Those in the Worker’s Compensation industry understand that sometimes even getting the most motivated, healthy patient back to work can be very challenging following a serious injury. A patient with additional obstacles can even be more challenging, and a recent benchmarking study by Rising Medical Solutions identifies which of these obstacles have the greatest impact from preventing a desired claim outcome. Their study listed Psychosocial Concerns and other Co-morbidities as the greatest barrier to successful claims outcomes, followed by Lack of Return to Work Options and Litigation. The study listed fear of movement, fear of judgement by their co-workers, obesity, troubled home life, limited proficiency in English and poor coping skills among other things as conditions, behaviors and predicaments that could lead to poor claims outcomes. Being out of work itself can propagate certain conditions, and the study states it can “lead to problems such as increased smoking, alcohol abuse, illicit drug abuse and risky sexual behavior. Suicide rates have been observed to increase by a factor of six.”
The study discusses how many large employers and insurance companies are devloping screening tools and team-based advocacy models to identify and address patients with these issues early on. Grocery chain Albertsons screens injured workers and states that approximately 9 percent receive intervention from a specialist, usually a psychologist “who provide(s) health coaching consistent with cognitive behavioral therapy principles.” Albertsons estimates this approach will save them 20 percent on their medical spending in the future.
While programs like these show promise, the majority of claims seen with these barriers are being handled primarily by claims adjusters and nurse case managers along with other health care professionals. Working with these difficult claims requires soft skills like customer service, communication and critical thinking. Focusing solely on the medical diagnosis and finding medical solutions will not always help the patient – particularly when there are a large number of non-medcal difficulties involved in the patient’s life.
Using the proper patient advocacy models has demonstrated improved closed claims ratios and should be considered as an ongoing part of the professional training of claims and healthcare professionals.
The study quotes Noreen Olson, Worker’s Compensation Manager at Starbucks, on her definition of claims advocacy in Workers’ Compensation. She states “In Workers’ Comp, advocacy is a process grounded by the values of dignity, respect, and transparency which coordinates activities to assist the injured worker effectively, promote expectancy and engagement in recover, efficiently restores (and often improves upon) health and well-being, and resolved the experience in mutual satisfaction.”
I have always believed that those interacting with Workers’ Compensations patients should treat them with the highest respect and dignity – like they would with any other patient. That could be partly because of my altruistic nature as a Physical Therapist. However, studies like these demonstrate that we should not only do this because it is the right thing to do, but also that it is essential to get the desired claim outcome, particularly in these very difficult cases.
To read the entire Rising Medical Solution study go to https://goo.gl/7m2Lpy. To learn more about how Results Physiotherapy can help with your Workers’ Compensation programs, contact us at https://resultspt.com/request-info.
