Among the ‘emerging’ trends in workers’ compensation is the adoption of telehealth services. Carisk Partners is embracing the trend.
“CorVel first introduced our workers’ compensation telehealth solution in 2015,” said Michael Combs, president and CEO of CorVel. “While we received positive feedback early in the program, the initial usage rates were short of expectations.”
Among the ‘emerging’ trends in workers’ compensation is the adoption of telehealth services. “CorVel first introduced our workers’ compensation telehealth solution in 2015,” said Michael Combs, president and CEO of CorVel. “While we received positive feedback early in the program, the initial usage rates were short of expectations.”
During the company’s Q3 conference call last week, Combs said that has since changed. “Over the last two years, the pace of adoption has increased and is now consistent with the growth seen in the personal healthcare space. Patients are becoming more comfortable with use of technology
for receiving healthcare services including video conference capabilities.”
Telehealth is being used in the workers’ compensation system for a variety of purposes, although not necessarily in the same ways as in group health. Part of that is due to the nature of the injuries, and part is due to the nature of the industry. But organizations are increasingly finding ways that telehealth can improve the experience for injured workers and payers, by providing better outcomes and reduced costs.
Opportunity for Integration
The specifics of an injury, such as where and how it occurred determine how the medical care will be funded; through the workers’ compensation system, group health, or auto insurance, for example. That, in itself, can set up workers’ compensation as an adversarial system.
“The sense I get is that people don’t necessarily believe their employer or insurer is really trying to work hard in their best interest,” said Joseph Berardo, Jr., CEO of Carisk Partners. “It’s a shame – it’s a litigious set up. ”
Carisk Partners, which provides risk-transfer and care coordination of delayed recovery and complex, catastrophic cases began its journey into telehealth about two-and-a-half years ago after research revealed the impact that biopsychosocial issues can have on injured workers’
recoveries. They sent out an RFP to see if a system could be developed that integrated behavioral health profiling with medical surgical issues. The system that was ultimately created allows for both one-on-one visits between providers and injured workers, as well as video conferencing involving multiple people, such as attorneys and family members.
The company uses telehealth to varying extents, depending on the type of cases involved. For example, it is used less in acute cases until the middle or end of recovery “when the injured worker is working on depression and addiction avoidance, ” Berardo said. It is used more by the company as a supplement to in-person therapies in older cases. “We’re just using is as a practical tool, an extension of the network,” Berardo said. “And we’re
using it to gain trust with the patient so they deal with the same clinicians, see the same faces.”
Other organizations are using telehealth successfully to treat workers who sustain less-than severe injuries, and are finding success. “We enhanced our existing telemedicine service by providing the ability to conduct a medical visit by video with a physician early in 2018,” said Rich Ives, Vice President of Workers Compensation Claims at Travelers. “We’ve received great feedback on this convenient method for certain injured employees to get quick access to medical advice. We are excited about the further potential for our customers and injured employees.”
Sprains and strains deemed to be grade levels I or II, for example, can easily be treated virtually at the worksite with great success. “Telehealth physicians use evidence-based guidelines to treat the injured workers, focusing on capabilities and return-to-work,” said David Lupinsky, VP of Medical Review Services at CorVel. They can prescribe medications, as well as schedule short-term physical therapy and diagnostic imaging when appropriate. Early indicators tell us that the rate of prescribing unnecessary and costly ancillary services is significantly less in telehealth than in the traditional clinic model.”
Lupinsky said CorVel’s use of telehealth for its workers’ compensation clients was a natural outgrowth of the nurse triage the company has been providing for a decade. “At that point, there was no treating physician involvement yet, so it made sense there to insert telehealth,” he said. “Intake was the best place to start with telehealth.”
Improving Usage Rates
Encouraging the use of telehealth is not always a smooth process. For one thing, it’s important to know where it should or should not be used. It is not appropriate for injuries that require more hands-on evaluation and treating.
“The key is, can you assess it the right way and treat it with all the modalities available in a brick and mortar setting,” Lupinsky said. “That’s how we check them off. We ask what is the standard treatment [for a particular injury], and look to replicate that in the virtual setting. What we say is, when in doubt, refer out.”
Convincing medical providers to try telehealth can be challenging, as CorVel found when some of its nurses objected. “They weren’t sure about the treatment. So we had every nurse do a telehealth visit. It’s changed
their perception,” he said. “They are so surprised at how engaging it is, and the attention from the physician they get.”
One aspect of telehealth that might make it more appealing for employers/payers is the way and cost of doing it in the workplace. For example, many people think telehealth must be done at a kiosk, furnished with an otoscope for checking the ears, and devices to take blood pressure and temperature readings. At a cost of roughly $40,000, that can be expensive — and is unnecessary.
“The reality is for workers’ compensation, that type of information is not really relevant for the disease states we treat,” Lupinsky said. “We typically have a private room, where the injured worker’s visit can be done with an iPad or mobile device. In group health it is very different.”
As organizations increase their uses of telehealth in the workers’ compensation system, one thing they are finding is that it reduces the need for large provider networks. For behavioral health, that can be especially beneficial.
“There is a shortage of primary physicians and an even greater shortage of psychiatrists and even psychologists,” said Berardo of Carisk Partners. “What telehealth has done is created the ability to extend your network. Sometimes it’s not enough to have a psychologist talk to the injured
worker. Sometimes the patient wants a male or female, or an older or younger person, depending on their preference and whom they trust. Telehealth opens up a lot more choice to connect the right person to the patient.”
Many organizations have ranking of area providers. Those deemed ‘best’ may only be available in a specific area. “I’d rather take the provider in the state, or the West, or the country,” Lupinsky said. “Good care is less expensive because it promotes independence,” he added. “We want them to
get better and take care of themselves. That’s a win for patients and it’s a win for payers.”
Source: Nancy Grover, workerscompensation.com