Remarkable technologies entering the market could radically transform claims management in workers’ compensation. These revolutionary innovations include natural language processing, virtual reality, cost-effective sensors, intricate reporting mechanisms, and especially artificial intelligence or AI.
Last week’s Leaders Speak article stressed the need to remain focused on patient outcomes while navigating the age of AI. Organizations must be careful not to fall prey to the “shiny object syndrome” by simply plugging in technology to solve a problem that isn’t even there. They need to carefully examine the technology’s ability to positively affect the company’s workflow and the patient’s outcomes.
Answering the important questions posed in last week’s article will help you determine if a particular technology indeed aligns with your mission. This week, we delve deep into the next three steps that can improve the implementation, and more importantly, adoption and user satisfaction with the AI tool.
Staying mindful of biases and their potential impact
When harnessing the power of AI, it is imperative to acknowledge and address the inherent issue of bias that can permeate its outcomes. The foundation for AI predictions rests upon the data it processes, underscoring the importance of curating a robust and representative dataset. Thus, the quality of the dataset used for training the AI engine directly influences the accuracy and fairness of the AI’s conclusions.
Just as our biases subtly influence the instructions given to children, biases that may be present in our training data also have the potential to infiltrate future results, leading to biased AI predictions. It then becomes paramount to remain cognizant of these biases and their potential impact on AI systems. And while complete eradication of bias is impossible, fostering awareness enables us to take proactive measures.
Furthermore, efforts should be dedicated to not only identifying biases but also mitigating their effects. Ensuring transparency and accountability in the AI development process is essential. It is incumbent upon developers to comprehensively assess their datasets, identify potential sources of bias, and implement corrective measures. By meticulously scrutinizing the training process and using curated synthetic data sets, companies can minimize unjust prejudices and bolster AI’s functionality.
Designing with the end user in mind and facilitating meaningful interaction
As with any new processes and technology, AI adoption often faces resistance, particularly among experienced professionals who believe their judgment supersedes automated systems. This is especially evident in the realm of workers’ compensation, where adjusters’ expertise is highly valued. Crafting AI solutions with the end users in mind then requires a thoughtful approach to overcome the initial skepticism and ensure meaningful adoption.
A strategy to encourage adoption is to design AI interactions that can dialogue with claims managers similar to the way adjusters consult with each other on complex cases. A well-designed AI can engage adjusters in a Q&A dynamic where context is supplemented and personalization is prioritized. Here, AI’s role is a collaborative one, allowing adjusters to query AI about predictive drivers for the injury, or request examples of similar cases to broaden their insights.
When claims managers can pose questions, refine queries, and draw on AI’s rich bank of information, AI becomes a conversational partner and a rich research resource instead of a mere prediction engine. This collaborative approach breaks down barriers to acceptance. Instead of replacing human expertise, AI complements it by taking that gut feeling adjusters develop over time, systemizing it, and scaling it.
Contextualizing outcomes as a supplementary tool
AI undoubtedly has the potential to serve as a valuable addition to our toolset, complementing existing interventions and enhancing the diligence and effectiveness of our operations. Its power lies in aggregating accumulated knowledge and insights to drive informed choices and decision-making.
All things considered, however, employing AI also demands a nuanced perspective. It’s crucial to avoid absolute judgments – AI isn’t inherently right or wrong. It is also neither the end-all and be-all nor a one-size-fits-all solution, and users must steer clear of blind adherence to AI-generated responses. After all, no two cases are exactly the same and results must be contextualized within the appropriate actions. Moreover, it’s important to break down informational silos within an organization and across stakeholders to improve communication and data-sharing in order to maximize results
Striking harmony between the use of AI and a patient-first ethos
Ultimately, the successful integration of AI within the workers’ compensation industry hinges on three crucial considerations that form the cornerstone of our approach: staying acutely mindful of biases and their potential impact on outcomes, designing solutions to foster meaningful interactions, and using AI-generated results as a supplementary tool in driving outcomes.
At the end of the day, our ethos is patient-first, not AI-first, and our primary purpose is to guide patients back to work safely post-injury. Remaining steadfast in this mission, however, should not preclude us from embracing transformative technologies. And as we navigate this new AI-driven landscape, our perspective should extend beyond mere technology adoption and more towards strategically employing AI to influence better outcomes across the patient journey.
Three Key Considerations for the Successful Integration of AI in Workers’ Comp. WorkCompWire.com, https://www.workcompwire.com/2023/09/sandip-chatterjee-three-key-considerations-for-the-successful-integration-of-ai-in-the-workers-compensation-industry/.
In the “age of AI,” how do we stay focused on our fundamental objectives and leverage technological advancements in achieving them?
Today’s rapidly advancing environment has introduced our industry to the wonders of groundbreaking technology such as artificial intelligence (AI), sensors, virtual reality (VR) headsets, and natural language processing (NLP) capabilities. These developments have grown so rapidly over the last few years that we find ourselves in what we could call “the age of AI,” presenting us with a multitude of opportunities for prediction, automation, and other tools.
But while these new technologies all promise to revolutionize how we do things, it’s important to never lose sight of our core purpose: patient recovery. Yes, these innovations present immense potential to improve patient care, but we must be careful not to fall victim to the “shiny object syndrome,” the allure of adopting the latest technology without a clear understanding of its alignment with our industry’s core mission.
Staying grounded in our collective mission and identifying opportunities for genuine improvement
The journey of patient recovery is central to every decision and strategy within the physical therapy (PT) industry and our core purpose should always be helping each patient safely return to work following an injury. With this in mind, we begin to look for areas where we can do things better and then look for tools that can help. It is from here that we take a pause and ask, “to what end?” Before embracing the next technological innovation, we must first understand if and how it enables patient compliance between treatments, measures progress in recovery, and promotes safe behaviors that prevent future injury.
Maximizing the value from insights
There is a wealth of data to be mined within the PT industry. We gather valuable information on providers, injuries, and treatment patterns from each case we manage. In addition to what we gather today, the PT industry is also inundated with numerous digital musculoskeletal solutions, each claiming to deliver unprecedented insights. However, regardless of the volume, data are of little use unless we are able to apply them to our purpose.
Technologies like NLP have made it easier to derive meaningful insights from vast volumes of data. Predictive AI models are helping us spot patterns across cases more quickly and, ultimately, make the right plays earlier on.
Aligning technology with the North Star of patient recovery
The vast expanse of technological innovation should always be navigated by our North Star: patient recovery. Will it enhance the patient’s experience? Does it have the potential to save us time and reduce costs? Can it bridge a significant gap or address a pain point that’s crippling the ability to provide effective and efficient care? Will it simplify a complex process or will its implementation only further complicate things?
Before embracing the latest trends, it is critical to meticulously evaluate any new “shiny object” against these questions.
While technological advancements offer incredible potential, they must always be deliberately aligned with the objective of improving patient outcomes. By staying grounded in the purpose of the workers’ compensation industry, we unlock the ability to leverage technology effectively and create a future where patient recovery remains at the forefront of every decision and strategy.
Navigating the Age of AI with Purpose. WorkCompWire.com, https://www.workcompwire.com/2023/09/sri-sridharan-navigating-the-age-of-ai-with-purpose/.
Here’s a hot take: claims management is a team sport, but for far too long, the players haven’t been able to huddle up. While claims administrators, networks, and providers each have access to troves of data, they have lacked a way to share insights in real time. The result has been incomplete passes, fumbles, and missed opportunities to identify risks early or improve outcomes.
Sports have long shown what becomes possible when teams work as units informed by data and insights. Today’s sports teams lean on big data and advanced analytics to better study their competitors and fine-tune their techniques and game plans. Need to predict the movement of the basketball team you’re up against? Data-tracking cameras at all angles of the court capture each player’s moves. Want to know how often a batter avoids being struck out at the plate? Studying the on-base percentage can help.
While training is key to performance improvement, data provides insights that create winning strategies and better decisions on the field. Feats that were once considered inconceivable or purely by chance become not only achievable but also routine thanks to collaboration and innovation.
In the world of claims, organizations will agree that there is one goal — optimizing patient outcomes. So, how can collaboration and innovation come to play to achieve winning results?
Leveraging new innovations
Claims outcomes are driven by several independent and dependent factors. These include independent factors such as the patient’s age, body part, nature/cause of injury, and psychosocial factors, along with dependent factors like treatment pathways and claim handling. It’s often observed that 20% of the claim drive 80% of overall cost. However, many of these claims actually start out simple but become severe and costly due to mismanagement and poor claim handling. Moreover, siloed approaches to treatment hinder the fast action required to manage these claims better.
Today, a new generation of digital technologies is changing the game for claims management. APIs and web services are the new cleats allowing seamless data-sharing at last. Predictive AI models are the coaching staff, trained to spot patterns and call the right plays. Customizable digital platforms are state-of-the-art stadiums, enabling collaboration when and where stakeholders need it most.
With physical therapy at the forefront of treatment, it’s only right that organizations use insights from physical therapy other than the actual treatment process. Today, AI-augmented clinical solutions can help in multiple ways.
Keeping in mind that not all patients are not the same, it’s important to assess each person for both physical and psychosocial factors that may affect their recovery. Physical therapists are well positioned to perform initial screenings and to monitor the development of any factors over the course of the claim.
They typically see the patient early in the claim and they have more one-on-one time with the injured employee than any other stakeholder. Frequent, continued involvement with the patient’s functional restoration gives physical therapists more opportunities to uncover hidden psychosocial factors, such as fear, anger, or unhappiness with their employer that may impact recovery.
When potential barriers to recovery uncovered by the therapist are fed into AI models trained on data sets and transformed into predictive insights, payers can detect which claims could veer off track. And when high-severity claims and possible setbacks are detected early on, appropriate resources can be assigned.
As treatment begins, AI models now also leverage enhanced digital and clinical solutions to monitor, measure, and provide actionable insights quickly so stakeholders can make better informed decisions. These insights along with direct, constant communication among all those involved in the claim, help identify additional opportunities to impact treatment and further drive improved claim outcomes.
This process also doesn’t stop once a patient has successfully recovered and returned to work. Data gathered from a closed claim can be compiled and used to benchmark against historical data and established clinical guidelines to fine-tune insights, potentially identify larger trends, and ultimately, improve the overall claim process and experience for the future.
Playing the long game
Sports have shown how far connected, data-driven teams can push the boundaries of achievement. Now, the world of claims is beginning to leverage its value. Instead of various stakeholders working in separate claims silos, the future of claims is a connected ecosystem where all parties work together as a team.
Emerging technologies are equipping providers, claims administrators, and managed networks to share meaningful insights instantaneously, identify complex cases ahead of time, determine optimal interventions, track progress, and achieve the outcomes that matter most to each client and patient. And the results are a homerun — reduced adjuster workload, reduced lost-time claim duration, improved financial outcomes, and the ability to focus on the 20% of claims driving 80% of the cost.
The truth is, in sports and claims, players can still win games, but it’s the combined power of data and collaboration that puts them in the best position to win championships.
Creating a Winning PT Program Through Data and Collaboration. WorkersCompensation.com, https://www.workerscompensation.com/expert-analysis/creating-a-winning-pt-program-through-data-and-collaboration/.
When we were young, most of us experienced all sorts of trips and falls. Whether it was from running too fast and stumbling over, a fun ride on playground equipment gone wrong, or a game with friends that got too rowdy, as kids, it was common to get scratches, sprains, breaks, and wounds. And while these were moments when we might have cried from pain, it didn’t take us too long until we were back on our feet ready to get back in action. But the ability to bounce right back up doesn’t last forever.
The Bureau of Labor Statistics estimates that 39% of the US workforce is expected to be older than 55 years of age by 2026. While studies show that older employees are generally injured less frequently than their younger colleagues, their injuries tend to be more severe and result in a longer time away from work. So, given an aging workplace and longer recovery times, what does this mean for employers?
Age increases total visits and durations
While there may be several factors at play, it doesn’t come as a shock that older adults tend to heal slower than younger people. This difference in recovery process can affect the rehabilitation journey in different ways.
A significant area of impact is the total number of physical therapy (PT) visits during an episode of care. Across all injury types, MedRisk’s data show that the number of PT visits attended by injured employees increases by about one full visit with each age group up through the 55-65 age bracket, where the average visits per episode of care remain consistent.
This means that injured employees aged 56-75+ need 21% more PT visits on average than those aged 18-55. Unsurprisingly, as the number of visits increases by age bracket, so too does duration. Data show that 31% of persons aged 56-75+ experience a longer rehabilitation process than those aged 18-55. Furthermore, while the number of visits remains fairly static in the higher age brackets, duration continues to increase with age.
Planning and acting with age in mind
As the number of total visits and duration trend higher for injured older adults, there’s obviously a domino effect. The longer these older adults take to recover, the more costly it becomes to rehabilitate and the longer it will take for them to return to work. Consequently, this can affect an organization’s operations, productivity, and bottom-line.
It now becomes increasingly more important for employers to take the necessary course of action to prevent injuries among the older workforce. One of the best ways to start is to prepare the spaces where older employees will spend a lot of time for safer functionality. From reviewing and rearranging the furniture and equipment layout to placing anti-slip mats and grip bars where needed, “age-proofing” the workplace will help lessen the probability of them getting injured at work.
Moreover, as more employers provide health and wellness benefits, they can encourage older employees to get moving. While engaging in low-impact, low-intensity activities does not mean their recovery will be as fast and smooth as it is for younger employees, physical activity certainly helps with overall balance and muscle strength.
Of course, even with preventative measures, accidents may still occur and older adults may still incur an injury in the workplace. In these cases, it’s important to have a PT partner that has clear clinical evidence-based guidelines which account for age. Based on these guidelines, they can make the appropriate, actionable recommendations from the outset, set clear expectations for the patient regarding their recovery journey, and, ultimately, ensure that the patient receives effective and efficient treatment.
A partner that can also score a claim’s potential long-term severity takes things even further. By taking into account claim, demographic, and medical data, such as the injury’s nature and cause, the patient’s age, and psychosocial factors, high-severity claims can be detected in the early stages and given the necessary attention to avoid going off track.
Effective care for age-specific recovery
While the expression that a person is “aging like a fine wine” might be common, there’s no denying that physical changes in the bodies of people as they age have a direct effect on their response to rehabilitation. With the US workforce expected to be significantly composed of older adults in the next few years, age in workers’ comp is quickly becoming a reality that organizations can no longer ignore.
And while getting these older injured adults back in action certainly won’t be as easy as it was when they were kids, arming yourself with the right knowledge, deploying preventative measures, and partnering with the right PT provider that can recommend the appropriate care for their age-specific needs can help smooth the process out.
The Growing Impact of Age on Rehabilitation: A Wake-Up Call for Employers. WorkersCompensation.com, https://www.workerscompensation.com/expert-analysis/the-growing-impact-of-age-on-rehabilitation-a-wake-up-call-for-employers/.
There’s a saying that goes, “To be early is to be on time, to be on time is to be too late.” You may see this as a hyperbole in many situations, but in the case of physical therapy, we might find that there is wisdom in the famous expression.
There’s no debate on physical therapy’s benefit to recovery for various musculoskeletal conditions. From neck, shoulder, back, hip, to knee injuries, PT has helped lower the number of cases requiring costly surgery and dangerous prescription drugs. It also brings down overall costs significantly. However, many of these benefits are still critically linked to one important thing — timing.
So, if it’s clearly crucial, how can we maximize the value of PT through timing?
Starting and educating early
PT is understood to be the first-line treatment for musculoskeletal injuries before considering addictive opioid prescriptions and invasive procedures. But researchers have also long agreed that there are significant benefits to starting physical therapy early – that is, within 14 days post-injury. According to a 2020 Workers Compensation Research Institute study, for workers with low back pain, early initiation of PT (as defined by WCRI) is associated with lower utilization, lower costs and a 42% decrease in the duration of temporary disability versus late post-injury PT. Moreover, decades of research have also shown that patients achieve better outcomes when they are treated in the acute stage (less than 6 weeks) compared to the chronic stage (more than 3 months).
To drive more positive patient outcomes, early access to PT and patient education must also go hand in hand. Studies show that an initial consultation with a PT provider may reduce overall healthcare utilization (e.g., opioid use) for patients seeking care. In this initial consultation, the PT can identify possible barriers to recovery — including psychosocial barriers — and can recommend the best course of action to mitigate them.
Because patients spend a great deal of time with their PT more than anyone else in the process, establishing a positive relationship between the patient and their therapist is also key. It’s one thing for PTs to deliver their advice but another if the patient truly receives and understands the intended message. PTs can use strategies like motivational interviewing, shared decision-making, and the prescription of simple, personalized exercises to make certain that patients hear and understand both their diagnosis and treatment plan.
Taking it a step further with early manual therapy
To further reap these benefits, practitioners are also seen shifting focus to one very specific type: manual therapy (MT).
A 2020 systematic review of randomized controlled trials updated a 2013 review exploring the value of MT among other interventions over the past several years. The 2020 review concludes by strongly recommending MT be integrated as an additional therapy. This supports earlier study results, which observed that patients who received only exercise (without MT) were 8 times more likely to experience a worsening disability compared to patients receiving exercise and MT treatment.
An initial study in 2021 from WCRI on MT for LBP claims also showed that the time temporary disability per claim was 22% shorter and the average indemnity payment per claim was 28% lower when workers received early MT compared with those receiving it later; a positive step towards more effective WC outcomes.
The utilization of early MT has also shown a positive impact on three key factors that impact case duration that happen to be traditionally difficult to tackle — patient age, surgical status, and case complexity. With early MT, some data show that patients between the age of 51 and 60 are discharged seven days sooner and those 61+, nine days sooner when they’ve received early MT. Following surgery, patients receiving early MT also require less treatment over a longer period of time than those who receive MT late in the episode. Furthermore, the use of early MT has proven to lead to fewer visits over a shorter duration for complex cases involving more than one ailment.
Timing is key for maximized PT benefits
In general, the growing use of PT has proven to be valuable as treatment for musculoskeletal injuries. But in order to truly maximize its value, organizations must support and encourage early intervention. Rather than waiting until a case gets serious and pain becomes chronic, utilizing PT early in the game allows for lower costs, better use of medical resources, and more optimal results in the most effective way possib
“How Timing is Key in the World of PT.” WorkersCompensation.com, https://www.workerscompensation.com/expert-analysis/how-timing-is-key-in-the-world-of-pt/.
It’s no surprise that the world we live in is ever-changing…
And yes, that includes even the world of claims and PT.
Each year, there are noticeable trends in the industry — trends that impact our day-to-day practices.
As we enter into the second half of 2023, have you taken note of the key trends shaping the future of our industry? Below, we list three trends that you need to know and more importantly, what you need to be doing about them.
As identified in our 2023 Industry Trends Report, here are the quick facts — keep scrolling if you want to learn more:
- An aging employee population. 39% of the U.S. workforce is expected to be older than 55 in 2026. Being that total PT visits increase by injured employee age, it’s increasingly more important for employers to take necessary measures to prevent injuries among the older workforce.
- Increased rates of anxiety and depression. With a significant jump in reported anxiety and/or depression among injured employees between 2019 and 2023, taking proactive steps to identify and manage psychosocial health conditions has become of the essence.
- Lower rates of surgery and opioid utilization. Only 16% of claims involving PT in 2022 were reported to have utilized surgery. With PT becoming a more widely accepted critical conservative care recommendation, a positive trend for claim costs and outcomes can be expected.
1. An aging employee population
While older employees get injured less frequently, it doesn’t come as a shock that older adults generally tend to heal slower than younger people. This difference in the recovery process can affect the rehabilitation journey in different ways — specifically in terms of total PT visits and duration.
Across all injury types, data shows that the number of PT visits attended by injured employees increases by about one full visit with each age group up through the 55-65 age bracket, where average visits per episode of care, remains consistent through the older population. What this means, however, is that persons aged 56-75+ need 21% more PT visits on average than persons aged 18-55. Unsurprisingly, MedRisk also found that while the number of visits increases by age bracket, so too does duration. Data shows that 31% of persons aged 56-75+ experience a longer rehabilitation process than those aged 18-55.
So what do you need to do? It’s now become essential to plan and act with age in mind. Start with arming yourself with the right knowledge and putting preventative measures to “age-proof” your workplace. Moreover, maximize new AI-driven PT innovations that can identify high severity claims early on to assign the appropriate resources for age-specific needs of older adults.
2. Increased rates of anxiety and depression
The COVID-19 pandemic has led to an increase in anxiety and depression among the general population. This is also true for workers who have been injured on the job.
Data reveals that 50% or more injured employees experience clinically-related depressive symptoms at some point, especially during the first month after the injury. These cases, when compared to those where these conditions were not reported, were also found to have 7% higher utilization than those who did not report these conditions
So how can you respond? Unlike bruises or lacerations, psychological setbacks tend to be invisible, but they can still derail recovery and claim progress, ultimately impacting claim outcomes. Partnering with the right PT provider that can help detect these early on is key. Pre-treatment consultation can provide predictive insights into a patient’s behavior, including any barriers or psychosocial issues that impact their recovery.
3. Lower rates of surgery and opioid utilization
There is a growing trend away from surgery and opioid use for workers’ compensation injuries. Prior to the coronavirus health pandemic, rates of surgery were already declining, with nearly one-quarter of all claims involving PT receiving surgery in 2015 compared to just 16% in 2022. This is due to a number of factors, including the high cost of surgery and opioids, the potential for addiction, and the availability of effective non-surgical treatments, such as physical therapy.
As a result of the trends mentioned above, there is an increased use of physical therapy for workers’ compensation injuries. Physical therapy can help workers recover more quickly and safely, and it can also help to reduce the cost of claims.
So what does this mean to you? With physical therapy playing a larger role in medical treatment and overall medical management costs, you can expect lower costs and shorter recovery times.