disability consultant practice and I've spent literally the last thirty years consulting exclusively on absence and disability and workers compensation programmers. So that's how I really entered the business. It was kind of a parking lot that so lasted for thirty five years. So around what time was that CEEOS recognition of the need for modified yeah, I remembered vividly. It was one thousand nine hundred and ninety. I asked because it's incredible that it can be recognized then and that there's still so much opportunity to perfect it now. I mean, I think we have more stability and policies and procedures around, you know, doing that, but I still think there's an opportunity, whether it be leveraging technology other ways to better meet people where they are to truly get them, you know, to a point where they feel that they can be productive in the work environment.

So that it's interesting. So what were some of the programs that you were able to implement within that? You know that that environment. Yeah, one of the keys to that program and that was first generation. There on like fourth generation now. But one of the keys back then was to identify tasks that had to be performed that weren't necessarily fully staffed at the time and they could take these partially disabled employees on the voluntary basis and put them into these temporary positions were giving their limitations and restrictions, they would still be able to perform meaningful work, and meaningful was were a key here. This isn't the old fashioned workers compensation forced the employee into the worksite to do nothing all day as a pewter measure. This was more of a given employee exposure to new aspects of the company and need to perform tasks that actually had true and treas of value back to the organization. So that's really what we focused on the early days. We needed vendor support, so we turn to the disability vendor marketplace and and partner with a company that helped build a modified duty return to work support program so that these claims could be he ministered in a way that would allow for partial pay for hours worked and in partial pay for disability benefits to keep the employee whole and to track their progression during that modified duty process. So it really it taught me a very important lesson early on that when you look at claim organizations there they really have three pillars. It goes along the lines of people, process and technology. And when we build that first generation return to work model, we had people both at the clients sit whose full time job was to facilitate modified duty return to work and at the vendor location, where we had claims specialists who work with these claimants in support of modified duty. We had technology because we had to track these events, because long before the Americans with disabilities act, or FMLA, came into being by the way, but we still need a technology for tracking purposes. And then we had a very very well, defined and wellcommunicated process to facilitate the return to work activity. Was this something that you saw quickly adopted by other organizations, other consultants? Because, as I said, I think that phase one that you're talking or even phase to translated into what's now standard filed, you know, insurance policy language, standard processes, standard expectations across all consultants. It sounds like you were kind of on the forefront of developing what is now a minimum expectation. That just didn't exist at that time, did it? Do you see? It evolved pretty quickly. It did evolved fairly quickly. Interestingly, the client was very interested in sharing their success story and they did... by personning at Trade Association meetings that they would speak one on one with with other clients who were interested in adopting the model. And so throughout the s we were really on the lecture circuit with this client telling the story, and there was a there was an awful lot of uptake from other employers that wanted to replicate the model in their version what makes sense for their workforce. So there are variances depend upon what your work photos actually looks like, but yeah, there were. There was tremendous uptake. Not to go too far back, but I wanted to ask you about your father. said he was an executive and industry and did he intend to pull you into the industry, because I know you've I believe you've done the same with your with your too today. Was this a plan that you will all as? This the the your version of the bushes? Yeah, it was pretty funny. My Dad ran what was called the ordinary and district agencies for provincial so what that translates into is individual life insurance sales and I entered the industry on the group side of a business and back then, when you looked at the organization hit predential or mat or some of the other players, the individual markets dominate the insurance balance sheet and income statement. The group business was really small, really fledgeling at the time back then, and proves in the medical underwriting business. They obviously exited that many years ago. But we talked about parential being a parking lot, and I don't mean that term to be used disparagingly, but it was just a place to go to work. While I continue to interview on Wall Street, and then when I fell in love with the idea of consulting and problems solving, my Wall Street dreams kind of die. Ironically, I now consult the firms on Wall Street, so I do have the opportunity to spend time on Wall Street, which is a real treat for me, very nice. The Beginnings of the Smith Dynasty are very nice. Let me ask that the Terry. So you know that was a critical component to what we do today. I'd say it's funny to because you hear a lot of those themes resonating a lot of the talks around advocacy today and meeting individuals where they are and working with them to get back to their whatever their current whole self is going to be. So when you look at that and you say, okay, that was transformative in the industry, what else have you seen, or maybe what's the most significant one or two things that you've seen also bring this industry? The group concerns this disability lead of absence space forward over the last, you know, ten twenty years. Well, one of the things that we've seen, and ironically with the same client, we built out behavioral health claim management opportunities. The the the client recognized the fact that behavioral health... presented new opportunities to assist claimings in their wellbeying, and so what they did is they turned to their vendor and they said, if we have a claimant who suffers from and behavioral health condition, be a primary or secondary we want experts in the field of psychology to interact with these folks as they process their disability claims and as they support recovery and eventual return to work. Really pioneering stuff. This was back in the late S, early two thousands. Fast forward to today and and just even prependam many employers are wrestling with how to best support their disabled population who have behavioral health conditions and try to prevent disabilities from taking place by getting ahead of the curve on on behavioral health related conditions. There's an awful lot of activity today in this space and the pandemic is only made it worse. It is such an a huge issue for many importers right now, with the stress associated with the pandemic on top of the normal stresses of childcare, financial issues, career related issues, etc. So really, really huge opportunity to really positively impact employee lives by addressing these conditions. Yeah, and I'm curious to see you know what you're what your thoughts are. I maybe what can be done, because you're right and early on early s for sure. It was primarily getting the right clinical expertise in place to evaluate kind of the known and unknowns around this potentially primary and most often a you know, a secondary come more of a type of condition in a way that we just did not a treat you know, the the the mental, similar to how we were even identify what we call the medical, the physical claims right and even the fact that we draw that distinction is somewhat kind of interesting of what kind of where our mindset was at that point in time. And and you fast forwards to today, I think the great evolution, especially over the past twenty two year, twenty months, twenty four months of this pandemic, is that we've evolved our appreciation, understanding and allowance of Mental Health, you know, as as just a topic to actually pre pre to exist before the disability. So it's more of a common way of everyday life thinking and of appreciation of where someone is in the need for communicating, support, specialization, etc. So when you think of the this this group insurance space, when you think of disability and leave, you know we have the pay family leave components that are happening at state level and then we are looking at a federal level. Is there something that needs to be done more intentionally to really hone in on the preventative or the supportive nature of mental health on...

...the front end. That from your thoughts? Yeah, I don't know that it's something that I'll be legislated, but I do believe that there's been some really powerful critical thinking around how to best manage these conditions. But I think that there's a lot more that could be done. I think that we've done a decent job of destigmatizing behavioral health conditions. It's okay to talk about it, it's okay to let your supervisor know that you your resting with something and you want to seek treatment for that condition. I think where we're still falling down and where I think there's tremendous opportunity is for employers to recognize the fact that there's are, in some cases, inherent barriers to letting employees seek treatment on somewhat of of an efficient basis. And I'll give you an example. So many of US participate in high deductible health plans and so many psychiatrists, whom psychologists, are out of network. They don't join networks, they don't need to join networks because demand is so high. So what invariably happens is you put employees in a situation where there're seeking care, it's out of network care and it's at a pocket cost for that care because of the high deductible health plan concept. So a lot of employees feel that there there are sufficient barriers to treatment, so they treat with their primary care physician and that may not be the best setting until receive treatment for a behavioral health condition. So I think there's opportunities for forward thinking employers to revisit the structure of their disability and of their health plans in an effort to make treatment more readily available and more affordable to employees. Great Point. That definitely agree. The data know proves it time and time again, especially as you get into, you know, your more rural areas or where you just it's just not as exceptive especialist is not as accessible. So you know it's got to be other creative ways to meet individuals where they are. I know there's been an expansion of telemedicine, at least during the initial phase of the pandemic. Will See if that continues into what degree that can support potentially. You know, this this space as well. So let's in line with that line thinking as we look out. You know the next five, ten years, let's say. Where do you also see opportunities and diss into the mental health focus, to really expand this market? I know sometimes we we lean on technology. We talked about legislation. Potentially, it could be any of those, both of those, but where do you see us growing and evolving to? Yeah, I think back to the people process and technology concept. I think that in today's world there is intense pressure on the people side of that equation as it relates to claim operations and and what vendors are able to support from a people perspective.

We're not convinced that that we have enough qualified case managers in the market place today. We see growing case loads and we know there's a really high correlation between high case loads and poor customer service. So we're hoping that vendors, carriers PPAs we can get on top of the people side of the equation. Yet the thing that a lot of vendors are doing, if we really applaud this, is they're heavily investing in technology. This business has become really, really complicated compared to where we were even ten years ago. Now we have mandated state leaf programs and we have an awful lot of forward thinking employers who are voluntarily offering paid family leave, paid parental weef programs, and the the concept of coordinating and mandated leave with a voluntarily offered leave is in some cases mind modeling. It is so complex. And now we believe at some point, sooner or later, there is going to be a federal paid family medical weef program in place, and so we question, it's nottly, how the federal plan will integrate with the mandated state plans and how they will integrate with a voluntarily offered plan by an employer. Really really complex stuff and I think that we can solve it through a combination of people and technology. Yeah, I mean I think the technology is a must. We the people. To your point, we have, I know we see it within, you know, the risk management casualty space, where you have that kind of silver tsunami of retirement phase happening with your kind of your more senior individuals that are bringing in the most experience from a claims administrations and standpoint. And and really, as an industry, have we done the best job of ensuring that there's a continual, continued flow of talent? Right? And then there's career paththing and I think that we've definitely seen opportunity to improve upon that. I mean there's there's no to my knowledge anyway, they're very limited degrees that are specific to our space, and so you really got to make sure that you're out there promoting and marketing the opportunities that exist that are extremely Dene dynamic and rewarding in so many ways. But you know it, you just not when you just lead with okay, it's insurance, that's not enough for someone to intuitively see themselves or what that could be for themselves from a career standpoint. And I couldn't never go more of the complexity has grown. At early on in the pandemic when everybody kind of retreated to their to their bunkers. We there was a running joke around you someone developing a bigger, better APP for all things, you know, leave of absence related, that we're going to put everybody out of business. But realistically, the way we balance the pillows that you're talking about with people is to absolutely have better technology to support the complexities of...

...these programs. And they are diverse from employer to employer, from state to state, and probably see something even diverse within the federal language whenever that comes to be. So we we definitely have our work cut out to to align ourselves that, to continue to align ourselves with where the market continues to evolve to. Yeah, today, on top of everything else, now we're turned to our vendor partners asking them to do things like tracking covid vaccinations, tracking covid testing on a weekly basis, tracking the the the explosion of Ada accommodation requests due to covid and vaccination lated issues. So it only becomes more and more complex. I think something you said earlier about career pathing is really, really important. I think that historically the claim organization was comprised largely of transient workers who were in the field for a couple of years then on to bigger and better things, and I think that vendors are now more and more talking about career path and in the claims organization and I think that there's a higher value placed on case managers today then there was ten fifteen years ago. So it really is a legitimate career path and so we encourage our vendor partners to continue to get that message out there and attract the best talent. Make sure you have proper internal training because, to your point, mark, there really isn't a degree that that's soule. We focus on the art of case manager. So it's some coming upon the vendors to provide that continued education and career to happen. Absolutely, absolutely well, Tarry, this was this is great. Is Everything that I was hoping for. I appreciate it so much. I'm sure that the audience does as well. So, Terry, where do you if anyone wants to reach out to you, they want to connect with you? I know linkedin as an option and email as well. was there anything that you would share with folks of how they can reach you? Yeah, I'm very, very active on Linkedin. You can easily find my profile. Even though my last name is Smith. You'll still be able to find it. With American benefits consulting or email. It's t Smith had ABC SYSCOM and I'd love to hear from you. Excellent. Thank you so much, sterry. Thank you for joining us and hopefully we can redus again down the road. Thank you for the opportunity. Thank you all for listening to this episode of beyond the claim. You've been listening to beyond the claim, a podcast for risk and claims leaders. To ensure you never miss an episode, please subscribe to the show in your favorite podcast player. If you use apple podcast, we'd love for you to give us a quick rating for the show. Just tap the number of stars that you think the podcast deserves. Until next time, stay curious and keep innovating.

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