By Pat Chavanu, Senior VP, National Accounts and Marketing at GENEX Services, LLC
This month Genex Services is celebrating its 40th anniversary, a significant accomplishment in this industry. For our company and staff, it’s a momentous occasion and cause for celebration.
I personally have not been along for the entire ride but a weighty portion of it – with 15 years at Genex and 22 years in the industry as a whole. My tenure in the business is one reason I was asked to write two columns to mark this milestone in our organization’s history. In this first piece, I reflect on key trends and challenges the industry recently faced which inspired our company – as well as the industry as a whole – to continually innovate and adapt to the changing times.
The Industry’s Evolving Landscape
First, it’s important to acknowledge that workplaces have become safer in general. Manufacturing and production have become more automated. Reducing manual operations has decreased the risk of injuries. And, at the same time, we’ve seen a proliferation and strengthening of safety programs. Employers care about their workers, and the last thing they want is to put employee health and safety in jeopardy. Many have leveraged their claims data to identify and target high-injury areas with safety initiatives.
Due to these trends, we’re now seeing fewer injuries. However, claims severity continues to rise. On occasion, there may be an extreme accident that leads to a severe or catastrophic injury, but the main factors contributing to the severity trend include:
- The Shifting Profile of Injured Workers. On the whole, the U.S. population is plagued by chronic health issues, such as obesity and diabetes. Our workforce is aging, as people live and work longer. Older individuals generally have preexisting medical conditions, such as high blood pressure and age-related muscle loss. Injured workers who are aging and have comorbidities usually require more treatment and may experience complications, which can delay return to work.
- An Overreliance on Medications & Opioids. Society as a whole has become more reliant on prescription drugs as quick fixes to their medical problems, with many taking multiple medications on a daily basis. Physicians have been prescribing high-powered opioids to enable injured workers to manage their pain. However, with the rise of the opioid epidemic, we now need solutions to address this complex challenge. To facilitate medication safety, opioid use must be carefully monitored. And when there’s a risk of abuse or addiction, there must be processes in place to wean injured workers off these dangerous drugs. Once a claimant has started down a path of dependency and abuse, it is extremely difficult to get these cases back on track. As such, companies also need early intervention to prevent such worst-case scenarios from happening in the first place.
- Complex & Costly Treatment Options. Not only has the make-up of injured workers shifted, but also treatment options have also become more advanced and sophisticated – not to mention expensive. For example, physicians may recommend surgical implants and procedures as part of the treatment plan, but we need processes to efficiently assess if such options are appropriate on a case-by-case basis.
The Urgent Need for Quality Clinical Services
The rise in severity has led to an urgent need for quality managed care to help achieve optimal outcomes. The industry wants a consistent approach that relies on clinical expertise and evidence-based guidelines to arrive at sound treatment decisions.
As a result, workers’ comp has demanded superior case management. It’s also required different facets of this service, including early intervention with telephonic case management, field case management for cases that require in-person attention and guidance, and catastrophic case management to assist with the most complex of injuries – everything from severe burns to amputations and spinal cord injuries.
Over time, the industry also called for broader clinical services, including utilization review and supplemental vocational services. It began to request not just nurses for clinical reviews, but also physicians for peer reviews. As a result, companies turned to managed care partners, with a deep bench in terms of clinical expertise, to ensure appropriate care and a safe return to work. In addition, leading service providers have honed specialty solutions to assist with problem areas, such as medication safety programs that identify cases that require early intervention or tapering protocols to get at-risk claimants off opioids.
As detailed in this column, the industry’s most pressing challenges have been addressed with innovative solutions that have evolved over time. In my next column, I’ll discuss how sophisticated technology has become integral to the managed care process.
About Pat Chavanu
Pat Chavanu is a tenured leader in the workers’ compensation and managed care industry. As senior vice president of national accounts and marketing, he is responsible for creating detailed account strategies in alignment with corporate objectives, developing and refining programs to meet customers’ individual needs, and improve service and profitability across the continuum of care. Pat has held senior leadership positions with Genex for 15 years and also served as president and chief sales officer at other leading managed care organizations. Pat’s expertise is recognized by leading industry publications who often seek him as a source on topics ranging from workers’ compensation trends and business strategy.
About Genex Services, LLC
Genex Services is the trusted provider of managed care services enabling clients to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex is a managed care leader with more than 2,900 employees and 41 service locations throughout North America. The company serves the top underwriters of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex is the only company that delivers high-quality clinical services enhanced by intelligent systems and 360-degree data analysis. The company consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems.
Disclosure:
Genex is a WorkCompWire ad partner.
This is not a paid placement.