These Catastrophic Workers’ Comp Cases Reinforce the Need for an Evolved Workers’ Compensation 2.0 Approach
When presented with acute catastrophic and complex workers’ compensation claims, it takes an integrated approach to address all injuries, while also keeping the injured worker’s physical and mental wellbeing top of mind. No injury exists in a vacuum, after all and healing requires more than mending a few bones.
“Our approach is based on the fundamental principle of human connection,” said Alana Letourneau, Chief Clinical Strategy Officer, Carisk Partners. “We aren’t just looking at an injured worker; we’re connecting with the patient and taking in how the injury affects them, their family, and their social support system.”
That is why the Carisk team has created Pathways 2 Recovery™, an evolved, patient-centered approach to managing catastrophic and complex workers’ compensation cases. The “2” represents an advanced Workers’ Compensation solution that meets the core needs of the industry.
Carisk calls it P2R, but it represents a WC 2.0, next-generation, innovative solution. In addition to providing care coordination and access to quality care, the program helps employers, TPAs and government agencies manage the risks associated without sacrificing the values-based approach the industry has been seeking.
“In addition to assessing the medical needs of the patient, we understand our patients are human beings who are in need of our help, and we feel compelled to help relieve their physical and emotional pain,” said David Vittoria, Senior Vice President, Clinical Business & Product Development at Carisk Partners.
Several key components, rooted in a behavioral health foundation, are incorporated into Carisk’s advanced Pathways 2 Recovery™ approach to managing these cases. One component, patient engagement, is initiated early in the patient/caregiver relationship and reinforced in the positive-focused, motivational interviewing conducted the moment the Carisk team comes on board. This is geared toward building trust and rapport with the patient, as well as setting a foundation for a therapeutic alliance.
A second component is a multidisciplinary care team matched to the individual. “Our internal team is made up of multiple physicians specialized in critical disciplines, who have first-hand clinical experience in workers’ comp injury areas of focus,” Vittoria explained. “Our experts do a lot more listening than they do talking, to discover the full picture of what is happening in the patient’s life. During this process, we are able to really solidify that bond by helping the patient know in this clinical interview, ‘We’re not your adversary; we’re your advocate.’”
It is through this approach that Carisk has seen tremendous results for the patients it serves. Here are just two examples of that very approach in action and how it drives positive outcomes for all involved.
Case Study #1: Ralph
Ralph is a 60-year-old who worked for most of his life as a tow truck operator. While on the job, he was struck by a tractor trailer and sustained a catastrophic leg injury. Within days of his injury, the Carisk team became involved in his case.
“After the injury, he reported nightmares and flashbacks, which were exacerbated by visiting his work site,” Letourneau explained. From the information the Carisk team pulled together, it was clear Ralph was exhibiting signs of Acute Stress Disorder, which later developed into Post Traumatic Stress Disorder.
In addition, the physical injuries Ralph sustained limited his mobility, and the added isolation of being away from work only exacerbated his growing depression and anxiety.
“He hadn’t even begun to grapple with the extent of his injuries when we first connected with him,” Vittoria explained. “He was looking at being away from the only job he’d ever known for 40 plus years, being away from the people who he had come to know over almost four decades, and that really exacerbated the grief and the depression he was beginning to experience because of the severe physical injuries.”
But the team knew what to do.
“We focused on the positives. We built trust and rapport with Ralph so we could best understand his situation,” Vittoria said. It took time, but Ralph responded positively to the efforts from the Carisk team. He opened up about how the injury not only was affecting him, but also his marriage. He mentioned that one thing he wished he could return to was riding his motorcycle — something that brought him joy.
He opened up about his past, as well, which gave the team a key insight into Ralph’s mental state.
“We learned that a couple years prior to his injury, his daughter had passed away in a tragic situation,” Vittoria said. “That took us from this overlap of depression and anxiety, significant clinical factors in and among themselves, to a more complex PTSD. He had layered traumatic experiences.”
Meanwhile, Ralph’s physical injury still needed care and attention. “Given Ralph’s injury type, connecting him with the right providers was key,” Letourneau said. “We sourced a plastic surgeon who had experience with catastrophic leg injuries, and Ralph underwent a full thickness skin graft, with our team staying in close contact with that attending surgeon. He also received inpatient rehabilitation and then transitioned to outpatient therapy, including PT and OT and required home wound care.”
But even with the best surgeon, there was still a persistent area of the injury site that wasn’t healing.
In the end, it was a multi-stage process for such a complex injury. On the medical side, a podiatrist was found for a series of allograft procedures; specialized diagnostic testing was needed; a nutritionist was brought on board; and Ralph began lymphedema therapy. On the behavioral health side, Vittoria said that it was key Ralph’s concerns were addressed.
“We wanted to look at the effect the injuries were having on his marriage,” he said. “We wanted to see what we could do about addressing his past traumas in tandem with these more recent ones.”
After some coaching and guidance from the clinical team, Ralph was connected with a trauma-trained clinician who implemented several therapeutic approaches, including Eye Movement Desensitization and Reprocessing (EMDR), which is a technique used with patients suffering from PTSD. Ralph responded very positively.
In the end, Ralph returned to his pre-injury level of mobility and was determined to have reached Maximum Medical Improvement by all of his treating providers. Through use of Carisk’s mobile app, developed with a health technology partner, Ralph’s progress was quantified and tracked over time. Both due to physical injury and psychological impact, Ralph had become less active immediately following his injury. By the point of case closure, Ralph had achieved a 40% increase in his daily step count. From a behavioral health perspective, Ralph demonstrated a 70% decrease in anxiety assessment scores, with reduction from severe to mild anxiety; he also showed a 30% decrease in depression scores, with a reduction to mild depression, managed with psychotherapy.
Though he was released for return to work, Ralph decided to retire. He and his wife were able to continue with a foundation that they had set up in honor of their daughter and since his retirement, he’s been able to enjoy a few extra motorcycle rides along the way.
Case Study #2: Barbara
65-year-old Barbara was in a state of delayed recovery when she was first referred to the Carisk team. In 2010, while working as a nurse, she was struck from behind by a patient and sustained a severe lower back injury that limited her mobility. When she came into Carisk’s care, the team learned Barbara did have a past history of using opioids to treat her pain, including polypharmacy.
“She also had a history of childhood trauma, and importantly, at the time of referral, she was depressed and demonstrated active suicidal ideation,” Letourneau explained.
Barbara’s anxiety was so severe, she was almost to the point of complete reclusiveness as well. As her injury progressed, Barbara had lost her emotional support system and friendships from work, as she further isolated herself.
On top of that, social stressors were putting a strain on recovery. “She said to us, ‘I know the Carisk team is acting in my best interest and I do trust you all. I’ll tell you what’s happening in my life, but even with your help, things are going to be very difficult. See, I don’t want to leave my house. It’s not safe. My son is actively using drugs, and he’s staying with me, and I’m afraid he’ll take my medication if I even leave to go to an appointment,’ ” Vittoria explained. Additionally, her grandson, who had alcohol issues, had also recently moved in.
Both were complicating factors that would directly impact her recovery, said Vittoria.
“By virtue, and the trust, rapport, communication and connection, not only did we glean all of this clinical information from a medical standpoint and assess objectively anxiety, depression and trauma, but we also heard what things are like in her home on a moment-by-moment basis,” Vittoria said.
The team knew that they needed to find the right clinician for Barbara’s case, particularly when looking at her childhood traumas as well. Because Barbara had been a victim of abuse, the right psychiatrist was paramount.
“We needed an experienced, properly-trained female therapist, because Barbara felt most comfortable talking with someone of her same gender,” Vittoria said. The psychiatrist they found worked with Barbara, placed her on the right psychotropic medication and helped her work through the previous trauma that she had been through. This reduced anxiety and depression.
Additionally, the past opioid use was also addressed by the psychiatrist to mitigate any potential return to use of those opioids. Vittoria said that this intervention was successful as well. In the end, Barbara began driving again and tended to her self-care. She started going to her medical appointments and began integrating back into her community.
But this wasn’t the end of Barbara’s story: “We knew that there was really no feasible way that we were going to see any demonstrable clinical benefit from the connection to the psychiatrist or the therapist or her medical appointments, if we didn’t help to address the issues going on in her home,” Letourneau said.
Carisk facilitated, at no cost to the carrier, community-based addiction treatment for Barbara’s son and grandson as well.
Success in Every Detail
Both Vittoria and Letourneau credit Carisk’s Pathways 2 Recovery™ approach for the successes in Ralph and Barbara’s cases. For each, the team worked to get to know the patient, understand the multiple factors inhibiting recovery and worked together to find appropriate solutions.
“It’s above looking at all sides,” Vittoria said. “There’s connecting with the patient, then there’s reviewing the clinical components and their health assessment. Finally, there’s a need to match the patient with a provider ready to address all aspects of the case.”
The Pathways 2 Recovery™ program at Carisk is specialized to tackle all three.
“Ralph and Barbara’s cases show just how important it is to understand the behavioral and physical elements to a case,” Letourneau said. “Finding mental health and medical professionals who matched each patient’s specific needs was a key part of success. That’s something that is foundational to the program. Simply put, this technology-enabled yet compassionate approach to patients is the epitome of Workers’ Compensation 2.0, and it sits at the center of our Pathways 2 Recovery system and program.”
It is with that patient-centered approach and the deep-rooted knowledge and understanding of behavioral health’s impact on an injury that has set the Carisk team up for success in acute catastrophic and complex claims.
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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Carisk Partners. The editorial staff of Risk & Insurance had no role in its preparation.