Nurse Case Manager Chronicles

Nurse Case Managers’ Holistic View of Injured Workers Positively Impacts Claims

Comorbid conditions have been known to lengthen claims due to high medical costs and increased risk of litigation. Enter the nurse case manager, a few healthy tricks up their sleeve.
By: | October 10, 2018 • 4 min read

When a worker is injured, the claims team has one thing in mind: help the worker heal and return to work and life. However, outside factors can prolong a claim and leave an injured worker feeling discouraged.

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These outside factors are often associated with co-morbidities, and they can play a big role in lengthening a claim. Co-morbidities refer to any disease a patient has that exists alongside an injury or illness. They include obesity, diabetes, high blood pressure, heart disease, arthritis and old age. Even depression can be considered a co-morbid condition.

As a former nurse case manager, Eric Patten, national product leader for diagnostics at One Call, knows firsthand the impact co-morbid conditions can have on a claim.

“Co-morbid conditions are not compensable, but they affect compensable injuries,” said Patten. “They often delay healing, which leads to increased costs associated with medical reserves, extended length of disability, more [total temporary disability] days and increased litigation rates, which was noted in a Harbor Health System study,” he said.

Nurse Intervention Cuts Costs, Saves Time

Patten entered nursing 25 years ago. He started his career in a hospital setting and then moved into case management for workers’ compensation. Through his experience, he witnessed how a co-morbid condition can impact a claim.

Eric Patten, national product leader for diagnostics, One Call

For instance, he was assigned an elderly woman’s case after she rolled her ankle walking from the parking lot to her place of work. When she was examined, the physician discovered her diabetes, pre-injury, wasn’t being taken care the way it should have been.

Added to that, she was older and blood circulation to her ankle was poor.

Patten had to be diligent and aggressive in the management of her actual compensable injury — the rolled ankle — to get her back to work. But he also had to start this worker down the path of managing her co-morbid conditions.

First, he coordinated with the treating physician to get her seen by an ankle specialist. Then, he touched base with her nephew to figure out who was treating her diabetes and partnered with an endocrinologist to monitor her blood sugars.

As the nurse case manager, Patten was watching over this patient holistically, keeping the entire medical team on the same page. He communicated results between the treating physician, the endocrinologist and the worker’s family. His background and skills as a nurse case manager enabled him to see the big picture: Co-morbid conditions lengthen claims. Treating them is vital.

Patten also played a key role in informing the carrier and the employer of any changes, so they too knew what was being done and how these interventions would benefit the claim.

“These types of interventions were considered above the duties of a nurse case manager for workers’ comp at the time,” Patten explained. “Today, we understand the importance of treating the injured worker holistically to improve return to work and decrease medical reserves.”

 Nurse Case Managers Advocate for Employee Wellness

Ultimately, when an injured worker has a co-morbid condition, the nurse case manager is key in getting them what they need. Many case managers will work with the claimant, the claimant’s employer and the claimant’s private health insurance case manager to ensure aggressive management of co-morbid conditions during the compensable injury.

They do so by connecting with HR and reaching out to the injured worker’s health care provider. It’s a needed step in the process, so that the nurse case manager can both treat for and inform on what is required from the carrier, employer, worker and physician.

In the past, some carriers have not been receptive to this thought process, but that’s changing due to an increasingly aging workforce likely to have at least one co-morbidity, said Patten.

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And employers know co-morbid conditions directly impact their medical reserves.

As a preventative measure, companies are investing in wellness programs such as yoga lessons, standing desks and fitness challenges. Some case managers will tap into these wellness resources while on a claim as an added measure to treat co-morbidities.

“We look at different approaches and work with the injured worker initially. Then we talk to the employer and ask if they have any programs for workers already in place,” said Patten. “It all comes down to the nurse case manager who is the key to getting an injured worker with a co-morbid condition what they need to get healthy and return to work.” &

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

Insurtech

Kiss Your Annual Renewal Goodbye; On-Demand Insurance Challenges the Traditional Policy

Gig workers' unique insurance needs drive delivery of on-demand coverage.
By: | September 14, 2018 • 6 min read

The gig economy is growing. Nearly six million Americans, or 3.8 percent of the U.S. workforce, now have “contingent” work arrangements, with a further 10.6 million in categories such as independent contractors, on-call workers or temporary help agency staff and for-contract firms, often with well-known names such as Uber, Lyft and Airbnb.

Scott Walchek, founding chairman and CEO, Trōv

The number of Americans owning a drone is also increasing — one recent survey suggested as much as one in 12 of the population — sparking vigorous debate on how regulation should apply to where and when the devices operate.

Add to this other 21st century societal changes, such as consumers’ appetite for other electronic gadgets and the advent of autonomous vehicles. It’s clear that the cover offered by the annually renewable traditional insurance policy is often not fit for purpose. Helped by the sophistication of insurance technology, the response has been an expanding range of ‘on-demand’ covers.

The term ‘on-demand’ is open to various interpretations. For Scott Walchek, founding chairman and CEO of pioneering on-demand insurance platform Trōv, it’s about “giving people agency over the items they own and enabling them to turn on insurance cover whenever they want for whatever they want — often for just a single item.”

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“On-demand represents a whole new behavior and attitude towards insurance, which for years has very much been a case of ‘get it and forget it,’ ” said Walchek.

Trōv’s mobile app enables users to insure just a single item, such as a laptop, whenever they wish and to also select the period of cover required. When ready to buy insurance, they then snap a picture of the sales receipt or product code of the item they want covered.

Welcoming Trōv: A New On-Demand Arrival

While Walchek, who set up Trōv in 2012, stressed it’s a technology company and not an insurance company, it has attracted industry giants such as AXA and Munich Re as partners. Trōv began the U.S. roll-out of its on-demand personal property products this summer by launching in Arizona, having already established itself in Australia and the United Kingdom.

“Australia and the UK were great testing grounds, thanks to their single regulatory authorities,” said Walchek. “Trōv is already approved in 45 states, and we expect to complete the process in all by November.

“On-demand products have a particular appeal to millennials who love the idea of having control via their smart devices and have embraced the concept of an unbundling of experiences: 75 percent of our users are in the 18 to 35 age group.” – Scott Walchek, founding chairman and CEO, Trōv

“On-demand products have a particular appeal to millennials who love the idea of having control via their smart devices and have embraced the concept of an unbundling of experiences: 75 percent of our users are in the 18 to 35 age group,” he added.

“But a mass of tectonic societal shifts is also impacting older generations — on-demand cover fits the new ways in which they work, particularly the ‘untethered’ who aren’t always in the same workplace or using the same device. So we see on-demand going into societal lifestyle changes.”

Wooing Baby Boomers

In addition to its backing for Trōv, across the Atlantic, AXA has partnered with Insurtech start-up By Miles, launching a pay-as-you-go car insurance policy in the UK. The product is promoted as low-cost car insurance for drivers who travel no more than 140 miles per week, or 7,000 miles annually.

“Due to the growing need for these products, companies such as Marmalade — cover for learner drivers — and Cuvva — cover for part-time drivers — have also increased in popularity, and we expect to see more enter the market in the near future,” said AXA UK’s head of telematics, Katy Simpson.

Simpson confirmed that the new products’ initial appeal is to younger motorists, who are more regular users of new technology, while older drivers are warier about sharing too much personal information. However, she expects this to change as on-demand products become more prevalent.

“Looking at mileage-based insurance, such as By Miles specifically, it’s actually older generations who are most likely to save money, as the use of their vehicles tends to decline. Our job is therefore to not only create more customer-centric products but also highlight their benefits to everyone.”

Another Insurtech ready to partner with long-established names is New York-based Slice Labs, which in the UK is working with Legal & General to enter the homeshare insurance market, recently announcing that XL Catlin will use its insurance cloud services platform to create the world’s first on-demand cyber insurance solution.

“For our cyber product, we were looking for a partner on the fintech side, which dovetailed perfectly with what Slice was trying to do,” said John Coletti, head of XL Catlin’s cyber insurance team.

“The premise of selling cyber insurance to small businesses needs a platform such as that provided by Slice — we can get to customers in a discrete, seamless manner, and the partnership offers potential to open up other products.”

Slice Labs’ CEO Tim Attia added: “You can roll up on-demand cover in many different areas, ranging from contract workers to vacation rentals.

“The next leap forward will be provided by the new economy, which will create a range of new risks for on-demand insurance to respond to. McKinsey forecasts that by 2025, ecosystems will account for 30 percent of global premium revenue.

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“When you’re a start-up, you can innovate and question long-held assumptions, but you don’t have the scale that an insurer can provide,” said Attia. “Our platform works well in getting new products out to the market and is scalable.”

Slice Labs is now reviewing the emerging markets, which aren’t hampered by “old, outdated infrastructures,” and plans to test the water via a hackathon in southeast Asia.

Collaboration Vs Competition

Insurtech-insurer collaborations suggest that the industry noted the banking sector’s experience, which names the tech disruptors before deciding partnerships, made greater sense commercially.

“It’s an interesting correlation,” said Slice’s managing director for marketing, Emily Kosick.

“I believe the trend worth calling out is that the window for insurers to innovate is much shorter, thanks to the banking sector’s efforts to offer omni-channel banking, incorporating mobile devices and, more recently, intelligent assistants like Alexa for personal banking.

“Banks have bought into the value of these technology partnerships but had the benefit of consumer expectations changing slowly with them. This compares to insurers who are in an ever-increasing on-demand world where the risk is high for laggards to be left behind.”

As with fintechs in banking, Insurtechs initially focused on the retail segment, with 75 percent of business in personal lines and the remainder in the commercial segment.

“Banks have bought into the value of these technology partnerships but had the benefit of consumer expectations changing slowly with them. This compares to insurers who are in an ever-increasing on-demand world where the risk is high for laggards to be left behind.” — Emily Kosick, managing director, marketing, Slice

Those proportions may be set to change, with innovations such as digital commercial insurance brokerage Embroker’s recent launch of the first digital D&O liability insurance policy, designed for venture capital-backed tech start-ups and reinsured by Munich Re.

Embroker said coverage that formerly took weeks to obtain is now available instantly.

“We focus on three main issues in developing new digital business — what is the customer’s pain point, what is the expense ratio and does it lend itself to algorithmic underwriting?” said CEO Matt Miller. “Workers’ compensation is another obvious class of insurance that can benefit from this approach.”

Jason Griswold, co-founder and chief operating officer of Insurtech REIN, highlighted further opportunities: “I’d add a third category to personal and business lines and that’s business-to-business-to-consumer. It’s there we see the biggest opportunities for partnering with major ecosystems generating large numbers of insureds and also big volumes of data.”

For now, insurers are accommodating Insurtech disruption. Will that change?

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“Insurtechs have focused on products that regulators can understand easily and for which there is clear existing legislation, with consumer protection and insurer solvency the two issues of paramount importance,” noted Shawn Hanson, litigation partner at law firm Akin Gump.

“In time, we could see the disruptors partner with reinsurers rather than primary carriers. Another possibility is the likes of Amazon, Alphabet, Facebook and Apple, with their massive balance sheets, deciding to link up with a reinsurer,” he said.

“You can imagine one of them finding a good Insurtech and buying it, much as Amazon’s purchase of Whole Foods gave it entry into the retail sector.” &

Graham Buck is a UK-based writer and has contributed to Risk & Insurance® since 1998. He can be reached at riskletters.com.