Claims Management

Telerehab Poised to Grow but Barriers Remain

Remote rehabilitation services offer the potential for savings in both time and money, but adoption is slow.
By: | December 4, 2017 • 4 min read

The prevalence of telehealth, including telerehabilitation, is poised for growth in all areas of health care, with the market projected to expand 18 percent between 2014 and 2020, according to the Global Telemedicine Market Outlook 2020.

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Although the group health market is increasingly embracing the use of telerehabilitation, its use in workers’ comp is still something of a rarity. That’s according to Mary O’Donoghue, chief clinical and product officer, MedRisk, a managed care organization based in King of Prussia, Pa. While a few managed care companies are offering telerehab to workers’ comp clients, either in partnership or solo, state laws and reluctance to change are barriers.

In the fall, MedRisk introduced a national telerehabilitation solution for injured workers. Another managed care group, Prime Health Services, also has a telerehab component for the workers’ comp industry through its partnership with tech company Consumer Health Connections. In addition, smaller technology companies are introducing platforms to enable rehab to be done remotely.

In the past few years, multiple university studies have been published supporting the use of telerehab. A 2015 study of veterans receiving in-home physical therapy via telerehab found that their outcomes were as good or better than traditional therapy and saved statistically significant amounts of time and travel miles.

“Within workers’ comp, [telerehab] is certainly going to save on travel time, save on time away from work and potentially keep the injured worker at the workplace,” O’Donoghue noted. “Injured worker compliance with treatment is one of the other major advantages.”

She also believes telerehab has the ability to improve patient compliance with their doctor’s orders and ensure that prescribed exercises are being performed.

“When you have the opportunity to work with someone in a telecommunications type of environment, you can reinforce good form,” she said.

Although MedRisk’s current clients are only taking advantage of telerehab in the employees’ homes, she said she is currently working with a company that wants to offer telerehab at the worksite.

A 2015 study of veterans receiving in-home physical therapy via telerehab found that their outcomes were as good or better than traditional therapy.

Tammy Richmond, chair of the Telerehabilitation Special Interest Group for the American Telemedicine Association and CEO of Go 2 Care, which provides telerehab services via its own tech platform, said she expects the use of telerehab in workers’ comp to significantly increase.

Over the past 18 months, she said, multiple companies and insurers have expressed interest in telerehab and how it could be integrated into the existing workers’ comp pre- and post-claim models.

Richmond’s business offers a bundled arrangement of both an online prevention service and a post-accident telerehab component. In such an arrangement, an employee reporting an early symptom can speak to a prevention specialist, who will suggest job modifications and coach them on first aid and wellness. Symptoms that escalate are reevaluated to see if a claim needs to be opened and whether the employee’s issues can be solved through telerehab or whether the employee’s needs would be better met in person at their contracted clinic.

Richmond said Go 2 Care’s own statistics have found that 72 percent of its clients’ issues could be resolved after three prevention visits, avoiding as much as $3,100 in physical therapy costs, and that the average return-to-work for her clients’ employees is 38 days versus the U.S. average of 70 days.

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However, significant barriers exist to expanding the use of telerehab in workers’ comp. Currently, only a few states with telemedicine parity laws include telehealth coverage under workers’ comp, said Latoya Thomas, policy director, American Telemedicine Association.

Only Arizona, Nevada and Oklahoma have explicit language covering workers’ comp in their telemedicine parity laws; Colorado and North Dakota have regulations that extend telehealth coverage, but Colorado only allows for its use in the home — not the workplace. Texas is considering the issue, but the state’s Department of Insurance is proposing very restrictive rules for coverage of telehealth in workers’ comp, Thomas said.

Another issue is an unwillingness to change on the part of employers. The Illinois Insurance Guaranty Fund last year contracted with CHC Telehealth for homebound workers’ comp patients as a way to improve convenience and outcomes, but they’ve had no opportunity to employ it, said Valerie McGregor, director of claims.

“We thought this would be a tool that would be useful for more remote, catastrophic claimants, but to date, no one has had any interest in getting it started,” McGregor said. “They’re accustomed to the way things have always been.” &

Angela Childers is a Chicago-based writer specializing in health care and business management. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

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