Xerox Canada At Xerox Canada, a 3,800-employee, Toronto-based company specializing in document technologies, helping sick or injured employees receive the medical treatment they need begins with Celia Dumas, manager, occupational health and wellness. Dumas manages all of the company’s short- and long-term disability claims, as well as worker’s compensation claims. She will spend one-on-one time with seriously ill or injured employees on the phone or in person to ensure they are receiving adequate treatment and support in the public healthcare system. She will also work with the employees’ managers to put together individual return-to-work plans that will help the employees reintegrate into the workplace.
“A lot of it is health teaching and support, and helping [employees] navigate through the healthcare system,” says Dumas. “We aren’t able to access care any quicker, usually, but I try to provide them with information and support, and empower them to look after their own healthcare and manage their way around the system.”
Looking after one’s own healthcare includes asking the right questions. Dumas will help employees come up with relevant questions to ask their healthcare providers. She will also help them find relevant information and resources to facilitate their recovery. Such resources may include disease or injury-specific websites and online articles, general health and wellness tips and information — even a list of local physiotherapy and rehabilitation experts. Dumas will also work with the families of the ill or injured worker, if necessary, to help them cope with their loved one’s condition.
Sometimes, if an employee is having trouble getting an appointment with a specialist in the public healthcare system, delaying his or her recovery and subsequent return to work, Dumas may decide that it’s in everyone’s interest to arrange for the employee to see a different specialist (paid for by Xerox) to speed things along.
EAP providers For employees who are experiencing difficulty or frustration as they journey through the healthcare system after an injury or a diagnosis, an employee assistance program (EAP) is also an invaluable tool. Rod Phillips, president and chief executive officer, Sheppel•fgi, a Toronto-based EAP provider, says an EAP can provide the employee with confidential counselling for psychological, stress-related and work-life balance matters, and act as a referral service for finding childcare or eldercare. Sheppel•fgi offers some clients a service called NurseLine, which allows employees to get specific medical advice from a registered nurse over the telephone. Phillips says, more often than not, nurses are called to answer such questions as, “What am I supposed to do about my stress or anxiety?” or “What steps do I take in my treatment?” Many EAP providers will also provide services to employees whose stress is due to the illness or injury of a family member.
“Often when there’s a health issue people get frozen by the fear of the unknown, or the complexity of what they’re facing. Our service tends to help with the first part, and we will help people work a plan through,” Phillips says.
“It goes back to this issue of helping people help themselves through the system to the greatest extent possible,” he adds.
The rising rate of diabetes Michael Decter, former chair of the Health Council of Canada, understands the issue of patient navigation well. His recent book, Navigating Canada’s Health Care: A User Guide to Getting the Care You Need, co-written by health policy expert Francesca Grosso, offers information and advice to patients and healthcare organizations on how to obtain and provide the best possible treatment and services in Canada’s complex healthcare system. It is no surprise that as the number of elderly Canadians rises, certain disease states, such as diabetes, are becoming increasingly widespread. According to the book, there are two million diabetics in Canada right now, and that number is expected to grow to more than three million by 2010. Also, many diabetics find it difficult to manage their blood-glucose levels, according to a recent study by PSL Research, putting them at risk for disease-related health problems, such as heart disease, blindness and even amputation.
Given the statistics, employers have reason to be concerned about the health of their workforce. Luckily, there are many things they can do to help employees better manage their diseases, Decter says. Employers, for example, can help pay for diabetes medications and put employees in touch with chronicdisease management programs. There are also many online resources employees can go to for more information on various disease states, he says. Some of these resources (which are outlined in the book) are websites for disease-specific associations, such as the Canadian Diabetes Association, the Heart and Stroke Foundation and the Canadian Cancer Society.
Navigating cancer treatment Most people don’t think about how they will navigate the healthcare system until they actually get sick or injured. And when people are sick, the last thing they want to do is worry about their care or how long they will have to wait for treatment.
This is certainly true for employees diagnosed with cancer. According to Bill Hryniuk, medical director of CarePATH, a Toronto-based company providing services aimed at reducing the burden of cancer on employers, employees and their families, cancer diagnoses are growing rapidly. So rapidly, in fact, that it’s the most common physical cause of long-term disability in Canada, surpassing all other diseases, including heart disease. This has major cost implications for organizations with cancer-stricken employees. Without assistance, these employees may miss work and develop depression and other stress-related by-products of cancer, prolonging their disability and absence from work, he says.
“[At CarePATH,] we navigate a cancer patient through the system to make sure they get the right treatment at the right place, at the right time,” says Hryniuk. “In almost all cases, the disease comes under control. Then we put them through the cancer prevention part.”
The cancer prevention part includes assessing and taking steps to reduce an employee’s risk for developing other diseases, such as diabetes, heart disease, stroke and osteoporosis. The reason for this is, the factors promoting cancer are the same ones that promote many other chronic diseases, Hryniuk says. After the health assessment, the employee is given a risk profile and is educated on what he or she can do to reduce the risk for other conditions.
The CarePATH team consists of oncology nurses, oncologists and exclusive Web-based resources. Together, they provide employees with “a little bit of coaching … to head them in the right direction,” Hryniuk says. The oncology nurses follow a specific care plan, which is published online by the National Comprehensive Cancer Network in the United States. The care plan is a set of detailed guidelines addressing every aspect of diagnosis, treatment and follow-up for every kind of cancer. It is maintained by committees of top cancer experts and revised every three to six months. (The guidelines are publicly available at www. nccn.org.)
“We explain to our clients where they fit in the guidelines and actually send them a copy of the guidelines with a yellow trail, showing them exactly where they are and what has to happen,” Hryniuk says, adding that follow-up with the employees occurs after several months.
Nearly 60% of a CarePATH nurse’s time is spent providing moral support to employees and helping to relieve the “paralyzing fear, anxiety and depression” that often accompanies a cancer diagnosis, says Hryniuk. He adds that 50% to 75% of employees who were working before their cancer diagnoses continue to work during treatment.
“Our nurses monitor and navigate the clients for the full course of their illness,” Hryniuk says. “Our nurses will spend up to 20 hours with each client during the six to nine months [he or she is] going through treatment.”
Government benefits Another way employers can help employees navigate the healthcare system is by educating them about their employee benefits, says Decter’s co-author Francesca Grosso. Many employees are unaware, for instance, that the cost of their child’s orthodontic work can be split between both parents’ dental insurance plans. So if the bill for the orthodontic work is $5,000, and each parent’s dental insurance cap is $2,000, the couple can claim up to $4,000 from their dental plans and pay just $1,000 out of pocket, Grosso says.
Employers can also educate employees about various government-sponsored benefits that are available to people under certain circumstances. Under the Disability Tax Credit, for example, the government will reimburse the cost of a home air conditioning system for someone with multiple sclerosis, provided that person meets certain criteria. Also, the recently introduced Compassionate Care Benefit program offers six weeks of job-protected leave with employment insurance benefits to employees who must take time off work to care for a gravely ill parent, spouse or child. A good employer will let employees know about these benefits and publish updated claims and benefits information annually, says Grosso.
Meanwhile, interest in patient navigation is growing fast. Since Decter and Grosso’s book was released this past winter, the duo has been invited to speak across the country on the subject.
Grosso says awareness is key to improving a person’s experience in the healthcare system. A savvier employee/patient will have a quicker recovery, and that, in turn [will help] both employers and the healthcare system save time and money. “Nobody is asking patients to practise medicine,” says Grosso. “What we’re doing is actually giving them the tools they need to manage their patient journey better. That’s in everyone’s interest.”
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