The Data-Driven Case for a Biopsychological Model in Value-based Care
Given two similar workers’ comp claims – same injury, same demographic – why does one recover as expected and one slide off the rails?
It’s not always easy to identify why some recoveries falter, and which employees are likely to fall into that 20% of claims that drive 80% of worker’s comp costs.
Here’s a place to start: Look for the employees in emotional distress.
Companies and workers’ comp carriers have struggled over the decades to manage the 20 percent in the 20/80 formula.
That’s why a team at the University of Colorado developed a data-driven model of the behavioral component that drives some claims south, said Maggie Alvarez-Miller, RN, CMM, supervisor with ICW Group. She has been in the industry for more than 30 years, on both the service provider and payer sides.
Identifying and addressing the disconnect between protracted physical pain and underlying emotional distress hasn’t always been straightforward. But the University of Colorado’s approach creates a better, faster path to the right information.
When an injured worker first seeks medical care, they complete an electronic questionnaire in the doctor’s office that asks questions about their physical symptoms, then their emotional health. How are stress and anxiety levels? Sleep? Communication with family members?
Seconds after “send,” the worker’s data is mapped on a quadrant. If the response lands in a certain quadrant, behavioral intervention might be appropriate.
The kinds of emotional distress that can predict a rocky recovery include anger (think: I hate my boss) anxiety about the injury itself, and both the prospect of returning to work or inability to return to work.
Those worries can present as insomnia and high blood pressure, among other symptoms.
“A patient isn’t just a fractured femur,” Alvarez-Miller said, although the medical community is just now starting to wake up to the importance of an injured person’s overall psychological state.
This represents a shift in society at large, said Scott Primack, assistant clinical professor, University of Colorado School of Public Health, as elite athletes use their celebrity platforms to bring attention to the psychological contribution to their physical wellbeing.
“There’s no better example than the GOAT himself, Tom Brady,” Primack said. The football player famously credited much of his success to a sports psychologist.
Dr. Primack has collected data for decades while diagnosing and treating neuromusculoskeletal conditions.
The Rabbit Hole of Pain and Prescriptions
In some cultures, a man’s inability to support his family strikes at the heart of gender roles, said Alvarez-Miller, which can trigger a cascade of depression- and anxiety-related symptoms.
Medical providers themselves can inadvertently contribute to the stress, Primack said. “Some doctors may say, ‘It’s your fault that you’re not getting better. You’re anxious because you can’t return to work.’ ”
The blood pressure cuff, he said, can provide early insight into a patient’s emotional condition. Like Chris Kyle, the Navy Seal sharpshooter Bradley Cooper played in the acclaimed film American Sniper, high blood pressure can be the somaticized evidence of emotional distress – PTSD, in Kyle’s case.
Unless interrupted, psychosomaticized symptoms “can lead down the rabbit hole of pain and demand for more meds,” said Primack. “When patients say they have problems sleeping or dealing with a back injury, I ask, ‘Why? Let’s look at that.’ ”
That front-end information can interrupt the 20 percent cycle, Primack said, allowing providers to deliver “the right care to the right patient at the right time, including cognitive therapy. Patients get back to work sooner.”
And when he encounters resistance and denial, like Bradley Cooper’s character?
“I say, ‘The cuff doesn’t lie. I’m a data guy, and the data says you’re under a lot of stress.’ ”
“We would say, ‘Let’s talk about why the pain in your knee isn’t getting better. Are you stressed about going back to work?’ ” Alvarez-Miller said. When the anxiety presents deceptively as pain in the knee, “the solution isn’t more pain meds,” she said.
In addition to sparing the patient protracted misery from the injury, early Identification of emotional distress can also spare all involved – the injured worker, the employer and the carrier – the ruinous and preventable specter of addiction, Alvarez-Miller said. “That’s how you get addiction: through prolonged treatment.”
Primack’s model identifies the disconnect in injured workers between emotional distress and the physical manifestation of the distress. “Injured workers don’t necessarily understand the disconnect,” Alvarez-Miller said. “They read their treatment plan, which is all about MRIs of the knee or back or shoulder.”
The data is persuasive, Primack said. “Patients come to understand that by holding their ground and insisting that their psychological state is irrelevant, they’ll pay for their denial in a disappointing recovery.” The data helps patients and providers understand that stress and depression are important factors in the transition back to work.
Alvarez-Miller and Primack, together with Sophia Centi, MPH Professional Research Assistant at the University of Colorado, will dive even deeper into the university’s model in action during National Comp 2021 presentation, The Data-Driven Case for a Biopsychological Model in Value-based Care, on Thursday, October 21 at 3:00pm at Mandalay Bay in Las Vegas. &
National Comp — the National Workers’ Compensation and Disability Conference — is back! We’re planning an in-person show for October, 20-22, 2021 and we’re excited to see everyone while still adhering to all safety protocols set forth by local and national health authorities at the time of the event. Register today!
This year, we’ll feature seven tracks — from core content on medical and pharmaceutical management, claims and return-to-work, plus new and expanded avenues to explore like risk finance and injury prevention. All of our educational sessions are chosen for their ability to deliver sound takeaways and ideas that attendees can use right now.
In the meantime, National Comp will continue bringing you free virtual, educational content through our digital sessions series and our CompTalks program. Register today to make sure you don’t miss a digital session and check out our on-demand CompTalks library. Missed a session? Watch it here on-demand.