It’s Not About Telemedicine, It’s About TeleHEALTH
We recently partnered with Risk & Insurance on an article about the broad spectrum of services that is telehealth. Sean Sullivan, senior director of product management, breaks it down with six use cases. Read the full article below or on Risk & Insurance’s website.
Doctor visits represent just one corner of the world of health care. Payers should utilize technology to bring broader services to their injured workers.
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
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.
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 childcare, 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 encompasses 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.
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.
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.”