Tag Archives: virtual reality

Why Some Workers Don’t Heal

It’s well-known in workers’ compensation that 20% of cases account for 80% of costs. It’s been a mystery why four out of five cases progress fairly routinely, and why that fifth one is an outlier. Struggling to find the answer, we’ve continued to do versions of the same things over and over again for these patients, without success – the very definition of frustration and insanity. If it were easy to define who the 20% of patients were, we would have done it years ago, but the problem has essentially eluded us.

As an industry, we have spent countless hours and dollars looking for extrinsic causes to the problem. Could we build a better healthcare delivery network? Perhaps we need to change our drug formulary. Maybe the problem lay with the individual adjusters approving or denying care. All of these are viable and appropriate question, but they place the locus of control for the problem on the world around the patient. I submit that the reason 20% of patients struggle and fail with recovery is purely an intrinsic problem and the solution to the problem is easily fixable once it is identified.

The Real Reason Why That 20% Languishes

The core problem is twofold: Patients do not respond the same way to treatment, and they experience trauma and suffering in very different ways.

A one-size-fits-all approach simply does not work for everyone, because their symptoms and suffering are different. 

The nature of an injury is not just a broken bone or a laceration. While the physical manifestation of trauma is easy to see and treat, trauma expresses itself in emotional ways, as well. So far, our approach to treating injured workers has been primarily biologic – and pharmaceutical. Only recently have we begun to identify the ramifications of mental and emotional health on an injured worker’s recovery and ability to return to work. 

These emotional wounds and physical suffering express themselves differently in different individuals. We need to recognize these variations and develop customized and innovative ways to treat them on an individual level that are cost-effective and long-lasting and can provide patients with a truly positive experience.  

Why Are the Psychosocial Factors So Powerful? 

In 1997, George Engle introduced the bio-psycho-social construct for understanding the human condition as it relates to medical conditions. By identifying the fact that humans are much more complex than biologic creatures, he opened the door to detecting the underlying reasons why some people persevere in the face of grave illness or injury while others languish. To address this interplay, it is critical to understand two constructs.

First, there is a direct relationship in the brain among pain, trauma, depression and anxiety. They are inextricably tied through the neural pathways of the brain. When someone suffers from one of these issues, the others are directly correlated. In physics terms, for every action there is an equal and opposite reaction, and those reactions are not always positive. 

Second, a work-related injury is a life-changing event. Consider what the patient is facing:

  • Anxiety about continuing in their job and being able to support themselves and their family.
  • A loss of sense of self – will I ever be the same again?
  • A loss of identity – our jobs, our professions, our roles in the family and the community are representations of who we are. With an injury, those identities may permanently change.
  • Fear of the unknown – success in treatment is not guaranteed to restore full function.
  • Time to ruminate and worry during the recovery process.
  • A loss of control for their own healthcare – patients are reliant on their adjuster and payer to grant access to care for their problem.

See also: Impact of PTSD on Workers’ Comp Costs

If you consider the biologic connectedness of trauma and mental health and then factor in the emotional impact of a workplace injury, it’s no wonder that anxiety, depression and other mental health problems are present in most cases that drive volatile claims cost and poor patient outcomes.

When the injured worker is in pain, as most are, the recovery is longer, discomfort persists on a daily basis and emotional problems are exacerbated. Sleep is interrupted, delaying the healing process and increasing anxiety and depression. This downward spiral is clinically referred to as the fear-avoidance cycle, and it continues, often ending in permanent disability and addiction, because patients, and oftentimes medical providers, do not know how to break this vicious cycle. 

As noted, pharmacology has been the traditional answer for both pain and emotional/mental health issues. These medications were the only resource available to us clinicians, so they became the proverbial “hammer” and everyone we treated became the “nail.” We’ve seen what long-term reliance on painkillers can cost in terms of addiction, more suffering and even death. A pharmacological solution alone doesn’t work. Not only does it fail to resolve the source of the pain, but it also fails to treat the array of psychosocial symptoms that are related to pain. If anything, narcotics and pharmacology have the potential to make these problems worse. 

Science Leads to a Solution

Fortunately, recent breakthroughs in technology, science and clinical care offer alternatives to effectively treat the 20% of outliers that have long stymied us for their lack of response to the current biologic treatment paradigm. The innovation is understanding that the brain has the ability to promote neuroplastic change when given the appropriate clinical cues for the right frequency and duration. This neuroplastic change promotes a biologic re-wiring of the brain to create permanent resiliency to the symptoms related to the traumatic event. It is imperative that the biologic changes be coupled with social and psychologic training and education to provide an individualized level of support for the patient. The ability for a clinician to use a single therapeutic modality to address all three of these humanistic pillars is unparalleled.

This disruptive approach consists of four components: 

  1. Virtual reality technology: This technology is used to immerse the patient and to distract from the maladaptive sensations. The brain’s ability to create new pathways (neuroplastic change) reprioritizes these signals to create resiliency in the patient. Using the immersive technology, patients report an immediate decrease in their symptoms as well as a residual, or legacy, effect. This equates to acute relief from their symptomology with continuing relief even when they have removed the VR platform. Previously, similar results could only be accomplished with prescription drugs. The results using VR are obtained in a purely non-pharmacologic and safe manner. In addition to the reduction in symptoms (pain, depression, anxiety or PTSD), patients are also reporting a dramatic increase in the quality and quantity of sleep, which is essential to healing following any traumatic event – physical or emotional.
  2. Individualized behavioral counseling and coaching: The coupling of masters-level behavioral health specialists to coach and guide the patient through the virtual reality platform allows for an extremely customized and individual therapeutic experience. These weekly encounters help maximize the protocols within the virtual world as well as drive engagement and behavioral change skills in the real world. The coaches have been charged with helping traumatized patients return to their version of normalcy in their lives or helping them identify and adapt to a new version of normal as they move forward.
  3. An exceptional patient experience: Digital engagement in a virtual setting means that patients don’t need to leave home to engage in therapy. Patients receive direction as to when and how to use their platform from their personal coach, and then it’s available any time of the day or night. When a person is injured at work. there is a loss of control in their life, as their daily routine is interrupted. With this unique therapy, traumatized workers have complete control of one aspect of their healthcare—this is an extraordinarily powerful tool that helps engage these patients and gives them some ownership in the treatment plan. 
  4. A time limit: The 90-day duration of treatment is designed to promote the necessary neuroplastic change, coupled with behavioral change and goal-setting education. The goal for any therapy should be to create change in a timely manner. Furthermore, a true biopsychosocial program needs to drive the patient toward a graduation event—accomplishing a series of goals promotes positive behavioral change.

See also: Why to Provide Life Insurance for Workers

Through this combination of virtual reality technology and customized behavioral counseling, we now have a solution to effectively bring relief to injured workers in a holistic and patient-centric manner. The goal is to be synergistic and complementary to other therapeutic modalities, while promoting a safer and more efficacious treatment pathway. Simply put, this treatment modality delivers on the notion of the triple AIM – better patient outcomes, lower financial burden, and exceptional patient experiences.

A New Burst for Augmented Reality

Augmented reality and I go way back, to when it burst on the scene in the early 1990s. As a technology reporter for the Wall Street Journal, I was a skeptic especially about virtual reality (where a headset provides an immersive experience unrelated to the physical world around the wearer) but also about augmented reality (where goggles add images or other information to what the wearer sees through the glasses).

In fact, while the VR/AR concept was clearly powerful, the technology wasn’t close to good enough yet to provide even a useful experience — the computing power in the devices was about one-millionth of what is available today, thanks to the exponential improvements in electronics.

In the last decade, enthusiasm returned. Facebook bought Oculus for $3 billion in 2014, when the VR company still barely even had a product. Pokemon Go had hundreds of millions of people in 2016 trying to “catch” Pokemon projected onto the real world via an AR app downloaded onto their phones. But interest faded again. VR/AR made only modest inroads, primarily in some video games.

Just in the past week, though, an announcement suggests that augmented reality may be close to becoming very real. There could be significant changes in how clients operate and, eventually, in how insurers themselves do business.

The announcement came from the U.S. Army, which said it is buying $21 billion of AR headsets from Microsoft “to help soldiers map the battlefield, select targets and stay aware of possible threats by overlaying intelligence information directly onto their field of vision.” Even beyond the Army’s hefty endorsement of the technology, the contract for AR headsets will give Microsoft a lot of real-world experience with AR and will finance a great deal of continued research and development. Microsoft might initially focus on providing AR for its growing video game franchises but will surely look for ways to bring AR to its bread-and-butter corporate customers, too.

I suspect that early uses in the business world will be at the fringes, rather than in routine work, where augmentation would help far less, if at all. For instance, AR could allow measurable improvement in certain types of inspections.

Perhaps someone repairing equipment that he doesn’t see often, or that may even be decades old, will have his AR glasses project schematics on the device, with information from the manual projected just off to the side. Perhaps someone conducting an inspection could look at a valve or pipe and, right next to it, have an image projected showing what it should look like. There could even be some interplay: An artificial intelligence or a centrally located expert person could be viewing the same scene through the AR’s “eyes” and offer guidance.

There has long been optimism about AR applications in medicine, especially surgery, given that the surgeon doesn’t know exactly what she’ll find inside until she cuts into a person — amalgamating all the pre-surgery scans into an image that could be projected onto the patient could provide some initial guidance. I think of Sam, my closest friend growing up, who is wonderfully educated and trained (Harvard undergrad, Yale med school, surgical residency at Massachusetts General), but who petrified his mother when he became the chief resident in the cardiac unit and was the one using a jigsaw to cut through patients’ sternums at the beginning of heart surgery. “Do those doctors know he flunked wood shop?” Sam’s mother once asked me.

In time, AR could work from edge cases into the mainstream. For instance, workers in industrial settings might start wearing goggles that are designed to provide technical information, as summoned by the user, but could also then head off accidents — maybe a flashing stop sign is projected onto an intersection in a factory because an overhead camera has spotted a forklift speeding toward it right as you’re about to get in the way. Once AR glasses earn their way onto the bridges of people’s noses, all sorts of workplaces can become not only more efficient but safer.

The same sorts of warnings could be provided for cars, where AR glasses could give drivers the sort of heads-up display that fighter pilots have on their windshields. I don’t imagine a reprise of Google Glass, which tried to do too much, hoping to provide a new way of looking at the whole world. But I can see the value of glasses that would warn the driver of an accident ahead or even of a blind intersection known to be dangerous. People could use some combination of voice and head movements to control the car environment so they wouldn’t have to take their eyes off the road. As so-called connected cars begin communicating with each other and with “smart” infrastructure, the AR could also deliver warnings of a car that you can’t see but that is braking hard on a crowded freeway just ahead of you. Or the AR could alert you that a car recently skidded on some black ice on a stretch of road you’re about to reach.

Once AR becomes widely adopted, adjusters could well use the glasses to not only help assess damage on site but to have estimates of repair costs and timeframes appear right next to what they’re seeing.

And, as always, clever people will come up with a far broader list of potential uses as the technology takes hold, both among clients and in the insurance industry itself.

As history shows, AR will take time to spread — but I’m more optimistic than I’ve been in 30 years.

Stay safe.


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

Want Some Insurance With That?

Insurance is becoming the French fries in a meal deal–offered as part of another transaction at a moment of need. The change is profound.

The Digital Journey in Personal Lines

Personal lines insurers are focusing on self-service capabilities for policyholders, especially for policy service and claims.

Post-Pandemic: 4 Tips for Independent Agents

There is an opportunity to improve on objectives like paperless processes, remote relationship building and digital communications.

Rational Ignorance and the Protection Gap

Insurers need to acknowledge rational ignorance as a major sales obstacle; that could be a first step in a recovery for life insurance.

In Search of the Digital X-Factor

How commercial insurers capture, clean and use data across their distribution channels will become their competitive lifeblood.

The Cost of Uncivil Discourse

The successful rollout of vaccines worldwide will calm many but will not, alone, decrease the risk of civil disturbances and riots.

Expanding Options for Communications

Most P&C insurers have gradually expanded their options for digitally communicating with prospects, policyholders, producers and employees. As the industry moves beyond the web, portals and email, there is a growing recognition that a whole new world of digital communications options can be applied in insurance. Messaging and collaboration platforms, business texting, chatbots, voice, personalized interactive video and even augmented/virtual reality are now on the palette. Add these communication options to the zillion different ways to make or receive a payment, and a great thing happens. These options often simultaneously improve the customer experience while reducing expenses!

Technology options and solution providers are plentiful, but the big question for insurers is how to leverage the right mix of these across the enterprise. There are three really important components for successfully leveraging the new communications options: 1) a digital communications strategy, 2) digital content capture and creation and 3) content management and e-delivery.

Digital Communications Strategy: The methods of communications have often been driven by the requirements of specific areas of the business. Marketing uses a variety of tools and approaches to reach prospects and customers. Distribution uses another set to interact with agents and other partners. Claims has many types of external participants to communicate with during the claims life cycle. Underwriting and other areas of the business have their own needs and favorite technologies. But, now that digital transformation is accelerating, a comprehensive digital communications strategy is needed to determine how and where to best leverage capabilities like chatbots, messaging platforms and other tools. The capabilities for delivering customer documents and communications via email, portals and other traditional methods will continue to be equally vital.

See also: Will COVID-19 Be Digital Tipping Point?

Digital Content Capture and Creation: Inbound communications, such as submissions or first notice of loss, benefit from intelligent capture solutions that can efficiently gather and organize the information sent to insurers. Also, the ability to create and manage forms, documents and customer correspondence is essential. Communications that are created must adhere to branding guidelines, enable regulatory compliance, provide a modern customer experience and have the flexibility to support today’s array of outbound channels (including print and digital channels).

Digital Content Management and E-Delivery: Managing the digital content used for customer communications is an important capability. Insurers must be able to efficiently create, store and (re)use content objects such as visual branding elements, signatures, text blocks and the templates that they support. Moreover, in a world of many digital delivery options, the digital communications platform must support the delivery to the recipient through any technology option or channel, including messaging platforms, business texting solutions and chatbots, as well as traditional print, email, the web or mobile.  

Traditional options for communicating (such as portals, email and even print/mail) are not going away. But establishing a digital communications strategy and implementing a platform solution for creating and managing those communications is even more important in an era where the world is more rapidly shifting to digital due to the pandemic and work-from-home environments.

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.

What Digital Can Do for Disability Claims

Healthcare is being transformed by advances in artificial intelligence, virtual reality, machine learning, sensors and other innovative technologies. Practically everybody has a smartphone, making it easier than ever to gather data and consent to third-party access. Unique data insights mean providers can offer people products and services tailored to them individually.

For insurers, digital technology offers new ways to manage risk that relies less on face-to-face and traditional clinical assessment; this is why there is so much interest in understanding how innovation might work. Selected comments from four key players in the digital health ecosystem make clear the appeal of putting two and two together.

Thomas Lethenborg at Monsenso, a mobile platform for mental health, said, “Digital technology helps an individual move from reactive behavior to being more proactive – and this changes the paradigm in particular with engagement.”

It’s a view shared by David Forster of Thrive, a digital interventions app for mental health: “Data drives our understanding of what works best for the individual.” According to Forster, the success of digital technology in clinical settings points to real opportunities in insurance: “It makes it possible to provide policyholders help with illness prevention, early detection and assistance on a personal level.”

Ian Prangley, of exercise rehabilitation service TrackActive, continued the theme when he said, “For insurers, digital solutions can drive connectedness, engagement and customer satisfaction while enabling people to self-manage their health. Harnessing data insights and implementing artificial intelligence (AI) is key to achieving this.”

See also: Why to Digitize Disability Claims  

A comment by Danny Dressler of AIMO, an ecosystem integrating intelligent motion analysis into musculoskeletal care, added further confirmation: “As more and better data is gathered and processed safely, AI offers the most promise to take care of people’s health, and fix issues in both healthcare and the life and health insurance sectors.”

By using digital means, insurers can create scalable, automated, speedy ways of supporting people when they need help the most. Proponents argue it offers better health outcomes for policyholders that will reduce the costs associated with long disability claims – a win-win for both insurers and consumers.

Dressler also said that “technology like ours lets insurers offer customers new solutions such as dynamic pricing and automated claims and even help to prevent claims from happening.” Lethenborg says it represents “an opportunity to ensure the data collected gives holistic insights and analytics that we can use to intervene more rapidly, when help is needed.”

But it’s crucial the highest levels of privacy and data protection are guaranteed and operators are in full compliance with regulations. An imperfect balance of privacy with innovation is a deal-breaker for consumers.

Forster is clear how delicate this balance is: “We recognize our responsibility to safeguard users’ data, but at the same time information technology empowers people to make choices and participate actively in managing their own health – it puts them in the driving seat for the first time.”

For digital solutions to be convincing, research and scientific evidence are needed, but with newly made services, long-term experience is scarce, and a leap of faith is required.

Dressler spoke for all in saying, “We maintain strong links to scientific institutions because the general technologies underpinning our solutions emerges from scientific thesis…[This means] we only implement new features or functions after a rigorous validation process, especially because we are asking people to trust us with their health and well-being.”

Dealing with high volumes of data is not without risk, particularly when it’s shared with third parties.

See also: Digital Innovation in Life Insurance  

Prangley has pointed to recent concerns over how sensitive data is being used to highlight the challenges faced, “The key is to anonymize and protect data, and have customers consent to sharing it on the understanding it will be used solely to improve their health.” This insight is driven home by Lethenborg, who said, “Transparency about how the data will be used is essential to building trust.”

Digitization has already brought new products and services that have had positive medical and scientific impact. As Prangley said, “Technology has connected people and changed how we relate to each other. There [are] arguments for and against this of course, but in the context of health and wellbeing we believe it’s a great thing.”

With mental health and musculoskeletal problems as the leading causes of disability claims in every market, these companies can bring digital solutions and opportunities – and health insurers can also feel great about them.