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These 6 Use Cases Demonstrate Why It’s Not About Telemedicine, It’s About TeleHEALTH

Doctor visits represent just one corner of the world of health care. Payers should utilize technology to bring broader services to their injured workers.
By: | November 7, 2018 • 9 min read

Telemedicine has been touted as a way to bring the doctor’s office right into your living room, cutting out wait times and increasing the likelihood that injured workers actually keep their appointments. In workers’ compensation, that means lower cost of care for injured workers without compromising clinical outcomes. But telemedicine is limited to a sliver of clinical services that fall under the broad category of healthcare.

“From a public perspective, telemedicine typically refers to traditional physician or nursing led services; however telehealth is more comprehensive than that. The delivery of healthcare through technology needs to be holistic, and there are no fundamental differences when it comes to the care of injured workers,” said Sean Sullivan, senior director of product management, One Call.

Workers’ comp payers should be thinking about telehealth.

Telehealth includes a diverse set of healthcare services, of which telemedicine is only one example. Clinically effective telehealth services include things like physical therapy, patient monitoring, behavioral health, pain management, new hire baseline testing and even supplemental language translation.

“Telehealth offers the opportunity to put a broad spectrum of offerings at injured workers’ fingertips, so they can access the type of care they need, when and where they need it,” Sullivan said. “At the end of the day, it’s the connection of an injured worker to a critical healthcare service made available through technology to advance the outcome—and that can happen in multiple ways.”

The key to optimizing claim outcomes is by providing an integrated and centralized access point that connects the dots between telehealth tools and traditional care offerings. This allows payers and injured workers to avoid many complications that impede medical progress and return-to-work. When injuries are treated in a siloed vacuum that does not effectively communicate on the big picture, opportunities to use a telehealth solution or enhance the outcome can be entirely missed.

The following six use cases demonstrate how an integrated telehealth strategy can improve outcomes for injured workers:

#1: Pain management and opioid reduction

Sean Sullivan, Senior Director of Product Management, One Call

A 45-year-old injured worker who suffered a lower back injury at work is in for his 15th physical therapy visit, but he reports that his pain is not improving. Even with his daily opioid prescription of 20mg Hydrocodone, he says his pain is at a level 8 out of 10.

“While this situation is unfortunately not uncommon, there are opportunities for workers’ compensation payers today to connect the dots – driving telehealth solution identification that extends beyond a painkiller and physical therapy to help guide this injured worker back to recovery,” Sullivan said.

In this case, data analytics programs can be layered into a medical services network capable of collecting and responding to information sourced from claim files or objective physical therapy provider reporting. This information can be processed to identify red flags such as symptom magnification, fear avoidant behaviors, or non-compliance, as examples.

“When more individualized pain management is needed, a dynamic suite of telehealth solutions can be presented to payers based on clinical utility, cost and convenience,” Sullivan said.

An integrated telehealth solution can bring high quality clinic-style pain management consultations or behavioral health support directly to that injured worker via video or telephonic conferencing. “Telehealth solutions geared toward preventing and reducing the incidence of pain are going to make a measurable impact on reducing opioid overuse and abuse in America,” Sullivan said.

#2: Compliance and engagement

Fatalistic attitudes, frustration and fear can all prevent an injured worker from fully committing to their recovery plan.

“Injured workers might fear they’ll never return to their full functionality, and they’re afraid of returning to work and getting injured again. Or they start to feel identified by their injury and can’t find the motivation to heal. They can become depressed and disengage,” Sullivan said. “As someone who has treated many injured workers directly as an occupational therapist, I have heard these types of statements go frequently unaddressed.”

Connecting virtually with a licensed psychologist or qualified behavioral health provider can help bridge the gap for injured workers to overcome the behavioral and emotional barriers preventing them from recovering and returning to work. Knocking down those barriers with a highly patient-centric approach will drive positive outcomes across the board. The convenience and immediacy of the service removes the feeling that it’s yet one more obligation to fulfill on the part of the injured worker.

#3: Rehabilitation

Physical therapy is a vital component of many recovery care plans, but depending on the severity of the injury, not every encounter needs to be in-person. Having to travel to a brick and mortar location, especially while dealing with pain, may create unnecessary stress for the injured worker.

The convenience factor can’t be discredited either. As an example, claimants can find the hassle of coordinating child care, traveling in inclement weather, or the limited hours of traditional service providers to be one of the challenges virtual physical therapy, known as telerehab, can solve.

Telerehab makes physical therapists accessible to injured workers at their home or workplace through live video conferencing. Quality telerehab providers receive specialized training to evaluate and deliver precision treatment that provides relief, improves function and gives the injured worker confidence that he or she can successfully resume normal job duties. Telerehab encompass a range of clinical rehabilitation services including initial assessment, monitoring, intervention, education and prevention of re-injury. Having a virtual option can increase an injured worker’s choice, program compliance and can speed up return-to-work timelines.

#4: Telemedicine

Telemedicine can be utilized for a range of physician-led services, including initial injury treatment, specialty consultations and follow-up care.

“Instead of driving or coordinating transport to the doctor, the injured worker can just pick up their smartphone and have the same discussion at the same dedicated appointment time, depending on their condition,” Sullivan said. The same applies for specialty services like orthopedic follow-ups or consultations. Patient records, including diagnostic imaging can be securely shared on compliant telemedicine platforms. This allows best-in-class clinicians to share recommendations with claimants who would have otherwise been limited in terms of who they can see and talk to due to geographic proximity. This connectivity to qualified and specialized providers can help shorten recovery timelines and avoid non-essential procedures from being authorized.

Telemedicine is what most people think of when it comes to telehealth, and it is a vital component of an overall telehealth strategy. But it’s important to remember that it can be complemented by several other services.

#5: Baseline Testing

“Employers are dealing with an aging workforce, a more sedentary young workforce, high incidence of back pain, more arthritis and overall declining joint mobility of workers,” Sullivan said. “Not everyone getting hired today has full health in their joints. That matters because workers’ compensation treatment plans and impairment ratings are often based on loss of joint mobility and function caused by the workplace injury. How do workers’ compensation payers know the extent to which they are responsible for restoring joint health in a claimant if they never established a baseline for that worker when he or she started working?”

To illustrate the importance of collecting baseline data, care plans for workers’ compensation musculoskeletal injury are commonly built to return workers to a baseline or maximum medical improvement regarding joint function. Often, the unaffected limb is used as a baseline. If no accurate and individualized baseline is established, providers may keep ordering more treatment in an attempt to improve the injured workers condition further beyond their pre-injury status.

“We can send a medical-grade wearable device to a workplace for almost no cost. A new hire wears the device on their limbs, and it will measure and record the objective performance of their joint mobility over a few minute test. That data is kept confidential from an employer in a HIPAA secured location. If that employee gets hurt, we can pull the report the device generated and establish a more reliable treatment objective. Wearable and baseline testing is a fast moving industry and there are several solutions in the marketplace moving the needle when it comes to telehealth enabled physical evaluations,” Sullivan said.

#6: Translation

Individuals that speak English as a second language are categorically disadvantaged when it comes to accessing healthcare in the U.S. Getting solid translation services at medical appointments, including telehealth services has remained a challenge until recent advancements. Technology enabled translation services provide on-demand access to interpretation services in a fraction of the time and cost it used to take to coordinate onsite providers. This technology can be integrated within the continuum of care services from devices housed in urgent care centers to the various telehealth solutions in the marketplace.

“Clear communication between injured workers and providers is absolutely critical to ensure treatment makes sense and is being adhered to,” Sullivan said. “Affordable and competent translation services must supplement any clinical service for a non-English speaking claimant to facilitate a better outcome.”

A Diverse, Patient-Centric Solution

Expanding the perception of telehealth beyond telemedicine provides more flexibility for injured workers and improves access to a diverse set of health care services. Adopting a comprehensive telehealth strategy truly puts the injured worker at the center of the care plan.

“The diversity that One Call can bring to the table is the crux of an effective telehealth strategy,” Sullivan said. “We are the only organization that can effectively coordinate these services in unison due to our robust footprint and commitment to clinical excellence. Any telehealth service that a payer authorizes will ultimately be available to injured workers through a single sign-on portal. For payers, it’s an improved level of confidence that no matter the need of an injured worker, One Call can coordinate it.”

Integration and coordination of services through a single network will bring a natural reduction in administrative, medical and indemnity costs to workers’ compensation payers. “A true telehealth strategy is a win-win; a driver of better clinical outcomes for workers and better cost and utilization outcomes for payers. At One Call, we are continually working to deliver on those principles.”

For more information and the latest news, visit onecallcm.comLinkedIn (One Call) and Twitter (@onecallcm).

 

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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 One Call. The editorial staff of Risk & Insurance had no role in its preparation.




One Call is the nation’s leading provider of specialized solutions to the workers’ compensation industry. One Call’s solutions enable faster, more efficient and more cost-effective claims resolution with a focus on injured workers’ needs across the continuum of care.

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.

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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.

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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?

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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.

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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 an 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.

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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]