By Mariellen Blue, National Director of Case Management at Genex Services
Workers’ comp professionals are seeing delayed recovery as an increased challenge in claims – as injured employees may not be progressing along a medically reasonable and expected time frame. However, it can be difficult to pinpoint exactly why the delay is occurring in order to address the issue. We may believe the injured employee is simply not complying with treatment and malingering.
However, it’s important to step back and remember that health care is complex and complicated, especially for the layperson. Medical information can be difficult to understand – particularly if injured employees are distracted with feelings of fear and anxiety during medical appointments, as they may be worried about their injury and how it will affect their future.
Today, it’s coming to light that health literary is one factor that can play a significant role in delayed recovery. The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”
In a study, the United States Department of Education found that over a third of adults have a basic or below-basic understanding of health information. Injured employees may be directed by their treating physician to take a medication a certain way, or they may be given home care instructions, but they may be confused or too embarrassed to ask questions.
Challenges around health literacy – including these types of miscommunications and misunderstandings – can lead to poor claims outcomes. The condition of injured employers may worsen. The injured employee may not recover in a timely fashion or return to work as quickly as expected, or perhaps this individual will be unable to resume full duty.
All of these issues can lead to increased medical and indemnity costs. Patients with the lowest personal health care management skill levels and confidence had average costs that were 21% higher when compared to costs of patients with the highest skill levels (within a designated period of time following a base year). Injured employers suffer as delayed recovery affects their opportunities at work and quality of life.
For key stakeholders in the workers’ comp process, these best practices can help foster improved health literacy throughout the claim’s life cycle:
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Injured employees. There are several things injured employees can do to help themselves. First, they must foster the attitude that they want to be engaged in their own care and recovery. If they’re having difficulty understanding information about their diagnosis or treatment plan, they should ask questions, or they should request that the doctor speak in simpler terms. They should write down any home care instructions and repeat them back to the physician to ensure they’ve understood them correctly.
Employer/Payer. On complex injuries, employers and payers often assign field case managers to attend medical appointments with injured employees. The case managers can serve as an extra set of eyes and ears, especially when employees may be upset or stressed by the severity of the injury.
Claims staff. A claims adjuster should note whether injured employees speak English as a second language. Perhaps they would benefit from a translator being present during the medical appointment. They may also note other circumstances around medical complexity, which make it advisable for a field case manager to be present with the injured employee during medical appointments.
Treating physicians and other providers. When physicians are communicating with injured employees, they should aim information to individuals with a basic education level. Some employees have not obtained their high school diploma or equivalency. Providers should avoid medical jargon or complicated clinical language and, instead, try to engage with patients at their level. If it seems as if a person hasn’t grasped the information being conveyed, it doesn’t hurt to explain it a second time in a different way, or to ask questions to make sure the patient understands.
Nurse case managers. Serving as an advocate for the patient’s medical needs, nurse case managers are in a unique position to assist injured employees in understanding their diagnosis and treatment plan. For example, many injured employees have trouble following prescription drug labels and understanding medical terms. A case manager can help them navigate certain nuances. A patient may be prescribed an opioid painkiller. The prescription bottle reads “Q4H PRN,” which means “take every four hours, as needed.” Injured employers may focus on taking the medication every four hours around the clock, whether they need it or not, and in the process, develop an opioid dependency. A case manager helps by advising injured employers to transition off the opioid prescription as soon as possible.
The reality is injured employees who are able to understand their diagnosis, treatment plan and prescription instructions are going to experience better outcomes, as they’re better able to follow care instructions and, consequently, recover in a timely fashion. With stakeholders using the best practices above, we can foster improved health literacy throughout the injury and care management process, and encourage injured employees to actively listen, ask questions when they become confused, and make daily decisions that support timely recovery.
About Mariellen Blue
Mariellen Blue, RN, CCM, is national director of case management at Genex Services where she is responsible for overall product management and development, as well as regulatory compliance, accreditation, and quality assurance initiatives related to utilization management, telephonic and field case management, IME, and MCO services. A graduate of the Helene Fuld School of Nursing, Ms. Blue has an extensive background in nursing, case management and utilization review.
About Genex Services, LLC
Genex Services provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise 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. Genex Services and Mitchell International merged recently to create the broadest continuum of technology and products servicing the auto, workers’ compensation, and disability markets.
Notes
1U.S. Department of Education, “The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy,” September 2006.
2Judith H. Hibbard, Jessica Green, and Valerie Overton, “Patients With Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patient ‘Scores,” Health Affairs, February 2013.
Disclosure:
Genex Services is a WorkCompWire ad partner.
This is not a paid placement.