In under two minutes, join Brian Peers, MedRisk’s VP for Clinical Services, for Momentum where we discuss:
• Why surgical rates are down;
• The movement towards conservative care for minor injuries; and
• The impact of less surgical cases on resource utilization.
In under two minutes, join Brian Peers, MedRisk’s VP for Clinical Services, for Momentum where we discuss:
• Promoting health literacy;
• Why the words we say to patients matter; and
• How to arm patients with the right terms to assist their own research.
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.
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.”
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.”
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.”
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/.
I started at MedRisk in the Provider Relations Inquiry department (now called CIT) as a temporary employee in November 2013. I became a permanent employee of MedRisk in March 2014. Shortly after, I became an Account Representative, helping to support our executive account management team and valued customers. During this time, I became more involved with a variety of client facing projects and meetings. I learned a lot about the organization as a whole and became more familiar with reporting and analytics. This made my transition into the IT world a little easier. In July 2015 I moved into a position as a Junior Process Engineer. I was able to build on my knowledge of the business from a more technical standpoint. I began looking more in-depth into processes and workflows. Ultimately, this opened up the door for me to move into the Supervisor of Data Analytics role and most recently the Manager of Data Analytics position. Each position I have held with MedRisk enabled me to continue to learn and grow within the organization. Experiencing multiple departments including operations, account management and IT has made me well-versed and given me the ability to continue to develop in my career.
When I was first hired it was the IT department's uniquely collaborative atmosphere that initially struck me. I felt welcomed. Every office door was wide open. There were groups of people writing on walls and exchanging ideas. Within that first month, our Director and CIO voluntarily stayed late with us while we tackled an urgent project. These demonstrations of teamwork resonated. I found this same collaborative spirit permeating throughout the entire organization when I was asked to supervise the Help Desk after my first year. We felt supported. I cannot stress how crucial MedRisk's, "we're-in-this-together" approach was to my team's overall success. I became a System Administrator two years later, a position I'd been working towards for my entire adult life. As rewarding as that is, it's the environment that fosters these uncontrived relationships I’ve built with colleagues and friends that makes it fulfilling. The first time I met our CEO she gave me an enthusiastic hug and thanked me for joining the team – even before asking me who I was or what I did!
Throughout the last 4 and a half years, MedRisk has provided me more opportunities than I could have imagined. I first stepped through these doors to begin my professional journey in a temp to perm role as an Advocate Admin. Not long after, I was promoted to a Customer Advocate. Along the way, I have built many relationships with our clients as I served as their go-to for providing status updates on their claimants’ treatment. Later that year, I was able to get more involved in the department as a Senior Customer Advocate by assisting with our Customer Advocate Support inbox and helping my co-workers as needed. One year after I started my permanent position, I was given the opportunity to step into a leadership role taking on a Team Lead position in Advocacy. I continued to further develop the necessary skills to be an efficient leader while managing a team of about 10-15 Advocates. Shortly thereafter, I was offered the position of Assistant Supervisor and within a couple of months was promoted to an Advocacy Supervisor. I spent about two years in the Supervisor role while leading a group consisting of Team Leads and Advocates. Last year, I was given the opportunity to transition into a Senior Supervisor position for the Advocacy Program which helped to further develop my leadership skills. I am thrilled to say that I have now transferred to the Human Resources department and have started a new role as a Human Resources Generalist. Although I have decided to go down a different path, I am looking forward to continuing my profession with this company. I can’t thank MedRisk and my managers enough for their continued support and assistance throughout my career.
