I Tried Telerehab To See What The Fuss Is About. Here’s What I Learned

Can virtual physical therapy really be an effective alternative over in-person care? A test session revealed the answer.
By: | March 13, 2019 • 7 min read

Telehealth is a popular topic in the world of workers’ comp. It’s been touted as a way to reduce missed appointments by bringing providers right into patients’ living rooms, cutting out the need to travel or find a ride, and saving time in the process. This should translate into better outcomes for injured workers and lower costs for employers and payers.

Most of us would agree that seeing a doctor right from your couch is more convenient than making your way to an office and having to kill time in the waiting room. But skeptics have questioned whether quality care can really be delivered within the limitations of video conferencing. Separated by screens, can clinicians see their patients well enough? And in the case of physical therapy, how can they administer treatment without the ability to touch their patient?

I tested a telerehab platform to see if virtual PT can really be an effective mode of care for injured workers. Here’s what I learned:

1. Virtual treatment can work for more than just soft-tissue injuries.

While it’s true that not every injury is suitable to virtual care, any injury that inhibits movement can be improved through a telehealth platform.

“Pretty much anything non-surgical makes sense,” said Michelle Despres, Vice President, National Product Leader, One Call. “Injuries that are muscular or skeletal in nature can be treated in this setting, but post-surgical rehabilitation and even chronic pain can also be addressed.” One Call is one company in the workers’ comp arena providing technology to payers that connects injured workers to qualified, independent therapists.

Injuries that need to remain immobile in order to heal — like an open wound or fractured bone — would be unsuitable. But “as long as a person is cleared for active movement, that person would be a fine candidate for a telerehab platform,” Despres said.

I connected with Aideen Turner, my virtual physical therapist for the day, via smartphone as she conducted an assessment for neck and shoulder tightness. Turner works with Virtual Physical Therapists LLC, one of the independent telerehab providers that partner with healthcare networks to bring their services to the patient.

She explained how she and other virtual PTs are trained to look for inhibited range of motion of even a few degrees.

“The therapists are trained in mechanical diagnoses and treatment. They evaluate based on function and movement patterns. What used to be done by touch and feel can now be done by cueing movements for the injured worker and watching how their bodies respond,” Despres said.

In my case, running through a series of movements like turning the head from side to side and up and down revealed some tightness in the left shoulder and neck area. Turner could then recommend a few specific stretches and postural adjustments that would loosen the area and prevent it from getting worse.

2. The technology is easy to use.

All an injured worker needs to access a telerehab platform is a smartphone and WiFi access. After setting up a user account on the Virtual Physical Therapists app, accessing a scheduled appointment was for me a two-step process — opening up the app and clicking on the “Appointments” tab.

Most telehealth platforms are designed to be intuitive and user-friendly. When the primary benefit is convenience, a clunky or difficult user interface would only sabotage its effectiveness.

One would wonder, though, if less tech-savvy users would feel more comfortable seeing a therapist in person. Despres and Turner, however, said that even patients less comfortable with technology have been enthusiastic about the convenience factor of virtual platforms and reported no technical issues.

“Almost everyone has a smartphone. It’s safe to say that the learning curve associated with these devices has been well-surpassed,” Despres said.

3. It saves time and avoids scheduling stress.

The biggest benefit of using a virtual physical therapy platform is convenience. Traditional, in-person appointments can be difficult to fit into a normal workday schedule. An injured worker’s employer may require them to clock out for an afternoon appointment; accounting for travel time and an hour-long visit, that worker could lose two hours of his work day. Avoiding that scenario means scheduling an appointment before or after work hours, but many clinics do not have schedules to meet that need.

Virtual therapists are often available as early as 6 a.m. until 10 p.m. Patients may also be able to complete their appointment from their workplace. A quiet conference room with a good WiFi connection may be all that’s needed.

In addition to removing scheduling stress, that flexibility can contribute to better care by facilitating a faster first appointment and increasing the likelihood that patients keep appointments. Appointments in this format also tend to be more efficient.

“Virtual appointments generally last 30 to 45 minutes. They’re laser-focused. As you move through the appointment there’s no ice or heat applied, no electric stimulation, no ultrasound. They hone right in on the problem that needs to be addressed and address them immediately. This format is better suited to speed. You typically don’t need a full hour appointment,” Despres said.

4. It sets the foundation for long-term health.

As I wrapped up my session with Turner, she demonstrated correct posture and several stretches to prevent and correct muscle imbalances that typically arise in workers who spend their days hunched over keyboards and computer screens.

Much more so than with traditional care, virtual care includes a larger educational component. Because the therapist is not physically present to assist with movements or joint stabilization, the onus is much more on the patient to learn these techniques and practice them continually.

“Self-management is a big factor. But that can translate into faster recovery. Instead of a patient practicing these movements three times a week with their therapist, they are encouraged and enabled to do them three times a day on their own,” Despres said.

“You’re taught to identify your symptoms, to connect your symptoms to movements, and to self-mobilize.”

Other Surprising Benefits of Virtual PT

As with any new technology, employers are slow to adopt virtual health platforms; they first want to understand its use cases and whether it will bring additional benefits they haven’t seen before. Even in its early stages, however, virtual PT is producing some surprising results that may result in significant cost savings for employers and workers’ comp payers.

With the ability to schedule appointments faster, telerehab platforms enable a “PT-first” approach, which can cut down on unnecessary (and expensive) diagnostic testing.

“But we’ve learned that virtual PT actually can provide a greater degree of one-on-one attention. Many patients have said ‘Wow, this is the first time I’ve had someone’s attention for a full 30 to 45 minutes.’ And suddenly their care takes a turn.” – Michelle Despres, Vice President, National Product Leader, One Call

“We had a gentleman who worked in an office experience a shoulder injury. He had an MRI before he started therapy, which showed a small tear. Well, a tear is a fairly common occurrence in our shoulders. After three virtual PT visits, he was 100 percent functional and felt fine,” Despres said.

“But the fact that this word ‘tear’ was officially diagnosed in his MRI report… it made him fearful. It made him feel like this is a big problem to be fixed, and this is the kind of thinking that can lead to surgery when surgery may not be the best route. It’s often better to try PT first to see if that makes a difference before taking more drastic measures. Our experience using a telerehab platform has shown that.”

Virtual platforms have also proven effective at addressing chronic pain — something no one was expecting.

“When we first conceptualized what telerehab looked like, we didn’t think chronic pain patients would be good candidates. They’ve been experiencing pain for a long time, there’s a lot going on — we thought they’d benefit from a face-to-face interaction,” Despres said.

“But we’ve learned that virtual PT actually can provide a greater degree of one-on-one attention. Many patients have said ‘Wow, this is the first time I’ve had someone’s attention for a full 30 to 45 minutes.’ And suddenly their care takes a turn.”

At a time when healthcare providers are searching for alternative chronic pain treatments that don’t involve addictive painkillers, this result demonstrates that virtual PT is an effective option. &

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

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.


Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.

R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.


We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?


Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.


Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now and where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.


More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]