Apr 25, 2024 | Insights
Early PT can be the key to improved injured worker outcomes and lower claims costs. How can workers’ comp promote quicker access to care?
Any sports fan can probably recall a moment when they saw a professional athlete get injured on the field. A wide receiver limps off the field grabbing his hamstring. A basketball player sprains his ankle. An outfielder nurses his shoulder on the way to the dugout.
For common musculoskeletal sprains, strains and similar injuries, athletes will be in PT almost as soon as they’re off the court — getting them back to full health and function will be top priority for their teams.
That immediate access to PT has proven results, and it’s caused some in the workers’ compensation industry to wonder what would happen if injured workers got that kind of care. After all, a professional athlete is also just a worker doing a job.
“What’s the difference for an industrial athlete that is working in a coal mine and a professional athlete that’s on a football field?” said Greg Nichols, PT, president of SPNet, a division of MedRisk. “They’re still trying to make a living for their family.”
A growing body of evidence suggests that fast and direct access to PT improves outcomes for injured workers and can reduce claims costs. Now, new technologies are helping payers and their PT partners catch potential claims hurdles earlier and improving communication throughout the workers’ comp process.
A Growing Emphasis on Early Access to PT
Greg Nichols, President of SPNet, A MedRisk company.
The broader U.S. health care system has long known the benefits of early PT. A study from the U.S. Department of Defense found that seeing a physical therapist resulted in $3.6 million in reduced medical spending and improved patient outcomes.
“There’s this accumulation of evidence that points towards the benefits of starting the rehab process early,” said Brian Peers, DPT, MBA, vice president of provider management and clinical services at MedRisk.
“It seems to be independent of the body part, the age, the job type, the type of injury, the severity. Across the board, earlier access to rehabilitation is translating to better outcomes — not just clinically but also as far as the claim outcome goes.”
Other studies have found that PT can reduce costs and improve outcomes for a variety of common workers’ compensation injuries. MedRisk’s 2024 trend report found that when PT is used over alternative treatments, payers can see $39,533 in net economic savings for carpal tunnel and $4,160 for low back pain.
The key here: direct patient access. Rather than seeing a primary care physician or a chiropractor first, patients went directly to a PT, as many patients in the Department of Defense study had immediate access to a PT, much like a professional athlete. They didn’t spend time seeing other providers or working through the workers’ compensation system.
Simply put: “If someone needs physical rehabilitation, let’s get them in physical rehabilitation as soon as we can,” Peers said.
Access to quick and conservative medical care like physical therapy is obviously important to improving claims outcomes. Workers’ comp payers and providers need to work together to get injured workers the care they need. Yet speed-to-care in workers’ comp has only increased by about 2% over the past 10 years, per MedRisk’s 2024 injury trends report.
“If the injured worker is struggling to enter into the medical ecosystem, we’ve got to create another entry point somewhere,” Nichols said. “If we don’t have clear channels of communication with these injured workers, then we’re dropping the ball.”
How Does Early PT Drive Improved Patient Outcomes?
Brian Peers, DPT, MBA, Vice President of Provider Management and Clinical Services, MedRisk
In order to get the workers’ compensation industry to embrace early access to PT, it needs to understand the benefits. The studies are clear. “We’re seeing people getting back to work faster. We’re seeing lower expense for the claim overall,” Peers said — but it’s important to know why that’s the case.
So, why is early PT so critical to driving positive claims outcomes?
One component is physical. Early access to care can prevent injuries from getting worse and requiring surgery or other costly treatments down the road. “We want to get these folks started as early as we can because we know that the outcomes will be better,” Peers said.
But the benefits of early PT go beyond physical health improvements. Physical therapists spend significant amounts of time with injured workers. They can detect changes in mood, like depression or anxiety, or flag other biopsychosocial factors that could influence a claim before it derails recovery and drives up costs.
“What we’re starting to learn about is the value of the interaction between the PT provider and the claimant to pick up on barriers that might exist but are buried underneath the surface,” Peers said.
New technologies are helping PTs share these insights with adjusters and other stakeholders; data-driven models are helping to process the information and create recovery models to help predict claim progress. All these factors contribute to quicker return-to-work timelines and lower claims costs.
“TPAs had a bunch of information regarding a claimant, and it would have been great if we were passing that information on to the PT provider early,” said Skip Brechtel, executive vice president of strategic partnerships, CCMSI.
“Clinicians were gleaning all of this information, literally talking to the claimant significantly more in the early stages than an adjuster does. Having that information enhances what we can do to better move along in that claim.”
A Collaborative, Data-Driven Approach
Skip Brechtel, Executive Vice President of Strategic Partnerships, CCMSI
The benefits of early PT — for patient outcomes, for claims costs — are unambiguous. Injured workers get the treatment they need sooner and claims costs are reduced.
MedRisk has long been a leader in providing workers’ compensation PT services. Last year, the company treated over half a million injured workers, and 90% of workers’ comp payers choose MedRisk for managed PT services.
The company has invested in a number of innovative tools to help capture and process claims data so providers and adjusters can effectively use it to drive recovery. Its tools can help process unstructured claims data, like the data gleaned from interviews, so it can be processed and used to drive better recovery outcomes.
“It takes all these things and it scores the claim,” Brechtel said. “You’re capturing significantly more information on that claimant.”
Most important of all, MedRisk understands that workers’ comp is a collaborative business with many stakeholders. It understands the importance of working with health care providers, insurers and other stakeholders to ensure the best possible care for injured workers.
“One party can’t do it alone,” Brechtel said. “It’s got to be all three working in unison.
All in all, MedRisk helps injured workers get the physical therapy they need, when they need it.
“We have a lot of musculoskeletal injuries,” Peers said. “We have this mounting data that’s getting better at predicting who needs what and when, and what’s effective and what’s not working. But we still, as an industry, have to get better at delivering the right care to the right person at the right time to get these outcomes.”
Oct 3, 2023 | Insights
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/.
Oct 3, 2023 | Insights
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/.
Oct 3, 2023 | Insights
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/.
Oct 3, 2023 | Insights
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/.
Oct 3, 2023 | Insights
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/.
