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

2018 Risk All Stars

Stop Mitigating Risk. Start Conquering It Like These 2018 Risk All Stars

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]