By Curtis Smith, Executive Vice President, Medcor
It turns out that solving the additional challenges employers face when managing workers’ comp in remote worksites can yield valuable solutions for all worksites, even those in urban and suburban locations. All organizations struggle with rising medical and indemnity costs, claims handling, administrative fees, insurance, and variable quality – and these challenges exist in an ever changing environment of complex regulations. Remote worksites amplify these challenges because there are fewer providers, less competition, fewer options, longer response times for emergencies, and greater travel time away from work for scheduled medical appointments. In effect, everything becomes more expensive, more difficult to coordinate and takes longer to accomplish in remote settings. Employers in remote sites are often forced to prioritize, innovate and solve these problems not just to control their costs, but to stay in business. Many of those solutions can be effectively applied to any worksite.
Many people envision workers’ comp cases in remote worksites as due to exposure to the elements, wilderness mishaps (including wild animals) and heavy equipment hazards. And while these kinds of injuries do occur, the vast majority of cases are musculoskeletal, resulting from strains and sprains with mechanisms of injury just like everywhere else. Some people think of remote worksites as small or only involving a few types of industries, such as oil and gas or forestry. In fact, remote worksites can be very large not only in geographic size, but also in the number of employees. For example, commercial growers in California employ thousands of workers across tens of thousands of acres. The types of businesses are wide-ranging, too: some national parks and ski resorts employ thousands of employees, working in lodging, restaurants, and entertainment. Increasingly, data centers, manufacturing and other industries are operating in relatively remote locations to take advantage of tax breaks, low land costs, access to power, and other factors.
Worksite Clinics Can Provide Both Occupational Health and Primary Care
Of course, urban and suburban worksites use on-site clinics, too. However, they are frequently focused on either primary care or, if they are in manufacturing or distribution, on occupational health. Out of necessity, on-site clinics in remote locations are likely to provide both services, and the best clinics learn to integrate them. Successfully delivering both occupational health and non-occupational care in the same clinic requires providers that understand both systems. Good medicine is evidence based and the best treatments for a given injury are the same whether they are occupational or not. However, the reporting, claims process, return to work, regulatory environment, and other aspects of the two systems are very different. Successful integration also requires data systems that not only clearly separate occupational health information from non-occupational information for reporting purposes, but allow the practitioners to see the whole health picture. The best systems also separate individual cases so comp cases can be managed without growing to include non-occ issues. The best systems also protect the employer from seeing personal health information when they aren’t entitled to it, but sharing comp case information and aggregate population data so the employer can effectively manage their health care costs and comp claims.
The clinic has to follow operating processes that accommodate both systems – including effective communication with employees – to resolve cases on-site. When off-site providers and specialists are abundant and nearby, referrals can be the path of least resistance and shifts tough decisions off-site. In remote locations with fewer referral options, the on-site provider has to be able to handle the wellness and prevention conversations and discuss causation, and accommodating restorations for modified duty.
Integrating occupational health and non-occ health in an on-site clinic also invariably exposes conflicts and gaps in the employer’s policies and procedures, and highlights the inefficiencies of operating two systems for handling injured and sick employees – one often managed by human resources and the other by safety and risk.
When work-related injuries are resolved in the on-site clinic without incurring off-site services or claims costs, the differences between the two systems largely fade away – the employee’s medical needs are met, he or she returns to work, and unnecessary costs are avoided.
This kind of occ and non-occ integration, driven by necessity, works equally well when applied to urban worksites. The same on-site protocol that avoids a 100 mile drive to an off-site specialist from a remote worksite, can save the same amount of time away from work in busy urban traffic and waiting rooms!
Collaboration Between Employers and Community Providers
A worksite clinic can help bridge the gaps that often exist between employers and the providers in their area. When there is only one hospital in the county, it’s especially important to have a good working relationship. Human nature being what it is, however, one side often takes advantage of the other. The medical professionals in a well-run worksite clinic can serve as a liaison to community providers, bringing greater understanding of the employer’s needs to the community providers, and a clinical perspective and resource to the employer. The on-site clinicians can also take a cooperative approach rather than a competitive approach as they coordinate care with community providers, and refer for services such as x-rays, physical therapy, and other specialties available off-site. The best worksite clinics develop strong collaboration that benefits the employees clinically and the employers financially. A simple example: a worksite clinic may draw labs such as fasting glucose ordered by off-site family practitioners as a convenience to the patient (employee), and then direct the results to the family practitioner for follow-up. In the process, the employer avoids additional fees for the lab collection, and avoids lost time for an off-site lab (or a hungry employee not focused on the work at hand). In addition to delivering its own scope of services, over the course of a year, an on-site clinic can facilitate hundreds of these kinds of collaborative actions, improving patient engagement, and compliance with screenings, diagnostics and treatment regimens in the process. This drives down costs for comp and general health while supporting a healthier workforce. These collaborative practices yield equally valuable results in urban settings where greater choices in off-site providers may lull employers into “settling” for a mediocre relationship rather than building a more beneficial relationship.
About Curtis Smith
Curtis has nearly 30 years of experience in delivering heath care services, including emergency service, on-site services, and telemedicine in public and private sectors. As EVP at Medcor, Curtis is responsible for business development, including implementation of new services, and helping customers develop cost saving strategies. Curtis helps Medcor and its clients integrate data and services from multiple vendors within healthcare, including brokers, TPAs & ASOs, provider networks, and case managers. Since joining Medcor in 1995, Curtis has gained first-hand experience in many aspects of healthcare operations, from recruiting to training staff, to start-ups and vendor transitions, IT systems, supply chain, legal structures, and matching scope of service to client needs. He has worked with large and small clients, in rural and urban settings, with union and non-union labor, and with government agencies.
Medcor provides worksite health services to help employers reduce their workers’ compensation and general healthcare costs and improve health outcomes. Medcor provides its services with staff and systems located on-site in large client locations or via telemedicine for smaller locations. When injuries or illness occur, Medcor intervenes immediately. Following evidence-based medicine, Medcor can determine the severity of each case as well as the best course of action for its immediate treatment. With this approach, unnecessary treatments, claims, and costs are avoided, while required treatments are obtained right away.