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.
When we were young, most of us experienced all sorts of trips and falls. Whether it was from running too fast and stumbling over, a fun ride on playground equipment gone wrong, or a game with friends that got too rowdy, as kids, it was common to get scratches, sprains, breaks, and wounds. And while these were moments when we might have cried from pain, it didn’t take us too long until we were back on our feet ready to get back in action. But the ability to bounce right back up doesn’t last forever.
The Bureau of Labor Statistics estimates that 39% of the US workforce is expected to be older than 55 years of age by 2026. While studies show that older employees are generally injured less frequently than their younger colleagues, their injuries tend to be more severe and result in a longer time away from work. So, given an aging workplace and longer recovery times, what does this mean for employers?
Age increases total visits and durations
While there may be several factors at play, it doesn’t come as a shock that older adults tend to heal slower than younger people. This difference in recovery process can affect the rehabilitation journey in different ways.
A significant area of impact is the total number of physical therapy (PT) visits during an episode of care. Across all injury types, MedRisk’s data show that the number of PT visits attended by injured employees increases by about one full visit with each age group up through the 55-65 age bracket, where the average visits per episode of care remain consistent.
This means that injured employees aged 56-75+ need 21% more PT visits on average than those aged 18-55. Unsurprisingly, as the number of visits increases by age bracket, so too does duration. Data show that 31% of persons aged 56-75+ experience a longer rehabilitation process than those aged 18-55. Furthermore, while the number of visits remains fairly static in the higher age brackets, duration continues to increase with age.
Planning and acting with age in mind
As the number of total visits and duration trend higher for injured older adults, there’s obviously a domino effect. The longer these older adults take to recover, the more costly it becomes to rehabilitate and the longer it will take for them to return to work. Consequently, this can affect an organization’s operations, productivity, and bottom-line.
It now becomes increasingly more important for employers to take the necessary course of action to prevent injuries among the older workforce. One of the best ways to start is to prepare the spaces where older employees will spend a lot of time for safer functionality. From reviewing and rearranging the furniture and equipment layout to placing anti-slip mats and grip bars where needed, “age-proofing” the workplace will help lessen the probability of them getting injured at work.
Moreover, as more employers provide health and wellness benefits, they can encourage older employees to get moving. While engaging in low-impact, low-intensity activities does not mean their recovery will be as fast and smooth as it is for younger employees, physical activity certainly helps with overall balance and muscle strength.
Of course, even with preventative measures, accidents may still occur and older adults may still incur an injury in the workplace. In these cases, it’s important to have a PT partner that has clear clinical evidence-based guidelines which account for age. Based on these guidelines, they can make the appropriate, actionable recommendations from the outset, set clear expectations for the patient regarding their recovery journey, and, ultimately, ensure that the patient receives effective and efficient treatment.
A partner that can also score a claim’s potential long-term severity takes things even further. By taking into account claim, demographic, and medical data, such as the injury’s nature and cause, the patient’s age, and psychosocial factors, high-severity claims can be detected in the early stages and given the necessary attention to avoid going off track.
Effective care for age-specific recovery
While the expression that a person is “aging like a fine wine” might be common, there’s no denying that physical changes in the bodies of people as they age have a direct effect on their response to rehabilitation. With the US workforce expected to be significantly composed of older adults in the next few years, age in workers’ comp is quickly becoming a reality that organizations can no longer ignore.
And while getting these older injured adults back in action certainly won’t be as easy as it was when they were kids, arming yourself with the right knowledge, deploying preventative measures, and partnering with the right PT provider that can recommend the appropriate care for their age-specific needs can help smooth the process out.
There’s a saying that goes, “To be early is to be on time, to be on time is to be too late.” You may see this as a hyperbole in many situations, but in the case of physical therapy, we might find that there is wisdom in the famous expression.
There’s no debate on physical therapy’s benefit to recovery for various musculoskeletal conditions. From neck, shoulder, back, hip, to knee injuries, PT has helped lower the number of cases requiring costly surgery and dangerous prescription drugs. It also brings down overall costs significantly. However, many of these benefits are still critically linked to one important thing — timing.
So, if it’s clearly crucial, how can we maximize the value of PT through timing?
Starting and educating early
PT is understood to be the first-line treatment for musculoskeletal injuries before considering addictive opioid prescriptions and invasive procedures. But researchers have also long agreed that there are significant benefits to starting physical therapy early – that is, within 14 days post-injury. According to a 2020 Workers Compensation Research Institute study, for workers with low back pain, early initiation of PT (as defined by WCRI) is associated with lower utilization, lower costs and a 42% decrease in the duration of temporary disability versus late post-injury PT. Moreover, decades of research have also shown that patients achieve better outcomes when they are treated in the acute stage (less than 6 weeks) compared to the chronic stage (more than 3 months).
To drive more positive patient outcomes, early access to PT and patient education must also go hand in hand. Studies show that an initial consultation with a PT provider may reduce overall healthcare utilization (e.g., opioid use) for patients seeking care. In this initial consultation, the PT can identify possible barriers to recovery — including psychosocial barriers — and can recommend the best course of action to mitigate them.
Because patients spend a great deal of time with their PT more than anyone else in the process, establishing a positive relationship between the patient and their therapist is also key. It’s one thing for PTs to deliver their advice but another if the patient truly receives and understands the intended message. PTs can use strategies like motivational interviewing, shared decision-making, and the prescription of simple, personalized exercises to make certain that patients hear and understand both their diagnosis and treatment plan.
Taking it a step further with early manual therapy
To further reap these benefits, practitioners are also seen shifting focus to one very specific type: manual therapy (MT).
A 2020 systematic review of randomized controlled trials updated a 2013 review exploring the value of MT among other interventions over the past several years. The 2020 review concludes by strongly recommending MT be integrated as an additional therapy. This supports earlier study results, which observed that patients who received only exercise (without MT) were 8 times more likely to experience a worsening disability compared to patients receiving exercise and MT treatment.
An initial study in 2021 from WCRI on MT for LBP claims also showed that the time temporary disability per claim was 22% shorter and the average indemnity payment per claim was 28% lower when workers received early MT compared with those receiving it later; a positive step towards more effective WC outcomes.
The utilization of early MT has also shown a positive impact on three key factors that impact case duration that happen to be traditionally difficult to tackle — patient age, surgical status, and case complexity. With early MT, some data show that patients between the age of 51 and 60 are discharged seven days sooner and those 61+, nine days sooner when they’ve received early MT. Following surgery, patients receiving early MT also require less treatment over a longer period of time than those who receive MT late in the episode. Furthermore, the use of early MT has proven to lead to fewer visits over a shorter duration for complex cases involving more than one ailment.
Timing is key for maximized PT benefits
In general, the growing use of PT has proven to be valuable as treatment for musculoskeletal injuries. But in order to truly maximize its value, organizations must support and encourage early intervention. Rather than waiting until a case gets serious and pain becomes chronic, utilizing PT early in the game allows for lower costs, better use of medical resources, and more optimal results in the most effective way possib
It’s no surprise that the world we live in is ever-changing…
And yes, that includes even the world of claims and PT.
Each year, there are noticeable trends in the industry — trends that impact our day-to-day practices.
As we enter into the second half of 2023, have you taken note of the key trends shaping the future of our industry? Below, we list three trends that you need to know and more importantly, what you need to be doing about them.
As identified in our 2023 Industry Trends Report, here are the quick facts — keep scrolling if you want to learn more:
An aging employee population. 39% of the U.S. workforce is expected to be older than 55 in 2026. Being that total PT visits increase by injured employee age, it’s increasingly more important for employers to take necessary measures to prevent injuries among the older workforce.
Increased rates of anxiety and depression. With a significant jump in reported anxiety and/or depression among injured employees between 2019 and 2023, taking proactive steps to identify and manage psychosocial health conditions has become of the essence.
Lower rates of surgery and opioid utilization. Only 16% of claims involving PT in 2022 were reported to have utilized surgery. With PT becoming a more widely accepted critical conservative care recommendation, a positive trend for claim costs and outcomes can be expected.
1. An aging employee population
While older employees get injured less frequently, it doesn’t come as a shock that older adults generally tend to heal slower than younger people. This difference in the recovery process can affect the rehabilitation journey in different ways — specifically in terms of total PT visits and duration.
Across all injury types, data shows that the number of PT visits attended by injured employees increases by about one full visit with each age group up through the 55-65 age bracket, where average visits per episode of care, remains consistent through the older population. What this means, however, is that persons aged 56-75+ need 21% more PT visits on average than persons aged 18-55. Unsurprisingly, MedRisk also found that while the number of visits increases by age bracket, so too does duration. Data shows that 31% of persons aged 56-75+ experience a longer rehabilitation process than those aged 18-55.
So what do you need to do? It’s now become essential to plan and act with age in mind. Start with arming yourself with the right knowledge and putting preventative measures to “age-proof” your workplace. Moreover, maximize new AI-driven PT innovations that can identify high severity claims early on to assign the appropriate resources for age-specific needs of older adults.
2. Increased rates of anxiety and depression
The COVID-19 pandemic has led to an increase in anxiety and depression among the general population. This is also true for workers who have been injured on the job.
Data reveals that 50% or more injured employees experience clinically-related depressive symptoms at some point, especially during the first month after the injury. These cases, when compared to those where these conditions were not reported, were also found to have 7% higher utilization than those who did not report these conditions
So how can you respond? Unlike bruises or lacerations, psychological setbacks tend to be invisible, but they can still derail recovery and claim progress, ultimately impacting claim outcomes. Partnering with the right PT provider that can help detect these early on is key. Pre-treatment consultation can provide predictive insights into a patient’s behavior, including any barriers or psychosocial issues that impact their recovery.
3. Lower rates of surgery and opioid utilization
There is a growing trend away from surgery and opioid use for workers’ compensation injuries. Prior to the coronavirus health pandemic, rates of surgery were already declining, with nearly one-quarter of all claims involving PT receiving surgery in 2015 compared to just 16% in 2022. This is due to a number of factors, including the high cost of surgery and opioids, the potential for addiction, and the availability of effective non-surgical treatments, such as physical therapy.
As a result of the trends mentioned above, there is an increased use of physical therapy for workers’ compensation injuries. Physical therapy can help workers recover more quickly and safely, and it can also help to reduce the cost of claims.
So what does this mean to you? With physical therapy playing a larger role in medical treatment and overall medical management costs, you can expect lower costs and shorter recovery times.
A patient could be experiencing stress and worry over feeding their family or paying the bills.
Or they might have mixed feelings about returning to work because of fear of reinjury or concerns about conflicts with their supervisor that were bubbling before the injury.
Maybe they suffer from a comorbid condition that hasn’t been treated for a variety of reasons.
Unlike bruises or lacerations, psychological setbacks tend to be invisible. And they’re likely to stay that way unless someone asks questions and makes observations that haven’t typically been a part of the intake process on an average claim.
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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.
Matt H.TALKS ABOUT MEDRISK CULTURE
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!
Lindsey B.TALKS ABOUT MEDRISK CULTURE
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.
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