Viewpoint: Virtual Care May Become New Standard in Workers’ Comp

Claims and care management changed radically during the pandemic. We had to adapt to caring for patients with a previously unknown disease, face the potential of infection in the workplace, deal with a tidal shift to remote work, and handle concerns about giving and receiving in-person care.

As the industry rose to this challenge, telehealth in the claims management process broke through a barrier. From being merely a convenience or an option for remote locations, it is becoming a standard delivery platform and the foundation of end-to-end virtual care delivery — and many of the changes are here to stay.

The introduction of telehealth into workers’ compensation provided a remote way to evaluate injured workers, providing access to a nurse who could assess the injury and talk to them immediately to determine the best course of care. Analysis indicates that half of the injured workers — and their employers — are spared unnecessary trips to the clinic and can be managed through self-care measures with this advocacy model with telehealth in place. Injured workers requiring additional attention are quickly guided to the appropriate level of care with a provider.

Of cases sent to treatment with a provider, 45% are seen via telehealth, while 55% required in-person care in a brick-and-mortar setting. Faster, more efficient triage benefits injured workers and employers while at the same time communicating to patients that addressing their medical needs is the most critical priority. Telehealth intake results in more claims remaining medical-only than becoming indemnity claims, hence significantly reducing costs. Data from CorVel’s telehealth triage model found that telephonic or video triage succeeded in:

• Trimming wait time from two hours to 10 minutes
• Reducing time away from the job from four hours to 30 minutes.
• Cutting cost of treatment by 25% (for after-hours injuries, these costs are reduced by more than 600%).
• Reducing prescriptions of narcotics and other medications and the need for physical therapy and durable medical equipment (DME).
• Increasing average patient satisfaction ratings from 3.65 to 4.8 on a scale of 5.

With this real-time patient advocacy and responsiveness, the average claim cost is lowered by 31%, litigation frequency by 63%, and average days open by 26%. Telehealth deployed for virtual patient assessment improved outcomes on all fronts.

As the pandemic took root a year ago, the average company’s telehealth medical visits by employees skyrocketed from a few a week to hundreds. At CorVel, telehealth visits increased by more than 1,000% in just a few weeks. Patients were hesitant to come into medical offices. Providers were reluctant to see patients face-to-face, except where essential. Employers and employees feared potential infection at the worksite and were eager for guidance to address suspected cases of COVID-19 that might be work-related.

The telehealth infrastructure at many organizations was overwhelmed by the increased demand for remote care. For some, like CorVel, it was simply a pivot as telehealth was already an established program.

Patients with new or existing injuries needed a way to be treated remotely — safely receiving DME at home and remote instruction in its operation and safety, arranging home delivery of pharmaceuticals, and receiving rehabilitation via video. Their providers and case managers needed a way to connect digitally and access the necessary medical records.

At the same time, COVID patients needed immediate testing and care. Hotlines were implemented to answer questions and triage those with symptoms. In-home testing kits enabled employees to take their COVID tests at home, mail them in, and get results in a few days. Remote monitoring — even daily — was needed to watch for sudden changes in their condition that might warrant more attention or even hospitalization.

With the stress, fear, and upended lives precipitated by the pandemic, mental health needs for all patients intensified. The connections between psychosocial factors to health and recovery were even more apparent. Fortunately, the rapid deployment of remote counseling and mental health services brought relief. Video visits provided cognitive behavioral therapy to help manage anxiety and depression and taught the skills that lead to compliance and a positive outcome to overall treatment.

In the process, a new care delivery system was born — and an often-overlooked benefit of this new virtual care model is the transformation of the customer experience.

With providers and patients able to connect online or via smartphone, appointments were scheduled, test results reported, and questions answered rapidly and efficiently. Transportation time, to and from appointments, was eliminated. The increased responsiveness of the medical team served to assure patients that it was all about them, increasing their levels of satisfaction with the care and case management they received.

Huge numbers of employees are now working from home and will likely continue to do so. However, there isn’t a metric demonstrating the significant impact on the workers’ comp market due to work-from-home options. In her January 2021 analysis of “Telecommuting and Workers’ Compensation: What We Know,” Carolyn Wise, NCCI’s associate actuary, noted that telecommuting is particularly prevalent in the office and clerical industry group, which accounts for almost 60% of total payroll. She noted that about three-quarters of office-based business and professional employees have worked from home since early in the pandemic.

Office equipment, home office space, and ergonomic challenges have become broader concerns in the era of widespread telecommuting. This work mode may contribute to an increase in the number of work-related slips and falls as well as repetitive-motion claims due to things like exposed cords, distractions, and makeshift office arrangements. However, typically the occupations that work from home have relatively low claim frequency.

Regardless, it’s clear that telehealth, especially televideo, is especially applicable for remote employees who experience workplace injuries.

Although it may seem unexpected, contact between the medical provider and the injured worker has improved with the adoption of telehealth techniques, and employees already see clear advantages to telehealth.

• Our surveys show that nine out of 10 patients who have experienced telehealth would use it again.
• Workers rate their telehealth experiences at 4.8 on a scale of 5.
• Patients report improved flexibility and convenience for scheduling appointments. Physicians can see more patients using video options and spend more time with them.
• Outcomes, especially in virtual rehabilitation, have improved. Tele-rehab can be performed at the job site and monitored more effectively.
• Workers have seen improved scheduling and the ability to get medical appointments more efficiently.

The challenge is to adapt these technologies to the new post-COVID environment where remote workplaces and teleconferencing will continue to be more common, and concerns about infection — despite widespread vaccination — will continue.