Case Management

Missed Appointments, Missed Opportunities

Eliminating missed medical appointments can significantly reduce claims costs and improve outcomes for injured workers.
By: | September 7, 2017 • 4 min read

Non-compliance with medical protocols, including missed medical, therapeutic and diagnostic appointments, “are a problem and have always been a problem” for workers’ compensation carriers.

However, the mechanisms they and care managers use to keep tabs on injured workers produce a higher compliance rate — and better outcomes — than in the general medical environment.

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Stakeholders, including employers and insurers, “have a strong incentive to get workers back to work to reduce indemnity,” said Robert Hartwig, co-director, risk and uncertainty management center, Darla Moore School of Business, University of South Carolina.

Most employees are also eager to return to work, he said, other than a few instances of claim malingering, which preventive mechanisms tend to minimize.

Ten to 18 percent of injured workers never reach “substantial return to work,” according to new research by the Workers Compensation Research Institute that compares outcomes for injured workers in six states.

By contrast, only one percent of people on Social Security disability ever return to work, Hartwig said.

The goal of worker’s compensation — to restore to the maximum degree possible the employee’s health and ability to return to work — and the resources poured into that goal, accounts for the huge difference in outcomes, Hartwig said.

The workers’ compensation system is also sensitive to overutilization of appointments and procedures, he said.

Although no studies address the cost of missed workers’ compensation appointments specifically, all missed medical appointments cost the U.S. health care system more than $150 billion per year, said Joseph McCullough, senior vice president, transportation and language, One Call Care Management.

The cost of all non-adherence to medical protocols in the U.S. is approximately $290 billion, wrote Tomas Philipson, economist, University of Chicago, in “Forbes.” That equates to about 13 percent of total health care spending, or 2.3 percent of GDP.

Some Mechanisms

Carriers and care managers are harnessing all manner of mechanisms, high and low tech, to urge, prod and remind workers of their appointments. For example, One Call partners with Lyft to provide transportation for ambulatory workers to and from their appointments.

Through text messages limited to times, travel conditions and locations, One Call’s program seeks to prevent missed and delayed treatment caused by transportation snafus, McCullough wrote in an email interview, and instantly reschedules appointments when necessary.

Robert Hartwig, co-director, Center of Risk and Uncertainty Management at the Darla Moore School of Business, University of South Carolina

CorVel uses a three-point strategy that embraces highly coordinated care management, transportation and motivation techniques to make sure workers get to their appointments, understand their importance and accept accountability for their own recovery, said Karen Thomas, director, case management innovation, CorVel.

Its case managers — telephonic, field and one-off task managers — orchestrate scheduling with workers, issuing reminders about dates and what they need to bring. Most important, she said, “We educate them on why the appointment is important and how it impacts recovery. Case managers develop a relationship with the worker.”

Like One Call, CorVel arranges transportation for ambulatory and non-ambulatory workers. It schedules pick-ups, and through a proprietary system, communicates in real time with the worker, providers, adjuster and case manager, then documents and tracks the progress of the appointment.

Finally, Thomas said, there’s the worker’s accountability. “The worker doesn’t want to let the case manager down. After the appointment. I’ll ask, ‘Did you get what you needed? Are your questions answered?’ We don’t necessarily want to pressure the worker, but buy-in is important.”

“Our challenge is to figure out how to help workers get better despite themselves.” — Karen Thomas, director, case management innovation, CorVel

More encouragement may be necessary for the small number of injured workers who throw up roadblocks to their own recovery.

Case management is an advanced practice, Thomas said, and its nurses have experience with rehab medicine, trauma, chronic pain and its associated depression and self-sabotage.

“Our challenge is to figure out how to help workers get better despite themselves,” using every available motivation: return to an active lifestyle or playing catch with the kids.

Biggest Cost: Lost Time

Most physicians waive fees for missed appointments, said Dr. Teresa Bartlett, MD, senior vice president and medical director, Sedgwick Claims Management Services Inc. But every lost workday costs $400 to $900 as well as the worker’s lost productivity. It can also protract indemnity benefits unnecessarily.

For example, a missed appointment just prior to return to work could add a week or more to the claim if the physician can’t fit in a rescheduled appointment earlier.

Depending on the jurisdiction, deliberately missed appointments and other schemes to protract benefits can jeopardize workers’ compensation payments, Bartlett said. “That’s why we do friendly reminders. It’s in their own best interest.”

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Because timely care that conforms to best practices produces the best outcomes, Sedgwick, a claims and care manager, expedites appointments from the moment of the injury, said Bartlett. Sedgwick brings care to the worker almost immediately through telemedicine.

Sedgwick also trains its examiners to spot the signs of the behaviors and comorbidities that can lead to creeping catastrophic claims — the rolled ankle that spirals into wheelchair confinement, obesity, diabetes and heart disease, for example.

“If the worker says he just doesn’t have the energy to get into the car and go to the appointment, we’ll refer him for behavioral health intervention,” Bartlett said. “To get the case back on track, that worker will be queued up for telephonic nurse case management or field case management where a nurse goes with him to the appointment.”

Susannah Levine writes about health care, education and technology. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2017 Teddy Awards

The Era of Engagement

The very best workers’ compensation programs are the ones where workers aren’t just the subject of the program, they’re a part of it.
By: | November 1, 2017 • 5 min read

Employee engagement, employee advocacy, employee participation — these are common threads running through the programs we honor this year in the 2017 Theodore Roosevelt Workers’ Compensation and Disability Management Awards, sponsored by PMA Companies.

A panel of judges — including workers’ comp executives who actively engage their own employees — selected this year’s winners on the basis of performance, sustainability, innovation and teamwork. The winners hail from different industries and regions, but all make people part of the solution to unique challenges.

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Valley Health System is all-too keenly aware of the risk of violence in health care settings, running the gamut from disruptive patients to grieving, overwrought family members to mentally unstable active shooters.

Valley Health employs a proactive and comprehensive plan to respond to violent scenarios, involving its Code Atlas Team — 50 members of the clinical staff and security departments who undergo specialized training. Valley Health drills regularly, including intense annual active shooter drills that involve participation from local law enforcement.

The drills are unnerving for many, but the program is making a difference — the health system cut its workplace violence injuries in half in the course of just one year.

“We’re looking at patient safety and employee safety like never before,” said Barbara Schultz, director of employee health and wellness.

At Rochester Regional Health’s five hospitals and six long-term care facilities, a key loss driver was slips and falls. The system’s mandatory safety shoe program saw only moderate take-up, but the reason wasn’t clear.

Rather than force managers to write up non-compliant employees, senior manager of workers’ compensation and employee safety Monica Manske got proactive, using a survey as well as one-on-one communication to suss out the obstacles. After making changes based on the feedback, shoe compliance shot up from 35 percent to 85 percent, contributing to a 42 percent reduction in lost-time claims and a 46 percent reduction in injuries.

For the shoe program, as well as every RRH safety initiative, Manske’s team takes the same approach: engaging employees to teach and encourage safe behaviors rather than punishing them for lapses.

For some of this year’s Teddy winners, success was born of the company’s willingness to make dramatic program changes.

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Delta Air Lines made two ambitious program changes since 2013. First it adopted an employee advocacy model for its disability and leave of absence programs. After tasting success, the company transitioned all lines including workers’ compensation to an integrated absence management program bundled under a single TPA.

While skeptics assume “employee advocacy” means more claims and higher costs, Delta answers with a reality that’s quite the opposite. A year after the transition, Delta reduced open claims from 3,479 to 1,367, with its total incurred amount decreased by $50.1 million — head and shoulders above its projected goals.

For the Massachusetts Port Authority, change meant ending the era of having a self-administered program and partnering with a TPA. It also meant switching from a guaranteed cost program to a self-insured program for a significant segment of its workforce.

Massport’s results make a great argument for embracing change: The organization saved $21 million over the past six years. Freeing up resources allowed Massport to increase focus on safety as well as medical management and chopped its medical costs per claim in half — even while allowing employees to choose their own health care providers.

Risk & Insurance® congratulates the 2017 Teddy Award winners and holds them in high esteem for their tireless commitment to a safe workforce that’s fully engaged in its own care. &

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More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.

 

Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.

 

Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.

 

Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.

 

Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.

 

Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.

 

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]