Rubio’s Case StudyOutcomes from an Early Injury Reporting and 24/7 Delivery Model

California Coalition on Workers’ Compensation Annual Conference

Sarah Cato, Claims Manager, Rubio’s Restaurants

Peter P. Greaney, M.D., President, CEO and Medical Director, WorkCare, Inc.

Introductions

Sarah Cato, Claims ManagerRubio’s Restaurants

Overseeing all workers’ compensation and general liability claims

Rubio’s has over 4,000 employees and operates more than 200

restaurants in California, Arizona, Colorado, Utah, Nevada and Florida

Introductions

Peter P. Greaney, M.D.President, CEO and Medical Director, WorkCare, Inc.

Consulting occupational physician, Rubios

WorkCare is a physician-directed occupational health

company providing integrated workforce health management

solutions to employers in the U.S. and abroad

About this Session

Rubio's Restaurants collaborates with

occupational health specialists to:

• Promote employee well-being

• Effectively manage injuries at onset

• Reduce medical costs and workers’ comp claim rates

• Facilitate safe return to work after an injury

• Decrease the likelihood of lost work time and disability

Key Employer-based Interventions

• Senior management commitment to

workforce health and safety.

• Supervisor-employee collaboration and advocacy.

• Reporting injury, illness or physical discomfort at onset.

• Providing immediate, appropriate care guidance.

• Using work to promote recovery and sustain livelihoods.

• Monitoring progress during recovery.

Healthy Workplace

• Company culture facilitates

engagement and trust

• Employees have positive sense

of well-being and self-efficacy

• Supervisors are educated

about the process

Workplace Culture

• Engender trust and communication

• Create non-punitive climate for injury

reporting and early intervention

• Educate employees so they can

make informed safety- and

health-related decisions

“It Pays to be Nice”

4.3

3.8 3.8

4.2

3.1 3.1

4.3

2.8 2.9

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Doctor Employer Main Supervisor

Rating

Durable RTW Non-durable RTW No RTW

What We Know About Injuries

• Most work-related injuries are relatively minor

• Injury assessment typically notwithin supervisors’ skill set

• Reporting and intervention at injuryonset facilitates return to work

• “Simple” care guidance preventsunnecessary complexity

• Working during recovery promotes healing

Using Work to Promote Recovery

“...long-term worklessness is one of thegreatest risks to health in our society. It ismore dangerous than the most dangerousjobs...and too often we not only fail to protectour patients from worklessness, we sometimes actually push them into it, inadvertently…”

- Professor Gordon Waddell, “Is work goodfor your health and well-being?”

Value of Work

•There are physical and psychosocial

benefits associated with working

•Working through pain is better

for health than not working

•Advocacy means creating a culture

where employees feel comfortable about

reporting an injury or discomfort

‘Worklessness’ and Health Risks

Increased risk of:

• Dying (20% excess deaths)

• Heart disease and other chronic conditions

• Poorer self-reports of general health and well-being

• Poorer mental health (2-3 times risk of mental illness)

• Higher rates of medical utilization, hospital admissions

and suicide attempts

Acute

Subacute

Chronic

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 10 20 30 40 50Time (Weeks Since Pain Onset)

Percentage of Claimants Still Off Work

I

II III

3 to 4

weeks

12

weeks

By 12 weeks, injured workers had only a 25%

chance of ever returning to work.

Time is of the Essence

186 municipal workers with acute Low Back Strain

Initial medical evaluation within 1-2 days of going off work

Random Assignment

2 days complete bed

rest

1 Hr PT instruction &

vigorous HEP

Minimalist Treatment“carry on with usual duties

as much as possible”

Best outcomes at 3 wks & 12 wks:

Improvement in pain & functional status, substantially less lost time

Overtreatment: Helsinki Study

Injury Management Philosophy: The SPICE Model

We help prevent routine injuries from becoming complex, costly claims.

We understand that staying at work

promotes good health and healing.

We promote early intervention – optimally

during the "golden hour” – for best results.

We collaborate with all parties to effectively manage every case.

We provide reassurance and establish reasonable expectations for recovery.

The SPICE model provides the foundation for WorkCare’s approach to injury assessment and care guidance.The concept originated with the medical management of WWI soldiers suffering from post-traumatic stress disorders.

Right Care, Right Time, Right Setting

• 24/7 telephonic access to occupational clinicians

• Clinical guidance to support self-care/first aid

• Provider referral management to improve outcomes

• Physician peer consultation on return-to-work pathways

Benefits for Employees

Alleviate anxiety, provide reassurance

Encourage prompt reporting

Empower self-directed care

Support return to function, livelihood

Reduce likelihood of disability

Benefits for Employers

• Demonstrate caring, progressive approach

to workforce health management

• Identify and correct hazards enterprise-wide

– before more injuries can occur

• Gain insights to determine work-relatedness

Benefits for Employers

Reduce:•Lost work time

•OSHA-recordable rates

•Medical costs

•Workers’ comp claim rates

•Potential for disability

•Litigation

Rubio’s Challenges

• Connecting with mono-lingual, Spanish-speaking Team Members

• Showing we care in a fast-paced environment

• Preventing escalation of claims and out-of-MPN treatment

• Understanding injury causation

• Lack of trust to report injury due

to over-elevated medical treatment

• Comorbid conditions

• Return-to-work management

Triage Gaps

Re-establish trust for timely injury reporting

So….Now what?

Follow up and close the injury loop

The Data

49.60% 51%

63% 64%68%

50.40% 49% 37% 36% 32%

2013 Prior NT 2014 Prior NT 2015 WorkCare 2016 WorkCare 2017 WorkCare

Self-care Clinic Visit

How Does It Work?

WorkCare poster• All incidents called in regardless of severity

Report to nurse triage by end of shift• Occupationally trained nurses ensure

correct line of questioning

Demographic feed • Triggered by employee ID

• Reduces call times

How Does It Work?

Email notification is sent to GM, DM,

People Services, Ops, Risk & Safety ✓ Team Member investigation form

✓ DWC-1 (CA)

✓ Medical release form

✓ First fill pharmacy card

✓ Provide modified duty, as feasible

✓ Check in with Team Member to ensure he/she has needs

met throughout the recovery process

©2018 WorkCare - All Rights Reserved.

Incident Intervention ProgramSuccess measured through timely injury reporting

• Reduced disability days with improved

return- to-work communication

• Re-established trust with proper medical

referral based on severity of injury

• Self-care injuries have follow-up and resolution plan

• More precise injury causation determination

• Occupationally trained nurses make a difference

• Triage time is reduced

• Doctors are available when needed

©2018 WorkCare - All Rights Reserved.

Incident Intervention ProgramRubio’s Restaurants, 3/1/2017 to 2/28/2018

Total P2Ps*% of P2Ps

Possible

% Successful

P2Ps

128 88% 90%

Regular

Duty

Activity

RestrictionsOff Work

32% 55% 14%

First Aid Maintained Above First Aid

12% 88%

*P2P = Occupational physician peer-to-peer

engagement with treating provider

Discussion

Sarah Cato

scato@rubios.com

Peter P. Greaney, M.D.

Peter.Greaney@workcare.com