How Your PT Program can WIN with Data and Analytics

Jun 1, 2022 | Insights

If you ask anyone to explain the players’ role in any sport, the answer will probably be “score, of course!” But ask an award-winning coach and their answer will likely be different – the end goal is to win.

In the claims world, things are fairly similar. For many companies, the end goal is to get an injured worker back “on the field.” But companies with the best programs don’t stop there. Their goal is not just to get an employee through treatment and back on the job. The goal is to give quality care and effectively utilize available resources to get the employee back to work as soon as safely possible while keeping costs manageable…all while making strides toward better outcomes for the entire program.

With physical therapy playing a larger role in medical treatment and overall medical management costs, companies are already scoring in multiple ways. The number of cases requiring costly surgery and dangerous prescription drugs is going down. Recovery times are also trending in a positive direction. Across the board, physical therapy has paved the way for a better and quicker return to work journey for employees.

So, you might ask: if the shift towards physical therapy has enabled companies to score more in the short term, what does it take to win the big game? The answer? Data and analytics. Historically, a lot of the focus has mostly been on the cost of care. And while collecting data points on cost is pretty straightforward, the industry has evolved into a world where what was previously seen as “soft” savings from treatment quality and patient-centric care are becoming more tangible and as valuable as immediate discounts. To fully get there, companies must harness the power of hundreds of data points collected throughout a patient’s journey.

What does this look like? Here are examples of how you can use data and analytics before, during, and after treatment to help your PT program win.

Heading to the game with a plan

Whether it’s basketball, football, or tennis, players must come to the field prepared. The best athletes don’t just wake up and win championships. They seek the best coaches to get them in the best shape physically, mentally, and emotionally and to help them create a winning strategy.

To put this into a claim’s perspective, let’s take construction worker Mike as an example. While working on a project, Mike fell off a scaffolding and sustained injuries in his shoulder. Following the accident, his primary treating physician found that his injuries did not require any surgery and instead, initially prescribed six sessions of physical therapy.

Now, the easy way to score is to do a quick search of which provider is nearest to Mike and have him complete his sessions there. But winning requires a little more than this. The nearest provider may not necessarily be the right fit for Mike. To ensure that he gets the best care, a plan must be put in place even before Mike starts treating.

One effective strategy before sending an employee to treatment is having a consultation directly with the patient. Ideally, the consultation happens with a trained PT expert. In this call, the employee is asked baseline questions about their age, gender, location, injury severity, and chronicity. It’s also important to capture the employee’s psychosocial information at this stage, including their mental and emotional state, relationship with the employer, and their current disposition towards pain and returning to work. With this data, possible return to work barriers are identified and an employee is assigned an in-house risk score of low, moderate, or high. All these inform decisions on treatment. After all, injured workers spend more time with their physical therapist than anyone else, so it’s critical that they are assigned to a provider that best fits their needs.

In Mike’s case, the nearest provider two miles away might be the obvious choice. But if it was found that 35-year-old Mike incurred a rotator cuff injury and was experiencing depression and anxiety as a result of the injury, the best provider may perhaps be one that’s slightly farther but specializes in shoulder injuries. Another consideration is assigning Mike to a physical therapist he might feel the most comfortable with – say, someone of the same age, gender, or race. Moreover, additional data gathered from the consultation may also contribute to him being identified as a high-risk patient, informing the adjuster that this is a case that must be closely watched.

Keeping score and making continuous adjustments

Throughout a game, players are usually seen strategizing with their coaches. Based on how things are going, they evaluate whether to maintain the current strategy or if a change in play is required to move the game in their favor.

Similarly, it’s important to continuously monitor a claim and leverage data and analytics throughout treatment. By aggregating data and pulling key insights, you can employ a more effective, almost instantaneous information exchange across key players in a claim. Adjusters are given actionable insights, in the right format, at the right time so that they can make strategic decisions on what to do next. Employers or anyone looking at a claim from a broader view, on the other hand, are provided with a better picture of how a case is going and is predicted to go. This ensures things stay on track and, in cases where they don’t, additional resources are tapped.

Another effective method is comparing the status of a claim with similar cases and evidence-based clinical guidelines. Data from these cases and guidelines around comorbidities, psychosocial status, and other factors assist in predicting how long treatment will go and additional considerations that should be made. With the right information at their fingertips, a PT partner will be able to run an analysis not just within a particular employer, but across similar injuries, demographics, regions, and providers.

Going back to the example, since initial data has shown that Mike is a high-risk patient, the adjuster might decide to have a nurse case manager reach out to Mike periodically. This would allow close monitoring of his progress. If along the way, he has reached the recommended number of sessions based on clinical guidelines but is still not fully recovered, a clinical review could be triggered. In this peer-to-peer conversation, Mike’s treatment notes will be reviewed and possible actions to make his treatment more efficient can be planned.

Learning for what’s ahead

In most sports, winning one match or game isn’t the end of the story – elite performers want the championship. To continuously stay at the top of their game, players and their coaches take time to review their performance, identify winning plays, and recognize areas for improvement.

Once an individual case is closed, all data captured should be aggregated with data from other claims. From here, one can ask several questions. Was the outcome the same as what was expected? If it wasn’t, was there something unique about this patient? If so, is this something that should be factored in for future cases? What could be done to prevent incurring the same delays and additional costs?

Answers to these questions should feedback both to the predictive model and clinical guidelines, thereby helping teams get a better understanding of how an individual patient treats, paving the way for better predictions, and future-proofing strategy. Additionally, the data collected will give us insight into how providers in the network are doing. This allows us to ensure that providers are following clinical guidelines and providing the best quality of care.

As you gather more data from more claims, the more robust your data set becomes. And with your data and the right PT provider with proven clinical and industry experience, you can build a program that wins.

Getting an injured employee back to work through physical therapy gets you a point on the scoreboard, that’s for sure. But in a world that values not only immediate savings but also quality outcomes and patient-centric care, the industry must take things further. Leveraging data to inform strategy before, during, and after treatment, allows you to ensure that administered care is effective, both in cost and quality. And when you learn to plan ahead, keep score, and adjust your strategy based on learnings, you win.

“How Your PT Program Can Win with Data and Analytics.” WorkersCompensation.com, https://www.workerscompensation.com/news_read.php?id=41084.

Brian Peers: How Do You Keep Acute Pain from Becoming Chronic? Understand the Predictors.

Jun 1, 2022 | Insights

When you think about major health conditions affecting society, what comes to mind first? Cancer, diabetes, and heart disease all dominate the collective conversation, and rightfully so. They impact millions of people across the globe and have their own societies, awareness months, cereal sponsorships, celebrity spokespeople, and social media hashtags…the list goes on.

Chronic pain, however, is more prevalent than all three of these conditions combined. Perhaps it’s the pervasiveness or obtuse nature of the diagnosis that makes it a “sleeper pick” in the national conversation. Regardless, it’s a condition many in workers’ compensation know all too well.

Chronic musculoskeletal pain is the leading cause of disability, according to a recent study published in Physical Therapy. And people who try to keep working through pain say it reduces their productivity. Those with chronic joint pain estimate that they lose over two hours a week of productivity, and people with pain in multiple sites say they lose over nine hours a week.

Physical therapy should be part of any chronic pain patient’s regimen. It can relieve pain, increase mobility and flexibility, and guide patients to self-management techniques that work for them.

However, derailing chronic pain is a much better goal.

Preventing acute pain from transitioning into chronic pain has become a top research priority of the Federal Pain Research Strategy (US), prompting physical medicine researchers to analyze “predictors” of this transition.

What characteristics or circumstances indicate that an injured worker could develop chronic pain? Knowing these predictors empowers claims representatives and practitioners to get in front of it and deploy resources to block it.

Published in Pain Reports, the Framework for improving outcome prediction for acute to chronic low back pain transitions analyzed 20 previous studies that examined the transition of acute to chronic pain. Researchers combined the predictors identified in the earlier investigations and divided them into demographic, pain, health status, psychosocial, and individual context domains.

Authors noted some underrepresented predictors in the studies, including the health indicators of physical activity and sleep disturbance, along with alcohol, tobacco, and drug use. They strengthened social determinates of health, adding marital status, household size, and living arrangements to the demographic domain because emerging evidence points to their impact on chronic low back pain. Having Medicaid coverage was a predictor of poorer low back pain outcomes in one study and lower education and income levels decreased the positive effects of psychologically informed stratified care in another.

Since pain itself is a predictor, authors stressed the importance of the clinical history and covering things like the duration of pain, history of previous conditions, and the pain experience (anatomical location, severity, intensity, and impact). One study showed that multiple sites of pain can be predictive of poor low back pain outcomes.

In the psychosocial domain, authors stressed the need to capture negative mood and coping styles along with positive coping skills like self-efficacy and acceptance. They also recommended longitudinal monitoring, i.e., capturing time-varying factors, to track emerging psychosocial impacts.

The individual context domain refers to occupational factors, usually things like job satisfaction and perceived work stress. Framework authors recommended adding measures to capture the patient’s perceptions of receiving care, treatment preferences, and the expectation of having persistent pain.

Takeaways
Practitioners and researchers agree on the predictors of chronic pain, and the Framework research made great strides toward standardizing them. Standardization facilitates research and makes it easier to integrate predictors into electronic medical records.

However, claims representatives do not have to wait for integration to identify injured workers who are at risk of developing chronic pain because many predictive data points already reside in EMR systems. Data on previous conditions, weight, pain duration and location, drug, alcohol and tobacco use, along with anxiety and depression can be mined. Emerging predictors, such as marital and financial status and multiple pain sites could be added to screening tools to improve results.

Early and accurate predictions inform care decisions and drive the best use of healthcare resources early in the claim. For example, less resource-intense methods, such as telerehab and non-pharmacologic care, can be used on the low-risk claims. The high-risk ones need more treatment options and closer monitoring, possibly with nurse case management.

Arranging a consultation with a physical therapist who screens for psychosocial factors is a good starting point. During the consult, the therapist and patient discuss the injury, the pain, and its impact on their lives and ability to work. Consulting therapists also educate the injured worker on their condition, explain the mechanisms of pain and how it transitions to chronic, and help set expectations for physical therapy and relief.

The consultation report should flag barriers to recovery, especially psychosocial factors. Then claims representatives can deploy appropriate resources, such as cognitive behavioral therapy or psychologically informed physical therapy.

Keep in mind that the physical therapist is usually the provider on a claim who sees the injured worker most frequently and spends the most time with them on each visit. Therapists can be early identifiers of issues that cause pain to transition from acute to chronic.

Alternative medicine, acupuncture, and behavioral management therapy may be useful. In most cases, conservative care should be provided first, but some injured workers need injections, pain pumps, or surgical interventions to stop or reduce the pain. The same solution won’t work for everyone, and a nurse case manager can navigate different treatment options to find what works best for a specific injured worker.

While there’s always more to learn, here is what we already know:

• Early physical therapy and early manual therapy have the best outcomes (Workers Compensation Research Institute 2020,and  2021 studies.)
• An initial consult with physical therapist before therapy can have a positive impact on downstream healthcare utilization and is associated with reduced opioid use.
• Turning to physical therapybefore imaging and medication reduces the use of opioids, imaging, and surgery.
• Psychosocial factors are predictors of chronic pain. It’s important to screen for them and address them early and monitor for new ones as the claim continues.
• Patient education accelerates recovery, addresses many psychosocial factors, and has proven to be helpful in treating chronic low back pain.

Three Steps to Take to Prevent Acute Pain from Becoming Chronic

• Analyze portfolio for claims at high risk of acute-to-chronic pain transition. Closely monitor high-risk claims and strive to reduce or eliminate pain.
• Review and bolster screening tools to better identify predictors of chronic pain development, including negative mood and coping styles, perceived injustice, multiple pain sites, perception of persistent pain, and comorbidities along with marital and financial status.
• Invest in data analytics/predictive modeling technology and professionals or partner with companies who do.

There are many reasons that pain becomes chronic, including delayed treatment, the use of opioids, the intensity of the pain, provider choice, and psychosocial factors. Stopping acute pain from becoming chronic keeps injured workers from spiraling into a lifetime of pain and disability and saves workers’ compensation payers and the overall healthcare system billions of dollars a year.

“Brian Peers: How Do You Keep Acute Pain from Becoming Chronic? Understand the Predictors.” WorkCompWire, 4 Apr. 2022. https://www.workcompwire.com/2022/04/brian-peers-how-do-you-keep-acute-pain-from-becoming-chronic-understand-the-predictors/.