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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

Cyber Resilience

No, Seriously. You Need a Comprehensive Cyber Incident Response Plan Before It’s Too Late.

Awareness of cyber risk is increasing, but some companies may be neglecting to prepare adequate response plans that could save them millions. 
By: | June 1, 2018 • 7 min read

To minimize the financial and reputational damage from a cyber attack, it is absolutely critical that businesses have a cyber incident response plan.

“Sadly, not all yet do,” said David Legassick, head of life sciences, tech and cyber, CNA Hardy.

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In the event of a breach, a company must be able to quickly identify and contain the problem, assess the level of impact, communicate internally and externally, recover where possible any lost data or functionality needed to resume business operations and act quickly to manage potential reputational risk.

This can only be achieved with help from the right external experts and the design and practice of a well-honed internal response.

The first step a company must take, said Legassick, is to understand its cyber exposures through asset identification, classification, risk assessment and protection measures, both technological and human.

According to Raf Sanchez, international breach response manager, Beazley, cyber-response plans should be flexible and applicable to a wide range of incidents, “not just a list of consecutive steps.”

They also should bring together key stakeholders and specify end goals.

Jason J. Hogg, CEO, Aon Cyber Solutions

With bad actors becoming increasingly sophisticated and often acting in groups, attack vectors can hit companies from multiple angles simultaneously, meaning a holistic approach is essential, agreed Jason J. Hogg, CEO, Aon Cyber Solutions.

“Collaboration is key — you have to take silos down and work in a cross-functional manner.”

This means assembling a response team including individuals from IT, legal, operations, risk management, HR, finance and the board — each of whom must be well drilled in their responsibilities in the event of a breach.

“You can’t pick your players on the day of the game,” said Hogg. “Response times are critical, so speed and timing are of the essence. You should also have a very clear communication plan to keep the CEO and board of directors informed of recommended courses of action and timing expectations.”

People on the incident response team must have sufficient technical skills and access to critical third parties to be able to make decisions and move to contain incidents fast. Knowledge of the company’s data and network topology is also key, said Legassick.

“Perhaps most important of all,” he added, “is to capture in detail how, when, where and why an incident occurred so there is a feedback loop that ensures each threat makes the cyber defense stronger.”

Cyber insurance can play a key role by providing a range of experts such as forensic analysts to help manage a cyber breach quickly and effectively (as well as PR and legal help). However, the learning process should begin before a breach occurs.

Practice Makes Perfect

“Any incident response plan is only as strong as the practice that goes into it,” explained Mike Peters, vice president, IT, RIMS — who also conducts stress testing through his firm Sentinel Cyber Defense Advisors.

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Unless companies have an ethical hacker or certified information security officer on board who can conduct sophisticated simulated attacks, Peters recommended they hire third-party experts to test their networks for weaknesses, remediate these issues and retest again for vulnerabilities that haven’t been patched or have newly appeared.

“You need to plan for every type of threat that’s out there,” he added.

Hogg agreed that bringing third parties in to conduct tests brings “fresh thinking, best practice and cross-pollination of learnings from testing plans across a multitude of industries and enterprises.”

“Collaboration is key — you have to take silos down and work in a cross-functional manner.” — Jason J. Hogg, CEO, Aon Cyber Solutions

Legassick added that companies should test their plans at least annually, updating procedures whenever there is a significant change in business activity, technology or location.

“As companies expand, cyber security is not always front of mind, but new operations and territories all expose a company to new risks.”

For smaller companies that might not have the resources or the expertise to develop an internal cyber response plan from whole cloth, some carriers offer their own cyber risk resources online.

Evan Fenaroli, an underwriting product manager with the Philadelphia Insurance Companies (PHLY), said his company hosts an eRiskHub, which gives PHLY clients a place to start looking for cyber event response answers.

That includes access to a pool of attorneys who can guide company executives in creating a plan.

“It’s something at the highest level that needs to be a priority,” Fenaroli said. For those just getting started, Fenaroli provided a checklist for consideration:

  • Purchase cyber insurance, read the policy and understand its notice requirements.
  • Work with an attorney to develop a cyber event response plan that you can customize to your business.
  • Identify stakeholders within the company who will own the plan and its execution.
  • Find outside forensics experts that the company can call in an emergency.
  • Identify a public relations expert who can be called in the case of an event that could be leaked to the press or otherwise become newsworthy.

“When all of these things fall into place, the outcome is far better in that there isn’t a panic,” said Fenaroli, who, like others, recommends the plan be tested at least annually.

Cyber’s Physical Threat

With the digital and physical worlds converging due to the rise of the Internet of Things, Hogg reminded companies: “You can’t just test in the virtual world — testing physical end-point security is critical too.”

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How that testing is communicated to underwriters should also be a key focus, said Rich DePiero, head of cyber, North America, Swiss Re Corporate Solutions.

Don’t just report on what went well; it’s far more believable for an underwriter to hear what didn’t go well, he said.

“If I hear a client say it is perfect and then I look at some of the results of the responses to breaches last year, there is a disconnect. Help us understand what you learned and what you worked out. You want things to fail during these incident response tests, because that is how we learn,” he explained.

“Bringing in these outside firms, detailing what they learned and defining roles and responsibilities in the event of an incident is really the best practice, and we are seeing more and more companies do that.”

Support from the Board

Good cyber protection is built around a combination of process, technology, learning and people. While not every cyber incident needs to be reported to the boardroom, senior management has a key role in creating a culture of planning and risk awareness.

David Legassick, head of life sciences, tech and cyber, CNA Hardy

“Cyber is a boardroom risk. If it is not taken seriously at boardroom level, you are more than likely to suffer a network breach,” Legassick said.

However, getting board buy-in or buy-in from the C-suite is not always easy.

“C-suite executives often put off testing crisis plans as they get in the way of the day job. The irony here is obvious given how disruptive an incident can be,” said Sanchez.

“The C-suite must demonstrate its support for incident response planning and that it expects staff at all levels of the organization to play their part in recovering from serious incidents.”

“What these people need from the board is support,” said Jill Salmon, New York-based vice president, head of cyber/tech/MPL, Berkshire Hathaway Specialty Insurance.

“I don’t know that the information security folks are looking for direction from the board as much as they are looking for support from a resources standpoint and a visibility standpoint.

“They’ve got to be aware of what they need and they need to have the money to be able to build it up to that level,” she said.

Without that support, according to Legassick, failure to empower and encourage the IT team to manage cyber threats holistically through integration with the rest of the organization, particularly risk managers, becomes a common mistake.

He also warned that “blame culture” can prevent staff from escalating problems to management in a timely manner.

Collaboration and Communication

Given that cyber incident response truly is a team effort, it is therefore essential that a culture of collaboration, preparation and practice is embedded from the top down.

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One of the biggest tripping points for companies — and an area that has done the most damage from a reputational perspective — is in how quickly and effectively the company communicates to the public in the aftermath of a cyber event.

Salmon said of all the cyber incident response plans she has seen, the companies that have impressed her most are those that have written mock press releases and rehearsed how they are going to respond to the media in the aftermath of an event.

“We have seen so many companies trip up in that regard,” she said. “There have been examples of companies taking too long and then not explaining why it took them so long. It’s like any other crisis — the way that you are communicating it to the public is really important.” &

Antony Ireland is a London-based financial journalist. He can be reached at [email protected] Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]