By Lori Daugherty, CEO, IMCS Group, Inc.
Faster and better recoveries for injured workers, and spending our resources and money where it is most effective are the goals for the workers’ compensation system, now and in the future. What I’ve seen taking place in the workers’ compensation system over the last several decades makes me optimistic that we can truly accomplish these goals.
To do this we need to become more collaborative as an industry. The days of silos should be behind us. Insurers, payers, medical providers, attorneys — all stakeholders need to work together with the injured worker at the center. The employee with the injury is, or should be, the most important person at the table. Working in partnership is how we can make tremendous changes in the system.
We also must be willing to think outside the box, if you will. That is, consider alternatives to the way ‘we’ve always done’ things, especially things that impede recovery and drive costs. Among the most pressing issues we can and should better address are Post-traumatic stress disorder, the unnecessary use and overprescribing of opioids, and moving more toward patient-centered care. Changing the way we approach each of these can lead to better managed claims and create winning scenarios — for injured workers, our companies and payers.
PTSD, especially for first responders is (finally!) gaining traction in state legislatures, but we have a long way to go to get where we need to be. More than 100 bills on the issue were introduced in various states earlier this year, but few were actually implemented — with the exception of Florida.
Part of the problem is that despite the increased awareness of the issue, it is still very misunderstood. Contrary to what some may believe, only a small percentage of people exposed to a traumatic event actually develop PTSD. But for those who do, the consequences can be devastating.
In addition to depression, anxiety disorder, drug abuse, and divorce, suicide rates among those affected are high. But that doesn’t need to be the case. We have the tools to not only help first responders who already have PTSD, but also to prevent it from developing after a traumatic event.
Florida officials and legislators recognized the importance of providing the right medical care to first responders and adopted a proposal that was signed into law. As of Oct. 1, Florida first responders who develop PTSD as a result of exposure to work-related traumatic events are eligible for indemnity as well as medical benefits through the workers’ compensation system.
What Florida is doing is an interesting case study and should serve as a model for the rest of the nation. We at IMCS want to be a vital part of that solution.
The workers’ compensation community — pharmacy benefit managers, medical providers and others — have done a great job in reducing the unnecessary use of opioids among injured workers. But we still have a lot of work to do. We still see far too many of these employees with opioid-related problems.
IMCS has had great success helping to wean these workers off opioids by using short-term, cognitive behavioral therapy. But more needs to be done to protect these workers from the scourge of these medications.
The industry has programs that are spot on for helping these workers early in the claims process. Strategies such as our Pain Screening Questionnaire can flag workers who are more likely to have delayed recoveries and become dependent on opioids, right after their injuries. We can then intervene and give them the attention and care they need to heal from their injuries, without unnecessary medications. Despite the industry’s accomplishments in this area, there still needs to be more awareness on the issue.
The idea of patient engagement is central to improving outcomes and reducing costs for payers. In my last article I discussed the idea of using patient satisfaction surveys to increase patient engagement, as they are doing in general healthcare.
This is an area where the workers’ compensation system can do a much better job. Some organizations have embraced the strategy and are seeing great results. Several organizations, including a major carrier that works with us are doing just that and becoming really engaged with injured workers right from the onset.
One huge obstacle to engendering patient engagement concerns the claims settlement process and the extremely high caseloads some claims managers have. While we want to close claims as quickly as possible, we sometimes do that at the expense of patient engagement. Claims managers at some organizations handle anywhere from 120 to 150 cases. That doesn’t give them enough time to provide that personal touch and spend time with the injured worker, and that is really a problem. Injured workers who are made to feel they are an important part of the process, rather than just a number, recover much quicker and are back to work sooner.
This is an area where technology could come into play. We could use artificial intelligence, for example, to handle some of the more mundane, routine parts of claims handling and give claims managers more time to focus on the injured worker as a human being. While the industry has evolved, we are still not as progressive as we could be in terms of managing claims.
Allowing case managers and other stakeholders in workers’ compensation to work closely with the injured worker is an area where we can make a significant difference in outcomes, which benefits everyone in the system. I’ve seen this change happening over the last few years and believe that by having everyone working together as a team and tackling some of our major challenges head on, this hundred-year-old industry can thrive for its second century.
About Lori Daugherty
Lori Daugherty brings more than 30 years of experienced to the industry. In addition to workers’ compensation, her extensive background also includes expertise in Medicaid, Medicare Part B and Third party contracting, administration, customer service, operations, billing and collections. She is especially adept at leading businesses and taking to market innovative ideas.
Among the many positions she has held are President of Pharmacy Services at PMSI, President and CEO for Avizent, President and CEO for One Call Comprehensive Care Inc., and President and CEO of WorkingRX, Inc. She has also served in executive positions at Staodyn, WorkCare, Inc., and PharMerica, Inc. She was recently named CEO of Integrated Medical Case Solutions (IMCS).
IMCS provides specialized, short-term cognitive behavioral therapy in conjunction with usual medical care to help injured workers with chronic pain, trauma-related conditions, and withdrawal from opioids, through an assessment, treatment and consultation protocol. Its network of 750 psychologists and psychiatrists works with more than 150 corporate employers, insurance companies and third-party