By Nancy Grover, Founder and President of NMG Consulting
Telehealth, telemedicine, teletriage, telerehab — you name it, and it’s becoming more of a presence in workers’ compensation. Efforts to provide faster and more appropriate medical care to injured workers are expected to increase exponentially in 2018.
As Joe Paduda said in a recent ManageCareMatters blog, “tele-everything will take off.” Paduda, a principal at Health Strategy Associates echoed the sentiment of many in the industry who predict 2018 will bring about a sea change of tele-related and on-demand healthcare efforts this year.
Companies large and small are jumping on the technology bandwagon and finding an array of strategies to improve both efficiencies and outcomes. While there are challenges to implementing some of these and the technology is not necessarily a perfect fit for every situation, one thing is certain: the workers’ compensation system is slowly but surely catching up to group health and utilizing technology to provide better, quicker and more appropriate medical care to injured workers.
Some injured workers who have agreed to settle their claims can now be virtually seen by a primary care physician any day, any time. Ametros, a post-settlement medical administration company implemented its telemedicine services as a value-added benefit to members.
“They don’t have to leave their houses to get medical treatment for their injury,” said, Tina Chirichiello, the company’s director of Operations. “The physician can diagnose their complaint, provide treatment, and prescribe non-controlled medications.”
Members can call or log into a portal to be connected with a physician through a secure link. Chirichiello says the program saves time and money, especially for members who cannot drive and would otherwise have to pay for transportation.
“We are focused on technology in our industry and trying to provide the most convenient options in ways that work for them,” she said. “Being able to call from your home makes it easier.”
Bringing treatment directly to the injured worker at the most convenient location is the focus of OnSite Physio, a company that is innovating the way PT is provided in the workers’ compensation system. The company’s ‘PT Triage’ program uses an advanced algorithm to rate the available treatment environments in the order most likely to produce the best clinical outcomes; the worksite, home, or a nearby clinic. The company then offers the injured worker the choice of time and location for treatment and manages the claim through completion.
“Our therapists go to the injured worker, wherever that may be,” said Daniel Sanchez, the company’s VP of Operations, and a physical therapist and certified ergonomic assessment specialist. “The best PT for an injured worker is one-on-one, hands-on. Not only does that allow for more targeted treatment, it also greatly enhances employee engagement.”
In addition to treating the injury itself, Sanchez said one-on-one treatment also helps prevent reinjuries. “By seeing exactly what injured workers do on a day-to-day basis, we can show them the most appropriate, least harmful ways to move their bodies.”
Where telemedicine could be an adjunct to hands-on PT is in providing education to workers. Sanchez also envisions telerehab when no other option is available, such as in extremely remote areas.
“In those situations, we’d be able to set up a mini clinic at the location,” he said. “It would consist of a room with a treatment table and other equipment. The therapist would have a similar set-up and could show the injured worker exact movements to mimic.”
Enhancing Soft Tissue Diagnostics
Testing that objectively assesses soft tissue injuries can now be done immediately from the injured worker’s location, thanks to a new telemedicine program. Emerge Diagnostics’ Electrodiagnostic Functional Assessment (EFA) involves attaching sensors to a patient to accurately gauge musculoskeletal pathology and pain. The test can now be done on a patient while a board certified physician is attending the appointment virtually.
“If we have someone in a rural area and a leading specialist is in another state, do you make that injured worker drive for three hours and incur all that liability,” said MaryRose Reaston, chief Scientific Officer and a co-founder of the company. “What if they could sit in their home or in a conference room five minutes away and see the specialist.”
The ‘EFA-STM bookend solution’ telemedicine component, as the company deems the program involves the injured worker and a medical specialist — nurse, EMT, physical therapist — on one end, while the physician is on the other end assessing the patient to determine if the test is warranted. Approved by the Food and Drug Administration, the EFA technology monitors musculoskeletal and spine during movement and other activities such as lifting
“We process so much information, you could never palpate that,” Reaston said. “For musculoskeletal disorders, we probably give the physician more information than if it were an in-person visit.”
The program caught the attention of judges of the 2017 Business Insurance Innovation Awards, who honored the company with the top prize in the Products and Services category. Reaston calls the telemedicine capability a game-changer saying, among other things, it can help reduce the unnecessary prescribing of opioids.
“If you get the right diagnosis you can prevent that,” she said. “We provide so much more information that we can see, for example, if it is a muscle spasm. Instead of giving the injured worker a narcotic, maybe a mild muscle relaxer will help.”
Reaston believes the many benefits of treating workers at their own locations will make traditional brick-and-mortar clinics obsolete in just a few years.
Improving Home Mods
A new software app allows interaction among all parties involved in home modifications for injured workers. “One of the biggest complaints we hear from adjusters is, ‘I don’t know what is going on, the price changed, what happened?” said Vonesa Wenzel, chief marketing Officer and partner at HomeCare Connect. “With TeleConnect they can be part of the process from the very beginning.”
The company provides home health care services, durable medical equipment and supplies. The new program enables virtual walkthroughs of a house being modified so adjusters can see in real time what changes need to happen, when and how. “Video shows the situation better than photos and adjusters can ask the contractor questions and get answers in real time,” Wenzel said. It also keeps them apprised of any expected snags.
“Sometimes, we encounter unexpected challenges. The house looks great during an initial walkthrough, but then we discover there are termites,” Wenzel said. “That might change the scope of the service and impact the timing. TeleConnect helps adjusters better understand why a change has to occur.”
In addition to home modifications, TeleConnect also enables injured workers and those caring for them to meet virtually with treatment coordinators through a virtual conference.
“We can connect with our field providers, our medical supplies and equipment contractors, injured workers, case managers, and others to quickly determine DME or treatment needs,” Wenzel explained. “For example, if a wound is not healing properly, our clinical care coordinator can watch the wound care being delivered and recommend immediate changes.”
Wenzel also said the software is especially helpful during inclement weather if the field provider cannot get to the injured worker’s location. “We can connect so the injured worker understands what they need to be doing,” she said. “It’s really a way to get a little closer to the injured worker and make them feel more a part of the process.”
Challenges to Implementation
Despite the advantages of tele- ideas for injured workers, stakeholders face several obstacles to their actual application. One concerns resistance from users.
“Unfortunately, some injured workers don’t want to be a part of [telemedicine], they just want a phone call,” said HomeCare Connect’s Wenzel. “It seems the older patient population is not as receptive to it as younger folks who are used to it.”
Another challenge is applying and integrating telemedicine into an employer’s existing work practices. Then there is the question of security, especially in these times of increasing cyber threats. Another challenge is the technology itself.
“There are plenty of technology solutions available; the issue is how to connect the collective – the patient, doctors, service providers, pharmacists and payers,” said Kimberly George, SVP Senior health Care Advisor for Sedgwick. “How do we take the information from the devices to actually make them meaningful to the system, meaningful to the patient outcomes, meaningful to doctors, etc. Without connectivity silos remain and the system is too clunky to be effective.”
During a recent ‘Out Front Ideas with Kimberly George and Mark Walls’ webinar, the topic of digital health was number 13 on the top 20 issues to watch in 2018. George said with improved technology and more consumer interest and awareness of telehealth, it is time for the workers’ compensation system to get on board.
“We’ve been slow to adopt comprehensive programs in telehealth for workers’ compensation, whereas the benefit space has been at it for five plus years. Group health has moved past triage and initial treatment of physical symptoms to treating mental health and in 2018 moving into chronic disease management,” George said. “I suggest this affords us an opportunity to look beyond what we’re using telehealth for today and really think holistically about how telehealth and digital health can impact workers’ compensation positively.”
Wenzel has a cautionary word about the increased use of technology in the workers’ compensation system. “I think technology is going to speed up processes, but we need to make sure we use it in a way that allows us to continue to treat injured workers; don’t forget the human aspect,” she said. “With any technology, it’s about getting better outcomes, better services, but remembering there is the injured worker out there who needs us.”