Early Intervention Program for Disability Plan Participants - PowerPoint PPT Presentation

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Early Intervention Program for Disability Plan Participants

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  1. Early Intervention Program for Disability Plan Participants Support for Those Who Serve

  2. Early Intervention Program (EIP)—Purpose What It What It IS IS NOT • Enhancement of disability plans • For all Comprehensive Protection Plan (CPP) and Basic Protection Plan (BPP) participants (enrolled for disability benefits) • The resource to support participants in the early stages of a physical or emotional condition • Single entry point for “short-term condition” coaching and case management support • Voluntary and confidential • Short-term disability plan • Income replacement planor other benefit plan • Required for disability benefits eligibility • Form of medical care, or an extension of medical plan or related health programs

  3. Early Intervention Program (EIP)—Supports Overview • Telephone support with medical professionals including: • Registered Nurse(s) • Certified Case Manager(s) (CCM)

  4. Early Intervention Program (EIP)—Supports Overview (continued) Periodic Coaching Follow Up Calls: • Same coach for all calls • Ongoing coaching support - Information & resources - Action plan development & follow-through - Referral to other services (D) A B Initial Assessment and Evaluation Call: • Assessment of the situation - Abbreviated - Comprehensive (including medical, emotional, social factors) • Initial coachingsupport - Information & resources - Action plan development - Referral to other services (D) C D Case Management Activities: • Same case manager from initial call • Ongoing coaching support (similar to B) • Gather medical records & collaborate with physician, plan sponsor, and participant • Develop return-to-work or stay-at-work action plans Referral to Other Health and Wellness Services: • Employee Assistance Program • Lifestyle/Condition Management Program (HealthFlex only) • Other Conference resources

  5. When Should An Individual Access the Early Intervention Program? When do individual physical or behavior “changes” indicate a potentially greater underlying physical or emotional health condition?

  6. Possible Categories of “Change” A need for the EIP may exist if significant changes in: • Performance of pastoral duties • Interactions and personal relationships • Leadership and administrative style • Personal life

  7. How Does An Individual Access the Early Intervention Program? Encourage participants to call: 1-800-985-0242, use prompt #2 (Same toll-free number as Unum Disability Management Service Line)

  8. Other health and wellness services referrals Early Intervention Program (EIP)—Process Flow Summary • Case Management • “Lost time” and condition expected to last more than 180 days, or • “Lost time” and behavioral diagnosis 1. Initiate contact with EIP 2. Assessment and evaluation Periodic Coaching Condition expected to last less than 180 days 3b. Case Management Activities 5a. If it becomes evident that condition will last more than 180 days and involves: • Lost time 3a. Periodic coaching follow up calls 4b. As condition reaches 180 days • 4a. If it continues to appear that condition will last less than 180 days 5b. Hand off to Unum for LTD disability claim decision File will be closed

  9. Early Intervention Program (EIP)— Wellness Services Referral Process CCM determines if participant is part of Health Flex conference or not • All EIP participants will be referred to UBH EAP services, regardless of condition and whether in HealthFlex or not • CCM will either warm transfer the participant to UBH or inform them that they will be contacted by UBH • EIP participants with an existing physical condition, will also be contacted by Healthways for lifestyle/condition coaching (HealthFlex only) • CCM will also inform participant of other Conference specific services, resources and contact information (if applicable) CCM will warm transfer participant to UBH; otherwise CCM will notify UBH (and possibly Healthways for HealthFlex only) to reach out to the participant If notified to reach out, UBH contacts participant within 48-72 hours (24 hours if request is expedited)

  10. Other health and wellness services referrals Consider the Following Scenario Case Management “Lost time” and condition expected > 180 days • 1. Initiate contact with EIP • • Clergy; male; age 43 • Out of work or “lost time” situation • Chronic medical condition, resulting in back surgery • 2. Assessment and evaluation • Certified Case Manager (CCM) obtains demographics and contact information • CCM completes abbreviated assessment • CCM determines need and conducts comprehensive assessment • CCM evaluates condition and situation; determines most likely to last more than 180 days • 3b. Case Management Activities • Ongoing collaboration and coordination with the Participant, Physician(s), and plan sponsor (if applicable) • Stay at work or return to work action plans developed (with DS or CBO involvement, if applicalbe) • Ongoing coaching, action plan, resources, etc. • Referrals to wellness services (see flowchart) • Guide on how to apply for LTD • 4b. As condition reaches 180 days: • CCM will again inform the participant of the need to apply for LTD (if participant has not already) • CCM sends a EIP closure letter • CCM will electronically transfer all case notes to Unum system 3a. Periodic Coaching Follow-Up Calls 5a. If it becomes evident that will last more than 180 days and involves “lost time” • 5b. Hand off to Unum for LTD claim decision: • Consultation between the CCM and the LTD DBS. 4a. If it continues to appear that condition will last less than 180 days

  11. Other health and wellness services referrals Or the Following Scenario Case Management “Lost time” and Behavioral Diagnosis • 1. Initiate contact with EIP • • Clergy; male; age 49 • Struggling with depression. • Unable to keep up with work duties. • Diminished energy in all activity. • Advised by physician to cease work activity. • 2. Assessment and evaluation • Certified Case Manager (CCM) obtains demographics and contact information • CCM completes abbreviated assessment • CCM determines need and conducts comprehensive assessment • CCM evaluates condition and situation; determines behavioral diagnosis, with “cease work” direction < 180 days • 3b. Case Management Activities • Ongoing collaboration and coordination with the participant, physician(s) and plan sponsor (if applicable) • Stay at work or return to work action plans developed (with DS or CBO involvement, if applicalbe) • Ongoing coaching, action plan, resources, etc. • Referrals to wellness services (see flowchart) • Guide participant on how to apply for LTD • 4b. As condition reaches 180 days: • CCM will again inform the participant of the needto apply for LTD (if participant has not already) • CCM sends a EIP closure letter • CCM will electronically transfer all case notes to Unum system 3a.Periodic Coaching Follow-Up Calls 5a. If it becomes evident that will last more than 180 days and involves “lost time” • 5b. Hand off to Unum for LTD claim decision: • Consultation between the CCM and the LTD DBS. 4a. If it continues to appear that condition will last less than 180 days

  12. Other health and wellness services referrals Or the Following Scenario • 1. Initiate Contact with EIP • Clergy; female; age 54 • Noticeable change in interactions with others • Less engaged when talking with others • Becomes visibly frustrated with increased regularity • Reduced ability to counsel or console with care and compassion • 2. Assessment and Evaluation • Certified Case Manager (CCM) obtains demographics and contact information • CCM completes abbreviated assessment • CCM determines need and conducts comprehensive assessment • CCM evaluates condition and situation; determines no lost time. • Case Management • “Lost time” and condition expected > 180 days; or “lost time” and behavioral diagnosis 3b. Case Management Activities • Periodic Coaching • Condition not causing “lost time” 4b. As condition reaches 180 days • 3a. Periodic Coaching follow-up calls • Ongoing assessment, coaching, action plan, information, resources, etc. • 30 days following the initial call • 30-90 days after first follow-up call & thereafter (if necessary and depending on situation) • Refer to wellness services (see flowchart) • 5a. If it becomes evident that condition will last more than 180 days, or is a behavioral diagnosis, and involves “lost time”: • Elevate to case management • Guide participant on how to apply for LTD 5b. Hand off to Unum intake for LTD claim decision • 4a. If it continues to appear that will last less than 180 days: • Ongoing coaching supports and calls as needed (similar to 3a.) • Refer to wellness services (see flowchart) File will be closed

  13. Implementation Within Conference Develop implementation plan tailored for your Conference, which may include: • Cabinet buy-in and support • Active role of district superintendent • Communications directly to clergy and lay workers (from conference office, DS, etc.) • Communication and training with Staff Parish Relations Committees

  14. Implementation Within Conference (continued) • Integrate EIP materials and supports within conference processes • Leverage General Board resources • For communication materials • To attend meeting(s); participate on conference calls

  15. Eva Mullinax(847) 866-4050emullinax@gbophb.org Jon Jones(847) 866-4572jjones@gbophb.org For Any Questions or Additional Information

  16. GENERAL BOARD OF PENSION AND HEALTH BENEFITSOF THE UNITED METHODIST CHURCH Caring For Those Who Serve 1-800-851-2201 www.gbophb.org