By Joe Guerriero, SVP MDGuidelines, ReedGroup, Ltd.
The value-based care conversation has finally made its way to the Worker’s Compensation landscape, and stakeholders are Investigating new models aimed at improving outcomes and lowering costs. Now, as this change is occurring, industry leaders increasingly point to the need for expanding strategies to hone in one key tactic: patient advocacy.
The “more is better” mentality of past Worker’s Compensation care processes should now shift to focus quality over quantity, especially as it relates to prescription medication. For instance, one look at today’s destructive opioid epidemic shows us the overwhelmingly negative impact of that “more is better” method of treatment.
Recently, a New England Journal of Medicine study connected physician prescribing patterns with long-term opioid use, comparing “high-intensity” prescribers—those who sent one in four patients home with opioids—with “low-intensity” prescribers—those who gave opioids to one in 14 patients. Patients who saw a high-intensity prescriber were 30 percent more likely to become long-term users. This example gives us a clear indication of the outdated quantity over quality practices that simply need to change in our industry.
Within a complex Worker’s Compensation system, physicians must become better advocates for patient healing, as opposed to just patient treatment. Renowned Canadian physician and co-founder of John Hopkins Hospital, Sir William Osler, sums it up this way: “The good physician treats the disease; the great physician treats the patient who has the disease.” Physicians in Worker’s Compensation must break with non-evidence-based treatment habits and start to view patient factors holistically, from the physical to the psychosocial, in order to achieve quality treatments and become true patient advocates.
Characteristics of an Advocacy-Based Model
The majority of costs associated with workplace injuries are not actually related to catastrophic incidents, but result from poorly-engaged patients who do not have the right mindset about their care. That was part of the message delivered at the Workers’ Compensation’s 24th annual Education Conference in February, where Dr. Steven Feinberg estimated that 10 -15 percent of injured workers drive 75 percent of costs.
In truth, patients are often not the best self-advocates when it comes to healing and recovery, and some can be more negatively affected by a defeatist mindset than by their injuries. As such, the industry is increasingly embracing an advocacy-based claim model, driving proactive education, healing and recovery to help offset unsustainable, long-term healthcare costs that are sometimes associated with patients’ catastrophic mentalities. Characterized by efforts to better educate patients to help them make informed, realistic recovery decisions, these models ultimately drive improved outcomes, returning employees to activity faster.
For instance, consider that it is in an older patient’s best interest to stop taking the potent opioid fentanyl. Weaning the patient off the drug is likely to be difficult, and if the patient knows that the prescription has been addressing their symptoms, they may be weary of trying a new treatment, even if it will be better for them in the long run. A good patient advocate will stay the course even though the patient calls the nurse manager every week asking for a refill. An advocacy-based model will incorporate resources and education to help the patient understand that the best answer, in this case, is not pharmacological. This patient education and advocacy will create patients that are more engaged in their medical care and less likely to suffer from misconceptions about their prognosis that may hold back their recovery.
Practical Steps Forward to Better Patient Advocacy
The best strategies for advancing patient advocacy include using the right workflows and tools. First and foremost, designated provider resources are needed to assist and empower injured workers throughout the entire claims process, and to assist providers in educating their patients. The goal is to proactively engage patients in making the best choices to circumvent health decline and accelerate recovery times.
Providers and care managers also need access to the best tools for guiding care decisions. Evidence-based clinical decision support equips providers at the point-of-care and throughout the claims process with best-practice guidelines for ensuring injured workers recover efficiently and effectively. In addition, physiological duration guidelines can help physicians provide patients with realistic recovery expectations, which can alleviate error-prone psychosocial thinking on the part of the patient that lends to overprescribing, increased costs and subpar outcomes. This insight can help physicians educate patients immediately to circumvent such thinking.
Patient advocacy is increasingly critical as the Worker’s Compensation industry considers its approach to value-based care. Proper education and empowerment of patients is essential when convincing patients that additional medications and surgeries are not always the answer, and to moving the needle on outcomes and performance.
About Joe Guerriero
Joe Guerriero is Senior Vice President of MDGuidelines at ReedGroup, Ltd.
ReedGroup, a wholly owned subsidiary of the Guardian Life Insurance Company of America, provides absence and healthcare management services to over half of the Fortune 100 companies. With more than 2000 employees, ReedGroup has operations across the United States, Canada, and India.
ReedGroup’s product, MDGuidelines, is the industry’s leading solution for total health management and workplace productivity. MDGuidelines features the world’s most trusted disability duration tables, predictive modeling, analytic services, and evidence-based Practice Guidelines from ACOEM.