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

2017 Teddy Awards

The Era of Engagement

The very best workers’ compensation programs are the ones where workers aren’t just the subject of the program, they’re a part of it.
By: | November 1, 2017 • 5 min read

Employee engagement, employee advocacy, employee participation — these are common threads running through the programs we honor this year in the 2017 Theodore Roosevelt Workers’ Compensation and Disability Management Awards, sponsored by PMA Companies.

A panel of judges — including workers’ comp executives who actively engage their own employees — selected this year’s winners on the basis of performance, sustainability, innovation and teamwork. The winners hail from different industries and regions, but all make people part of the solution to unique challenges.

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Valley Health System is all-too keenly aware of the risk of violence in health care settings, running the gamut from disruptive patients to grieving, overwrought family members to mentally unstable active shooters.

Valley Health employs a proactive and comprehensive plan to respond to violent scenarios, involving its Code Atlas Team — 50 members of the clinical staff and security departments who undergo specialized training. Valley Health drills regularly, including intense annual active shooter drills that involve participation from local law enforcement.

The drills are unnerving for many, but the program is making a difference — the health system cut its workplace violence injuries in half in the course of just one year.

“We’re looking at patient safety and employee safety like never before,” said Barbara Schultz, director of employee health and wellness.

At Rochester Regional Health’s five hospitals and six long-term care facilities, a key loss driver was slips and falls. The system’s mandatory safety shoe program saw only moderate take-up, but the reason wasn’t clear.

Rather than force managers to write up non-compliant employees, senior manager of workers’ compensation and employee safety Monica Manske got proactive, using a survey as well as one-on-one communication to suss out the obstacles. After making changes based on the feedback, shoe compliance shot up from 35 percent to 85 percent, contributing to a 42 percent reduction in lost-time claims and a 46 percent reduction in injuries.

For the shoe program, as well as every RRH safety initiative, Manske’s team takes the same approach: engaging employees to teach and encourage safe behaviors rather than punishing them for lapses.

For some of this year’s Teddy winners, success was born of the company’s willingness to make dramatic program changes.

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Delta Air Lines made two ambitious program changes since 2013. First it adopted an employee advocacy model for its disability and leave of absence programs. After tasting success, the company transitioned all lines including workers’ compensation to an integrated absence management program bundled under a single TPA.

While skeptics assume “employee advocacy” means more claims and higher costs, Delta answers with a reality that’s quite the opposite. A year after the transition, Delta reduced open claims from 3,479 to 1,367, with its total incurred amount decreased by $50.1 million — head and shoulders above its projected goals.

For the Massachusetts Port Authority, change meant ending the era of having a self-administered program and partnering with a TPA. It also meant switching from a guaranteed cost program to a self-insured program for a significant segment of its workforce.

Massport’s results make a great argument for embracing change: The organization saved $21 million over the past six years. Freeing up resources allowed Massport to increase focus on safety as well as medical management and chopped its medical costs per claim in half — even while allowing employees to choose their own health care providers.

Risk & Insurance® congratulates the 2017 Teddy Award winners and holds them in high esteem for their tireless commitment to a safe workforce that’s fully engaged in its own care. &

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More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.

 

Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.

 

Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.

 

Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.

 

Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.

 

Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.

 

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