Add This to Your List of Work Comp Grievances – and Solve It!

2 months ago

Add This to Your List of Work Comp Grievances – and Solve It!

Add This to Your List of Work Comp Grievances – and Solve It!


By Michelle Despres, PT, CEAS II, REAS, CETS, Vice President of Product Management, One Call

We’ve all got it – that list of things that can easily annoy us throughout our daily lives. Rush hour traffic, telemarketers, slow wi-fi, dead cell phone batteries, long checkout lines, noisy neighbors. For many of us, the list is similar.

As a physical therapist and someone who’s spent more than 25 years in the worker’s compensation industry, there’s another one that’s high on my professional list – and it should be high on yours as well: injured worker care journeys that don’t result in desired outcomes.

There’s nothing more disheartening than seeing an injured worker hit roadblock after roadblock in their recovery journey, especially when those roadblocks could have been avoided.  

That’s why I’ve dedicated my career at One Call to building and incorporating key programmatic elements that prevent this from happening, such as clinical expertise, predictive analytics, and a biopsychosocial approach. At One Call, these three elements work together through our At-Risk Program to pinpoint and address injured workers at risk of experiencing delayed, stalled, or failed recoveries.

So, let’s break down each element to discover its potential impact.

Predictive Analytics

The number one challenge in preventing undesirable outcomes is identifying injured workers at risk of veering from their recovery plan early enough to develop and implement an intervention plan. These cases are often identified as problematic and at-risk only after a treatment plan exceeds the initial guidelines, and by then, it’s too late to reverse course. 

Sometimes, payers will invest in screening for injury types that tend to be problematic; however, this approach can result in an inaccurate assessment or under-count potentially problematic cases.

In reality, only a small subset of all cases need attention. The question is…which ones?

To solve this dilemma, it is important to develop an “early warning” system to identify these cases at inception, and proactively intervene.

Predictive analytics help to understand the characteristics of cases more likely to be prolonged and result in undesirable outcomes. The practice of deploying predictive analytics involves overlaying sophisticated algorithms onto claims and managed care data to quickly and accurately identify patterns and relationships – potentially altering clinical pathways and promoting faster, safer recovery for injured workers. 

Applied over multiple data points, predictive analytics can identify an at-risk injured worker and flag it at the onset of treatment. This enables the therapist to create a more proactive approach to their treatment plan.

Enter Clinical Expertise

Once a case is identified “at-risk,” it is important to have a team of clinical experts at the ready to institute intensive supervision, including additional scrutiny of the evaluation, rigorous and frequent reviews, and ongoing communication amongst all stakeholders. One Call’s clinical team informs stakeholders of an injured worker’s at-risk status, offers insight into the reasons, and provides possible alternative courses of treatment.

From there, our clinical experts facilitate peer-to-peer discussions with treating clinicians throughout the entire at-risk recovery journey to understand how the injured worker is progressing and proactively identify any potential barriers to a successful return-to-work.

Treat the Whole Person

So, you’ve identified an at-risk case – check. You have the right expertise on the case – check. Now, you must ensure you are treating the whole person vs. taking a biological-only approach.

Many factors in an injured worker’s life, which may be unrelated to physical health, can impact the speed, duration, and effectiveness of the injured worker’s recovery. Without tending to the psychosocial aspects of an injured worker’s life and health, recovery can be delayed or fail altogether. 

Some of the psychosocial factors that can influence recovery include:

  • Work demands  
  • Mental responsibilities
  • Work culture and community
  • Degree of control an injured worker has on the job
  • Quality of company leadership
  • Methods used by management to provide feedback
  • Social support amongst co-workers
  • Work stress

Throughout a comprehensive evaluation, an injured worker may complete a validated self-assessment questionnaire and be asked simple questions, such as:

  • How are you coping?
  • When do you think you’ll return to work?
  • How much do you worry that your pain will never get better?
  • Why do you think this happened to you?
  • What do you like about your work?

Once complete, the evaluation will outline potential psychosocial barriers to recovery, such as an inflated level of pain, a belief that recovery is impossible, permanent disability expectations, catastrophic thinking, opioid misuse, loss of physical fitness due to inactivity, a feeling of injustice, depression, and an absence of positive coping skills. 

Remedies for psychosocial barriers range from cognitive behavioral therapy to pain management techniques. Cognitive behavioral goals focus on envisioning the ability to manage despite ongoing pain, re-engaging in hobbies, reinforcing progress and achievements, and identifying and acquiring skills to overcome obstacles. 

Proven Results

When these three key elements work together, we have seen faster injured worker recoveries at a lower cost for payers. In fact, clients using One Call’s At-Risk Program have experienced up to a 30% reduction in utilization outliers, driving lower claim cost and duration.

 While our team of experts can’t ease your frustrations the next time you’re experiencing rush hour traffic, a long line at the grocery store, or slow wi-fi, we can help to keep your injured workers on a steady, seamless path to recovery.

Don’t let undesirable injured worker outcomes remain an unsolved grievance on your list. As an actively engaged partner, we are ready to successfully return your injured workers to work and life. 

Stay in touch! Subscribe to the One Call blog to get more updates like this, along with industry news. 

This article originally appeared in WorkCompWire.

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