By Matthew X. Engels, Vice President & General Manager, Carepath Networks, Medcor, Inc.
“Telemedicine is coming! Telemedicine is coming!” sounds the clarion call of the workers’ compensation industry. Telemedicine adds great value to occupational health, and its promises, while still yet to be clearly articulated, are attractive to an industry hungry for ways to improve outcomes and lower costs. Yet despite two years of claims that telemedicine will be the great disrupter to workers’ comp and the occ health status quo, traction remains painfully low and slow.
When will it get here? Why is it taking so long?
For my first installment I will explore the potential benefits of telemedicine, going beyond eliminating travel and reducing patient wait time. For the next installment, I will share the reasons for the slow adoption rate and offer solutions for overcoming the hurdles, enabling more injured employees to be brought into telemedicine and truly disrupting the clinic-based, occ health delivery model.
The Benefits of Telemedicine to the Workers’ Compensation Industry
Time and convenience
When you consider the fact that injured employees traveling for care in urban areas often battle traffic to and from “walk-in” occ med and urgent care clinics and ERs, and that injured employees in rural areas often travel long distances, you realize wasted travel time is an industry challenge. Even more time is wasted when you factor crowded waiting rooms with long queues once you arrive. “Time is money,” they say, and time savings are obvious and anticipated benefits of telemedicine.
Patient satisfaction and Outcomes
While the industry appreciates the value of time and convenience, we have potentially overlooked a more significant factor – that the time spent on the road, and the time spent waiting with a throng of others, costs more than dollars per mile and lost productivity. The tensions caused by traffic, the feelings of being ignored or overlooked while others get into the doctor ahead of me, how injured employees feel impacts outcomes. Injured employees traveling to walk-in clinics and ERs are often already in pain, confused about the process and their options, and concerned about their futures. By the time they finally see their doctors, many employees are already tense and frustrated. All too often, these compounding negative feelings contribute to poor outcomes.
When well executed, telemedicine makes patients feel like they are a priority. For appropriate injuries, the level of care delivered by telemedicine physicians is equal to or better than the care delivered in-person at walk-in clinics and ERs. Moreover, telemedicine can be delivered almost immediately post injury, bringing instant gratification Americans value, with little time to develop a sour attitude, or chance to fall into the sick role. Not surprisingly, in patient satisfaction surveys, including profiles in Health Data Management, patients rate telemedicine higher than urgent care – they like it better! Thus, telemedicine not only saves time, it is more likely to produce better claim outcomes.
Early identification of at-risk claims
Uncovering at-risk claims early is another way telemedicine adds value to workers’ comp. While our industry does a good job managing complex claims, the industry struggles with knowing which low-to-moderate acuity claims will become complex, and when. Causal factors linked to claim complexity typically relate to attitudes and feelings, and include how patients:
- Like their jobs and their supervisors,
- Manifest pain,
- Contribute to their overall health with bad habits and co-morbidities,
- Are motivated by secondary gains, and
- Respond to their providers.
While the industry looks to invest in data analytics and artificial intelligence to identify at-risk claims, and outcome-based networks purport to score and sort providers to improve outcomes, telemedicine is an elementary, proven way to identify at-risk claims on the front-end of the claims cycle and improve claim outcomes using only two data elements: (a) low-to-moderate acuity injury, and (b) off-work status. This powerful potential transcends mere remote/video visits from some platforms and requires codified data flowing dynamically and systematically from telemedicine platforms into claims systems.
Assuming cases are properly triaged before coming into telemedicine, nearly all telemedicine claims are low-to-moderate acuity injuries. For example, the most frequent diagnosis in workers’ comp telemedicine cases is low back pain, applied twice as often as knee pain, and three times as often as shoulder pain, the next two highest diagnosis categories. These three diagnoses are common across all of workers’ comp, and raise no red flags by themselves at claim on-set.
However, when telemedicine, as a low-to-moderate acuity claim indicator, is coupled with an off-work status indicator, these two data elements combine into an actionable, at-risk flag. In the typically scenario, it may take days or even weeks for data to migrate to the claims system and signal risk. With a systems-driven telemedicine platform, on the other hand, this data can flow into the claims system dynamically and set off an alert – within 60 minutes post injury, the claims manager already knows she has a low back strain claimant who is off work. Simple, but powerful. The claim manager can take the steps now to dig into the claim, perhaps assign a nurse case manager, and mitigate the risk.
Driving tighter physician networks and evidence-based practices
Additionally, applying telemedicine over a smaller, more tightly managed network of cross-licensed physicians allows network managers to educate telemedicine physicians on the expectations of the stakeholders, including that return to work is good, therapeutic medicine. This orientation dramatically reduces the likelihood of cases with off-work status, further qualifying the above risk-profiling example.
Orientation on the needs of the patient
Unlike many providers practicing in occ health and urgent care clinics, telemedicine physicians will never dispense medications from their offices, an expensive practice that promotes patients attaining prescription medications from unmanaged dispensing channels (and not prospectively and concurrently managed via a PBM). In addition, some telemedicine networks prohibit prescribing opioids, and systematically drive the use of over-the-counter and generic medications, improving patient safety, lowering costs, and potentially impacting OSHA recordability.
In a subset of workers’ comp telemedicine networks, providers are completely conflict free: they are not accountable for driving higher revenue per visit, and are not required to refer into a hospital’s orthopedic group, or to drive physical therapy visits. Unfortunately, many of these practices commonly applied in the clinic-based world are not totally absent from all telemedicine networks, and these behaviors may add unnecessary costs and delay recovery. With properly managed and aligned telemedicine networks with conflict-free providers, the needs of patients solely drive physician behavior and decision-making.
Going well beyond saving time and mileage, telemedicine offers the workers’ compensation industry the optimal tool for empowered claims management and instant and early interventions. Driving patient satisfaction; improving outcomes; identifying risk early; and promoting providers who are: oriented to industry expectations, conflict-free, and aligned with the needs of patients; the promise of telemedicine, with better claim outcomes and lower total cost of risk, is high.
In my next installment, I will disclose the hurdles that have heretofore undercut the adoption of telemedicine, and offer solutions to overcome the hurdles and increase traction.
About Matt Engels
With 22 years in managed care, Matt Engels is Vice President and General Manager over Carepath Networks at Medcor, a Health Navigation company. Building better ways to deliver care to address workplace injuries and illnesses, and to identify opportunities for strategic and timely interventions have been Matt’s passions throughout his career. Matt earned a BA in History from Columbia University in New York City and his JD from Loyola University Chicago.
Medcor provides health navigation and clinical services to improve outcomes, service levels, and access to care, while reducing costs. We use highly-trained professional staff, evidence-based medicine, proprietary protocols, and state-of-the-art systems to achieve sustained, positive results. We deliver our services with on-site clinics at large client locations and via telemedicine for smaller locations and mobile workers.