By Lori Daugherty, CEO, IMCS Group, Inc.
Payers are more in touch with the issues of the injured worker. That’s probably the biggest and most important change I’ve seen in 30+ years in the workers’ compensation system. That’s not to say the industry has not evolved; clearly, it has. There have been tremendous advancements in technology, as well as how we care for injured workers and process claims. But some of the problems we’ve faced for decades still exist.
We need to do more to help these employees heal and return to function and work sooner, and we can. Adopting some strategies that are prevalent in the general healthcare world would be a great place to start.
ACA Example
Politics aside, one of the goals of the Affordable Care Act has been to increase patient satisfaction and, in doing so, increase patients’ engagement in their own healthcare. We know that better patient engagement improves outcomes and ultimately reduces healthcare costs.
The idea of measuring patient satisfaction took on a whole new level of importance in Oct. 2012. One provision of the ACA that went into effect at the start of the 2013 fiscal year was a 1-percent cut in total hospital Medicare reimbursements. Hospitals could get some of that pay restored and/or bonuses if they were rated highly. In addition to clinical processes and outcomes and following standards of care, one of the measures of hospital ratings is its patient satisfaction scores.
The scores are based on patients’ answers to questions on a survey, the Hospital Consumer Assessment of Healthcare Providers and Systems — or H-CAPS — which measures patients’ perceptions of their hospital experience. The survey includes several categories dealing with patient outcomes; such as communication with physicians, cleanliness, responsiveness of hospital staff, and pain management. Not all patients are surveyed. It is done on a random basis.
In addition to the financial incentive to hospitals themselves, the overall goal of measuring patient satisfaction is to help these facilities improve their quality and efficiency of care.
A push for patient-centered healthcare and increased patient engagement have become focal points for many institutions seeking to improve or retain their ratings. This idea of patient-centric healthcare has caught on with some, though not all stakeholders in the workers’ compensation system. But imagine if it were the norm.
If injured workers truly felt employers and payers were focused on getting the best medical outcomes, they might be more inclined to participate in their care rather than just being mandated to do certain things. Engaged injured workers heal faster, return to work sooner and keep costs lower. I’ve seen that clearly demonstrated throughout my career and truly believe that getting injured workers involved in their recoveries and targeting positive outcomes is key to improving the workers’ compensation system.
IMCS
A focus on outcomes is what attracted me to Integrated Medical Case Solutions. Michael Coupland, who started the company, has tremendous data demonstrating the effectiveness of his approach to treating injured workers with delayed recoveries. The services he provides — whether it’s for chronic pain, post-traumatic stress disorder, or helping someone withdraw from opioids — is incredibly valuable. It’s not a commodity, but an actual tangible service that changes peoples’ lives — and, saves the payer money in the end.
I’ve been in the industry for more than 30 years but was not all that familiar with his company and its accomplishments until recently. Once I looked at the 10 years of data Michael has, the outcomes, I thought this would be a great opportunity for myself and the workers’ compensation system. We need to get the word out and show people how these services can have a significant impact on injured workers, their employers and carriers.
The Future
There are always new and better ways to do things. That’s what keeps me motivated and excited about the workers’ compensation system — the ability to continually improve. I’ve had a great career, largely because people have seen that I don’t like complacency; I like to constantly improve things and they’ve seen my ability as a leader, to move into different roles.
Sometimes I’m asked about my experience being a woman in high profile positions in what was once largely a male industry. I’ve always hated the ‘good ole boys club’ mentality and have set my sights higher. I don’t see myself as a woman in a man’s world. I look beyond that and don’t let it limit me. It’s not material. I have abilities just like everybody else.
One of the roles in which I find myself now is as a mentor to younger people. I think it’s really important to share your knowledge and abilities with those around you and to surround yourself with people from different walks of life.
Many of my core team members are millennials. I tell them to reach as high as they want to go. We all have much to teach one another.
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).
About 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