Page 7 - PFFW December 2018
P. 7

Steve Wilding
                                                                                            We Are Engaged and Vigilant as Insurance Claims, Coverage Evolves
Blurred lines between workers comp and health insurance
The employee health model is evolving. Employers are finding the need to provide a consistent health care experience for their workforce and plan members. They would like to find a model that provides both quality care and consistency for their employees, regardless of whether the need for treatment arises from a work or non-work-related injury. Because a healthy workforce is a productive workforce,
The leadership of the Professional Firefighters of Wisconsin is engaged with our membership no matter where we are; whether it’s a seminar, event, or just working in the office and receiving a call.
Among the hottest, current topics we are working on are issues with workers compensation claims we’ve seen from across the state. In recent years the laws
in Wisconsin have changed regarding this issue. Our members have experienced a reduction in benefits and an increase in denials of workers compensation claims.
Our members are being forced to make a decision to litigate and prove the claim is rightfully a worker’s compensation claim, or use their health insurance benefits and pay the deductible. Brothers and Sisters, we are working hard to help resolve these growing problems. This article provides some background on what’s going on in the industry, some key information you need to know, and what to watch
as the political winds blow and what changes may be coming. The following information is taken from different publications that industry experts are following and outlines the dilemma our members, as well as other workers, are facing.
  employers also feel the need to tie together health and productivity.
We will continue to see health systems build accountable care organizations (ACOs) and enter the health plan, insurance, and risk-bearing arena with the goal of directly selling to and partnering with employers. ACOs are an attractive model for employers supporting a healthier workforce by extending the culture of health philosophy from work to the home for their employees and families.
Mental health is a top driver of worker absence across occupations, and is not simply a health cost concern. Mental health care needs to be as important as physical health care and is currently a focus of population health and employer programs. Employers are looking for healthcare models, which consider the person and offer consistent, engaging behavioral health and wellbeing workforce programs.
Workers compensation key stake holders
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