Tag Archives: telemedicine

COVID-19 Will Put ‘Tele’ in a Lot More Than ‘Medicine’

In the early days of the internet, a professor at Northwestern’s Kellogg School of Management said something to me that’s been rattling around in my head ever since: “Once you can manage something by wire, it doesn’t matter how long the wire is.”

The professor, Mohan Sawhney, was referring in particular to the possibility of managing factories from a great distance, but his insight from the late 1990s describes so many other possibilities, too. Basically, once a process becomes digital, you can do it from anywhere — and COVID-19 is greatly accelerating the digitalization of insurance processes.

So, let’s ponder for a moment what has historically been done face-to-face that will now be done remotely. Lots has been written about the surge in telemedicine, and that’s certainly an important trend that seems likely to continue, but that’s just the start. Remote handling of claims and sales will get a big boost from our experience during the pandemic and, perhaps, fear of future ones. So will an area I hadn’t thought much about until recently: property inspections.

Telemedicine has dominated the “tele-” discussion for good reason. We’ve been social distancing for months now, but people still need medical care beyond COVID-19, and a lot have realized that a doctor doesn’t have to say, “Stick out your tongue, and say ‘aahhh,'” to diagnose and treat many issues. Telemedicine had already been proven as a concept. It was just being held back by regulatory issues such as how to license doctors communicating across state lines and by the sort of uncertainty that comes as any truly new approach is adopted. So, when COVID-19 demanded remote treatment, telemedicine was ready.

Telemedicine is so much more convenient for both doctors and patients that it will continue to grow, though I see it becoming an integrated part of healthcare rather than a separate form of care. A doctor can’t fully evaluate me remotely, but if tele-visits become part of my relationship with my primary care physician, they could remove any worries I might have while helping the doctor spot problems sooner than he or she would if we waited for my annual seven minutes in front of the doc. Similarly, telemedicine capabilities could be added to what on-site clinics offer at many bigger companies. Telemedicine is already starting to be done to triage injured workers. I can imagine plenty of uses in caring for mental health, even beyond what’s possible via phone hot lines; a sympathetic face can mean a lot. Elder care seems promising, too — just looking into a nonagenarian’s eyes and talking to him or her for a minute can tell you a lot. (My mother, who just turned 90, still beats most of us at bridge online, so I’m excluding her from the possible beneficiaries of any acuity assessment.)

(If you’re interested in reading more about the possibilities of telemedicine, this article from McKinsey is quite thorough.)

Claims have been getting attention, too, because they were already heading in a do-it-yourself direction before COVID-19, and the trend has picked up speed. I remember how radical it seemed when Robin Roberson founded WeGoLook and we helped her promote her network of thousands of “lookers,” who were dispersed around the country and could go take photos of damage, saving an insurer the cost of dispatching an adjustor. But who needs lookers now? Everyone has a camera and, guided by a remote expert — on as long a “wire” as you like — can document the damage without the need for a visit by an adjustor. Claims will keep getting more “tele-,” and probably quickly.

Sales have been slower to go remote. People do much of their research online but have still finalized an awful lot of contracts face-to-face. Not so much now. Avoiding handshakes and wearing masks has taken a lot of the magic out of in-person meetings, even when they’re allowed. And, now that sales can be done remotely, we’ll have to see just how remote they become. I have a feeling I won’t see nearly so many “Insurance” signs in strip malls any more.

Property inspections have already gone a bit “tele-.” It’s now possible to have a drone fly around a house and take photos of the exterior while providing exact measurements, without making a guy with a tape measure spend an hour crawling through the bushes and climbing onto the roof. But that seems to be just the beginning, partly thanks to COVID-19. Startups such as Flyreel are enabling DIY inspections: You walk around your home or apartment, documenting everything that’s there while the expert on the other end of the video call asks questions. “Are those countertops granite?” “Could you go a little closer to the wall; I need to see if that’s dry rot?” You not only save time by not having to dispatch an inspector but wind up with a precise, video record of the state of a property — “Sorry, but no, that couch wasn’t brand new….”

Brett Jurgens, who is the CEO at an interesting “smart home” startup called Notion (and who introduced me to Flyreel), speculated that DIY could move beyond inspections in a way that blends insurance and maintenance. Why would you have to call a plumber, for instance, when you might be able to just call one, show him or her the problem and ask for advice? How many other visits could be handled remotely, perhaps as part of some sort of subscription service? (Free idea, independent of insurance, for someone: Having killed my share of plants over the years, I’m betting some “plant doctor” could sell inexpensive subscriptions for remote monitoring and advice.)

I think that Jurgens is on to something and that, if we let our minds roam, we can imagine all sorts of possibilities for remote handling of processes, well beyond healthcare, that now just have to happen in person. And that’s without getting into the sort of internal realignment that companies in the insurance industry will go through as they decide how much work will be done in the office and how much can be done from home — another topic for another day.

Stay safe.

Paul

P.S. Here are the six articles I’d like to highlight from the past week:

4 Key Changes to WC From COVID-19

How companies respond to these changes in workers’ comp may determine their survival in a challenging economic environment.

How Startups Will Save Insurance

The evolution is unstoppable because innovation benefits both the insurance markets and the underlying consumer.

Is Insurance Office Going Away for Good?

Take this time to plan how to restructure your business. As things settle out, you need to have permanent adjustments ready to go.

PRIA: A Tale of Two Policyholders

An uncomfortable reality is that a TRIA-style “make available” requirement would separate policyholders into the haves and the have-nots.

Planning for the Unknown Unknowns

In the New Normal, you cannot do as you did in the old normal, just harder. You need a new approach to strategy.

Now Comes the Flood Season

We can’t expect collective, nationwide resilience to flood events without innovation from FEMA and decisive action from Congress.

Pain Management, Wellbeing in Pandemic

The COVID-19 pandemic has put an enormous strain on the healthcare system, delaying non-emergency medical care, potentially creating a higher risk for pain patients. However, the behavioral health community is adjusting with transitions to telemedicine and other alternatives that allow their patients to receive the care they need. With clinicians feeling additional stress during this time, telehealth options are readily available for the healthcare community, too. We cannot expect those working in healthcare to properly care for others unless we are prioritizing their mental health needs.

Two of the leading researchers and practitioners in pain medicine joined us for our special edition Out Front Ideas COVID-19 Briefing Webinar Series to discuss the challenges of treating pain patients during the pandemic and how the healthcare landscape is adapting:

  • Beth Darnall, PhD – pain psychologist and associate professor, Department of Anesthesiology, Perioperative and Pain Management at Stanford Health Care
  • Steven P. Stanos, DO – medical director of pain medicine and medical director of occupational medicine services at Seattle’s Swedish Health

Workplace Wellbeing

Due to the additional stress that the pandemic has created for healthcare workers, behavioral health psychology and counseling have become available in many primary care facilities. The behavioral health industry has a concierge of services that allow doctors to work with a therapist confidentially in a time of need. This “care for caregivers” model also includes Zoom-based videos and lectures covering helpful techniques like tai chi demonstrations, breathing exercises, guided meditations and chair yoga. These videos are then saved in an archive, making them readily available for later use when caregivers need them. While created to get through the stress of the pandemic, these videos will help to alleviate tension that healthcare workers face regularly.

Behavioral health, as well as many other clinical disciplines, had to rapidly adjust to telehealth visits, creating safer access for patients. Not only does this alleviate stress for the clinicians, it creates a safer workspace for clinicians and staff alike. In addition to the creation of video resources for the healthcare community, crisis management and wellness resources are available. Organizations like the American Psychological Association have created online resources that collate information for clinicians and administrative leaders, providing on-demand access when they need it most.

Patient Wellbeing

COVID-19 has created disruptions in all areas of our lives, but it has been especially challenging for those managing chronic pain. These patients are seeking stabilization in their lives, but continued disruptions have complicated their paths to wellness. These disruptions can compound mental and physical ailments for a pain patient, making it especially difficult for those with co-morbidities. The pandemic has exposed the vulnerability of opioid patients given the difficulty it has created for those who need access to medications. Some patients have requested options to taper off opioids or reduce their usage since the current environment may leave them feeling even less in control. 

Because patients are at the mercy of the elements currently, it is increasingly critical to use patient-centered communication. Many pain patients who were just beginning to develop regular schedules are now dealing with the stress from a lack of routine. Refreshing patients on skills learned through previous treatments may help create structure and give clinicians key insights into their at-home routines. Understanding a patient’s stress level can make medication refills easier because conditions like anxiety may be exacerbated currently, putting an opioid patient more at risk than usual. This continued communication will be key when there is a return to normalcy, to maintain consistency in the care of an injured worker.

Treating Pain During COVID-19

Accessibility is essential in treating pain patients throughout the pandemic. Nearly all visits have become telehealth visits, including psychological follow-ups and physical therapy. Behavioral medicine now offers options like individual or group sessions and on-demand treatments that can be used without a therapist. Immersive, experimental treatments, like virtual reality (VR), have created more engaging therapy for patients, putting control in their hands so they can get help when they need it. This portfolio of options, including internet-based treatments, creates readily accessible care for pain patients.

Patients who were involved in rehabilitative programs can now experience treatment virtually. The same content they would receive in-office, through physical therapy, pain education and relaxation training, can be delivered through courses a few days a week. A couple of options for these treatments include Zoom group visits or private YouTube videos, which comply with the Health Insurance Portability and Accountability Act (HIPAA). 

All of these virtual programs work to support the hospitals when they need it most. For those experiencing significant pain and those with co-morbidities, emergency procedure clinics are now open to avoid ER visits and waiting on an approval process through a hospital. These clinics help to reserve hospital capacity for patients who need it most during the pandemic. 

Current Research

The need for alternative treatments during the pandemic has created a wave of new research and guidelines for therapy. The National Institutes of Health (NIH) introduced the “Heal Initiative” to reduce opioid usage and awards grants for tools creating alternative pain management. One of those viable options includes VR, which has shown to be equivalent and sometimes even more effective than in-person pain therapy. These concepts retrain a patient’s brain and can optimize experiences based on biofeedback. This type of experimental treatment is especially helpful in areas where there are not enough trained clinicians to deal with those experiencing acute and chronic pain. As this technology gets increasingly cheaper, it will create better long-term tools for patients in need.

New guidelines created by the American Academy of Pain Medicine (AAPM) and the American Society of Regional Anesthesia (ASRA), in conjunction with Veterans Affairs (VA) and the Department of Defense, outline best practices for pain management during the pandemic. This document also addresses public health issues and the welfare of providers. It covers the potential issues surrounding telemedicine, explains how to treat opioid management, outlines mental health considerations for patients and healthcare providers and defines emergency procedures, like those associated with cancer patients. The document discusses emergency procedures for patients with poorly controlled pain that need opioids and how to help those experiencing withdrawals from use. The document also advises the use of acetaminophen to treat pain because the topic is still controversial in its interactions with the treatment of COVID-19. 

See also: Impact of COVID-19 on Workers’ Comp

While this period is transcending longstanding barriers now that on-demand care has been proven necessary, it is also important to continue assessing pain from a multidimensional perspective. This includes evaluating the risk for each patient, so in-person psychological evaluations are being used to treat the more symptomatic patients. Using resources like patient records and history to discern patients’ pain can provide insight into which patients may be more at risk. Though it may seem that telehealth visits could increase the risk of opioid abuse, there is no evidence on the extent of that risk when it is still the same patient reporting the same pain value, in-office or not. It is critical to take a patient’s reporting at face value and remember that pain will always be subjective.

To listen to the full Out Front Ideas with Kimberly and Mark webinar on this topic, click here. Stay tuned for more from the Out Front Ideas COVID-19 Briefing Webinar Series, every Tuesday in April. View the full list of coming topics here.

Evolving Health Tech Models in Work Comp

Technology is continuously changing the healthcare landscape. From reshaping ease of access to quality care to improving system efficiencies and interoperability, all aspects are reimagined. Telemedicine and digital health are disrupters that will continue to evolve on-demand solutions and care management significantly.

Three industry leaders from the Alliance of Women in Workers’ Compensation joined us on our most recent Out Front Ideas With Kimberly and Mark webinar to discuss the evolution of healthcare and its impact on workers’ compensation: 

  • Artemis Emslie – CEO of Cadence Rx
  • Dr. Melissa Burke – vice president and head of managed care and clinical at Amtrust Financial Services
  • Ann Schnure – vice president of telemedicine operations at Concentra

Healthcare Reimagined

Access to care has become increasingly on-demand with advances in telemedicine and telehealth. Consumers want to engage with their health more than ever, and these tools put access in the palm of their hands. But from a claims perspective, are workers’ compensation professionals encouraging this kind of engagement from injured workers? Are employers encouraging use throughout their staff? It is essential to consider how useful these tools can be in communicating with an injured worker and in creating healthy trends in the workforce.

Applying consumer data is integral to creating the best healthcare solutions because new healthcare models are personalized, predictive and preventive. Healthcare has historically been viewed as sick care, but, with healthcare becoming more holistic, it covers a range that also includes well care. The range of care has moved to a decentralized model that connects everyone, including, payers, service providers and healthcare providers. While this model provides an easier connection to meet the needs of users, it also makes systems more vulnerable. Because private health data is often the target of cyberattacks, security must be at the forefront of technology advances. 

Throughout all evolutions of health, it is essential to remember that health is human-centric. Technology applications should always be used for improving efficiency and accuracy, shifting how engaged consumers are with their health data.

See also: The Graveyard of Digital Health  

Skills Competition

When developing solutions to advance the needs within the workers’ compensation industry, are you considering what skill gives your company a competitive edge? There is a considerable lack of engagement with digital health in workers’ compensation. Its real-time data could provide critical insights into medication adherence and post-surgery recoveries, and opportunities for an injured worker to speak to a case manager or nurse. Using these digital health advances could alter the engagement for all parties involved in a claim and should be considered when developing a path for a return to work. 

Using our most crucial skills also means leveraging partnerships to develop the best solutions possible. One speaker noted that partnerships occur across all stakeholders, including our patients, and how we are engaging them. Start with the patient journey and then move outward to other stakeholders to keep your solution consumer-focused. Then proceed to use external resources, even engaging with your competitors, because not all solutions can be developed from within one resource.

The Investment Thesis

Investments in new health technologies should always focus on the ability to drive smart, connected devices, personalized healthcare and digitalized guidance and provide 24/7 accessibility to experts. Investors lean toward these ideas because they typically make consumers more engaged with their health. Understanding patterns in consumer behaviors, investors are also aware that technology that links to increased employer-sponsored benefits drives funding and more substantial deals. In 2019, one in three healthcare deals were within the digital space. Notably, women’s health and behavioral health technology earned significant investments last year. 

One of our guests spoke to the critical changes being driven by employers in healthcare, noting that venture capitals and angel funds are explicitly looking to invest in this field of evolution. Investors want to see a real impact on employees. Because blockchain technology protects user data, allowing the sharing of information in a trusted and safe environment, investors are also highly interested in this ever-expanding technology. Blockchain could be used to improve the patient/pharmacy experience and securely share data across a supply chain. 

Payer Perspectives

In creating healthcare solutions, it is imperative to understand the perspective of a workers’ compensation payer and how payers are incorporating healthcare technology into their business practices. One guest noted that the workers’ compensation industry should be incorporating technology and innovation into the foundation of our builds. We should be asking how we can do things differently from the beginning and bring a personalized approach to each injured employee. It is essential to balance these new technologies with human nature and match our resources with the right claim, using them to improve our processes.

Wearables, for example, can be used as a preventative measure and as a motivator. They can be used to stay connected and engaged with an injured employee and track progress. They can provide valuable data regarding who is most at risk in the workforce, or who is taking the necessary steps to prevent injury. Providing experts access to this data maintains relevancy to our goals, allowing a more personalized and aggressive approach to the care of an injured worker.

Mental health has also changed with telehealth and telemedicine, providing us with information on how it impacts a claim. Access to the most updated information on new drugs can provide critical data on drug interactions and reactions, allowing us to make the best decision for an injured employee and improve the outcome of a claim. 

Telemedicine Disruptor

Before the pandemic, telemedicine was viewed as an additional benefit of employer-provided healthcare. Now, there is an urgency to work through all the regulatory issues and make it widely available. There is now a paradigm shift from patients not feeling comfortable with telemedicine, to asking if it is an option, so they do not have to go into a doctor’s office and put themselves at risk. This increased demand is leading to the most dramatic shift in healthcare delivery history.

There are still many regulations on the delivery of care for an injured worker. Everyone in the industry should understand what is permissible in their jurisdictions in the workers’ compensation system to deliver appropriate care. For example, Washington DC regulations have shifted to allow telehealth care within a patient’s home instead of within a medical facility. These changes are part of a group of emergency responses that will expire on July 2, so industry professionals need to keep an eye on how these regulations will shift.

There have also been significant interests in providing telerehab and behavioral health services. With federal-, state- and workers’ compensation-level emergency regulations changing daily, we need to work with regulators to make sure these types of services are reimbursable. Additionally, some companies are offering examinations for quarantined employees so they can be screened before returning to work, ensuring the safety of all other employees, especially those in the essential sector. 

See also: Can We Thread the Needle on the Coronavirus?  

Will You Be the Disruptor or Disrupted?

As health and healthcare continue to be more consumer-centric, evaluate if your company is doing what it needs to create solutions consistently, or if it is becoming stagnant in a data-driven world. Is your model engaging injured workers to custom-fit their needs? Consider retooling your solution to enhance the consumer experience if it does not have customers’ interests in mind. 

As workflow barriers continue to decrease, especially amid the pandemic crisis, it provides more room for growth in technology. Advances in virtual tools and assistance will increase as the need for a telehealth model only increases for at-risk individuals. Most significantly, post-pandemic, expect to see increased requests for telemedicine technology, and requested changes in workers’ compensation regulations.

To listen to the full Out Front Ideas with Kimberly and Mark webinar on this topic, click here. Stay tuned for our special edition Out Front Ideas COVID-19 Briefing webinar series, every Tuesday in April. View the full list of coming topics here.

Tele-Triage Comes to Workers’ Comp

We are all familiar with the concept of nurse triage to help manage work-related injuries. A new telemedicine concept, doctor triage, takes the idea to the next level.

The telemedicine approach reduces costs, increases flexibility for both doctors and patients and allows for consultations 24 hours a day. Patients speak with board-certified physicians who determine if self-care, emergency room or clinic visits are appropriate and do so more authoritatively than is possible with nurse triage. Early results from our own Doctor Now program find that 99% of the people who were recommended for self-care returned to work without additional treatment. Part of the reason appears to be that, among those who speak with a doctor, self-care recommendations are followed more often.

Doctor triage is part of the growing trend in enhancing telemedicine programs. The number of patients using telemedicine services increased to 7 million in 2018, up from less than 350,000 in 2013. In 2017, about 70% of employers offered telemedicine services as an employee benefit.

Telepresence combined with telemedicine creates saving not just in direct costs for treatment but also in indirect costs. In the U.S., the average total time for a medical visit is 121 minutes, with a minimum travel time of 37 minutes. The average clinic visit is 84 minutes, and the average emergency room visit is two hours, often extending well beyond. Most of the time is not spent with the physician but is spent waiting to see the doctor. By contrast, the average telemedicine visit takes 15 minutes (including wait time); the average time for a doctor triage call is less than 7 minutes.

Adults in the U.S. spent 1.1 billion hours of unnecessary time traveling and waiting for a doctor last year, resulting in additional costs of lost productivity and lost time from work.

Workers’ comp is an area that still remains very much uncharted for telemedicine, and that needs to change. Our young Doctor Now virtual clinic shows the potential. Looking at recent doctor triage sessions: 61% of the calls were for self- care, and 99% of those callers agreed to the self- care and returned to work. Only one person was referred to the emergency room for chest pains. Others were referred to clinics for evaluation and treatment of eye injuries, fractures, lacerations, etc. All received appropriate care, and most returned to work in some capacity.  

The tele-triage approach is especially valuable for those who use our electrodiagnostic functional assessment (EFA). Employers use it to screen employees when they join a company, to establish an objective baseline on physical condition and abilities that can be used as the basis for comparison when an injury occurs — the baseline and comparison let everyone see whether a work incident caused dysfunction, and the baseline provides a goal for treatment.

With EFA, a truck driver who feels he or she sustained a back at injury at work could simply pull to the side of the road and call the 24/7 clinic line. If no emergency care is needed, and there is a baseline EFA for the body part in question, the triage doctor can schedule a second EFA, sometimes for the same day. The triage doctor can also recommend self-care.

If there is no baseline EFA and there needs to be an additional evaluation outside of the triage, a virtual clinic evaluation can be arranged, typically within the hour. The individual can be seen while still at work or in the comfort of his or her home.

Virtual clinic visits offer the injured worker specific analysis; treatment often leads to full-duty release within four visits. Virtual clinic evaluations are typically $150 each. Therefore, with simple musculoskeletal disorders (MSD), a full-duty work release can be obtained for under $1,000, with no narcotics prescribed — telemedicine doctors are not allowed to prescribe narcotics. This is truly a good outcome for everyone.

Even in a state where the employer must give the employee a panel of doctors to choose from, the virtual clinic is one option presented to the employee, along with other panel providers. Insurance carriers are embracing this concept and adding the specialized virtual clinic providers to their panel.

New telemedicine services improve outcomes for not only employees but employers. The return-to-work results and cost savings for employers are dramatic, but the outcome for workers is even better: improved quality of life.

Telemedicine: Last Frontier for WC?

Telemedicine makes it possible for injured employees to reach a qualified clinician from home or the worksite, providing a promising alternative that ensures early treatment. In a session at the RIMS 2019 Conference and Exhibition, panelists discussed how technology can improve efforts to manage an injured employee’s healthcare experience.

Speakers included:

  • Ann Schnure, vice president of telemedicine operations, Concentra
  • Janine Kral, vice president, risk management, Nordstrom

Every state has adopted telemedicine in some form, with an increasing number accepting telemedicine for workers’ compensation, but many companies and individuals have been slow to adopt. In the past few years, however, adoption and usage have grown significantly. In addition, over 75% of health delivery organizations, like physician groups and hospitals, use or plan to use telemedicine soon. 80% of larger employers use telemedicine, and that number is expected to jump to over 90% in 2019.

Telemedicine Usage for Workers’ Compensation

The first thing to remember where workers’ compensation is concerned is that there are no federal regulations for telemedicine. Each state has its own medical board that regulates medical rules. For workers’ compensation claims, wherever the patient is when the person needs to see a doctor, that state’s medical rules will apply, regardless of where the patient lives or where the accident took place.

See also: The State of Workers’ Compensation  

There are some differences between telemedicine for group health and telemedicine for workers’ compensation. State workers’ compensation divisions provide additional oversight. Billing and reimbursement are also different. Rates vary widely between group health programs but follow standard billing and reimbursement procedures for workers’ comp. Despite these differences, patients report high satisfaction with their telemedicine experience. A robust communication and rollout plan is required to facilitate awareness and use.

Use Cases for Telemedicine in Workers’ Compensation

Telemedicine is not right for all workplace injuries but can be effective for certain situations. It can be used for minor injury visits, recheck visits, telerehab, specialty visits (dermatology, behavioral health) and pathogen exposure counseling/treatment. For these situations, telemedicine can eliminate travel to a provider, bring care to geographically dispersed workforces in remote locations and provide after-hours injury care.

Injuries appropriate for a telemedicine visit could include strains, sprains, contusions, abrasions, simple burns or occupational dermatitis. Telemedicine can be a option for up to 60% of rechecks, regardless of the initial injury type.

Implementing a Successful Program

One of the first things to consider in implementing a telemedicine program is choosing a model to use. There are several options to choose from, including Triage Only, Recheck Only, One-and-Done and Comprehensive. These models all vary in their use of occupational medical experts/generalists, phone/video and scope/continuity of care.

  • Triage Only is widely accepted, limited in scope and uses either phone or video.
  • Recheck Only requires the patient to first get in-person care. This model may or may not maintain continuity of care and typically uses video.
  • One-and-Done is typically staffed by a generalist, provides no continuity for follow-up care and could use phone or video.
  • Comprehensive models offer occupational medical experts. The patient can begin and continue with telemedicine, and these models use video for full treatment.

See also: How Telemedicine, AI Are Transforming Care  

Other items to consider include the technology and equipment needed, what the workflow will look like, the experience of the provider and communication between the employer and other stakeholders.

Telemedicine may not be right for every situation and will not affect spending on catastrophic claims but can provide several benefits for employers handling smaller workers’ compensation injuries.