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.


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.


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

Risk Management

The Profession

Janet Sheiner, VP of risk management and real estate at AMN Healthcare Services Inc., sees innovation as an answer to fast-evolving and emerging risks.
By: | March 5, 2018 • 4 min read

R&I: What was your first job?

As a kid, bagging groceries. My first job out of school, part-time temp secretary.

R&I: How did you come to work in risk management?

Risk management picks you; you don’t necessarily pick it. I came into it from a regulatory compliance angle. There’s a natural evolution because a lot of your compliance activities also have the effect of managing your risk.

R&I: What is the risk management community doing right?


There’s much benefit to grounding strategic planning in an ERM framework. That’s a great innovation in the industry, to have more emphasis on ERM. I also think that risk management thought leaders are casting themselves more as enablers of business, not deterrents, a move in the right direction.

R&I: What could the risk management community be doing a better job of?

Justified or not, risk management functions are often viewed as the “Department of No.” We’ve worked hard to cultivate a reputation as the “Department of Maybe,” so partners across the organization see us as business enablers. That reputation has meant entertaining some pretty crazy ideas, but our willingness to try and find a way to “yes” tempered with good risk management has made all the difference.

Janet Sheiner, VP, Risk Management & Real Estate, AMN Healthcare Services Inc.

R&I: What was the best location and year for the RIMS conference and why?

San Diego, of course!  America’s Finest City has the infrastructure, Convention Center, hotels, airport and public transportation — plus you can’t beat our great weather! The restaurant scene is great, not to mention those beautiful coastal views.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

The emergence of risk management as a distinct profession, with four-year degree programs and specific academic curriculum. Now I have people on my team who say their goal is to be a risk manager. I said before that risk management picks you, but we’re getting to a point where people pick it.

R&I: What emerging commercial risk most concerns you?


The commercial insurance market’s ability to innovate to meet customer demand. Businesses need to innovate to stay relevant, and the commercial market needs to innovate with us.  Carriers have to be willing to take on more risk and potentially take a loss to meet the unique and evolving risks companies are facing.

R&I: Of which insurance carrier do you have the highest opinion?

Beazley. They have been an outstanding partner to AMN. They are responsive, flexible and reasonable.  They have evolved with us. They have an appreciation for risk management practices we’ve organically woven into our business, and by extension, this makes them more comfortable with taking on new risks with us.

R&I: Are you optimistic or pessimistic about the U.S. health care industry and why?

I am very optimistic about the health care industry. We have an aging population with burgeoning health care needs, coupled with a decreasing supply of health care providers — that means we have to get smarter about how we manage health care. There’s a lot of opportunity for thought leaders to fill that gap.

R&I: Who is your mentor and why?

Professionally, AMN Healthcare General Counsel, Denise Jackson, has enabled me to do the best work I’ve ever done, and better than I thought I could do.  Personally, my husband Andrew, a second-grade teacher, who has a way of putting things into a human perspective.

R&I: What have you accomplished that you are proudest of?

In my early 20s, I set a goal for the “corner office.” I achieved that when I became vice president.  I received a ‘Values in Practice’ award for trust at AMN. The nomination came from team members I work with every day, and I was incredibly humbled and honored.

R&I: What is your favorite book or movie?

The noir genre, so anything by Raymond Chandler in books. For movies,  “Double Indemnity,” the 1944 Billy Wilder classic, with insurance at the heart of it!

R&I: What is your favorite drink?


Clean water. Check out for how to help people enjoy clean, safe water.

R&I: What’s the best restaurant at which you’ve eaten?

Liqun Roast Duck Restaurant in Beijing.

R&I: What is the most unusual/interesting place you have ever visited?

China. See favorite restaurant above. This restaurant had been open for 100 years in that location. It didn’t exactly have an “A” rating, and it was probably not a place most risk managers would go to.

R&I: What is the riskiest activity you ever engaged in?

Eating that duck at Liqun!

R&I: If the world has a modern hero, who is it and why?

Dr. Seuss who, in response to a 1954 report in Life magazine, worked to reduce illiteracy among school children by making children’s books more interesting. His work continues to educate and entertain children worldwide.

R&I: What do your friends and family think you do?

They’re not really sure!

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]