Assimilation Is Inevitable

The big focus at the California Workers' Compensation Institute's annual meeting yesterday in Oakland, CA was on medical treatment.

And not the cost of treatment, but what the lack of quality treatment is costing.

Dr. Gary Franklin, medical director for the Washington Department of Labor and Industries, challenged the audience of industry leaders to invest in quality medicine.

This also means providing treatment for psychosocial issues that would interfere with recovery or good outcomes.

Franklin said that he and his colleagues have developed a surprisingly accurate, but simple, six question survey that should be administered to an injured worker very early on in the treatment process to help identify whether there is an increased risk of prolonged disability.

The key then is to introduce appropriate treatment early in the game before disability progresses beyond the return point.

Bowzer Assimilated

People that are disabled for 3 months or more have a 50% chance of still being disabled at the one year mark post injury, and often long after that - thus early identification and intervention with all of the medical resources available should be implemented (within recommended guidelines, of course).

This includes providing psychological treatment, or better therapies to deal with chronic pain (which, Franklin noted, is defined as pain experience for 3 months or more - see the correlation to long term disability?).

And it's up to the administrators to take charge and provide this treatment - Franklin said most clinicians are not good at identifying patients who are at risk for long term disability.

Dr. David Deitz, former medical director for Liberty Mutual Insurance, echoed Franklin's presentation but put it into context with a comparison to general health, stating that without ensuring injured workers receive good quality care, there isn’t much more that can be done to reduce medical costs.

Both Franklin and Deitz advocate compensation for outcomes, rather than the present fee for service model currently employed in most work comp systems.

Deitz also demonstrated a general health provider that essentially advertises its outcomes via a web page. And the CWCI is releasing more tools to members and other researchers to use its vast repository of data to make more informed decisions about the who, what, when, where and how of treatment versus outcomes.

There are a couple of hurdles in this trend, some of them pretty big.

The biggest hurdle I see is the culture of workers' compensation. 100 years of doing things the same way over and over again is difficult to change. Everyone is in on it - providers, payers, patients, employers, the government - all of the players need to change their mindsets in order for such profound changes in the provision of medical care (not just to injured workers, but the overall health care delivery system) to actually work.

Transparency in outcomes is a tall order - we're talking about putting perhaps fragile egos onto the public stage; and there's the argument of privacy, and perhaps inappropriate discrimination.

Another large hurdle is education of the employee population, particularly before an injury occurs.

I'm not talking about telling an injured worker that there is no scientifically supported evidence that spinal fusion surgery is any more effective or efficient in dealing with back pain than physical therapy and exercise. There needs to be constant communication and education on the health treatment process - help identify issues early on, and then when an injury does occur (or is claimed) a constant flow of information about what will happen, when and by whom towards a certain expectation, must occur.

“Not only should we be focusing on quality from the perspective of whatever cost benefits we get, but without systematic health care improvement, we are not going to bend the cost curve at all,” Deitz said. “We are going to continue to spend money in increasingly inefficient ways and if we don’t focus on quality and outcomes, we’re lost.”

In the meantime, CWCI president Alex Swedlow in his opening presentation on the state of research at the Institute hinted at an upcoming report release expected mid-April that may challenge whether Medical Provider Networks are even working. A chart displayed to the audience suggests that the treatment model which existed in the early 1990s, the Preferred Provider Organization model, was not only less expensive than MPNs are now, but also returned better outcomes.

Peter Rousmaniere in his most recent white paper and four part web cast on Seismic Shifts argues that profound change is coming, and that industry people should be prepared to provide integrated benefits, not just workers' compensation. The good news is that the workers' compensation industry is already trained to provide medical care, return to work (or more broadly, return to lifestyle) services, and disability indemnity - expanding that expertise into a broader realm isn't that far of a stretch.

Some big health care companies are already trending towards that model.

The promise of workers' compensation when originally devised was prompt, efficient medical care in the event of a work injury. Today's promise should be prompt, efficient medical regardless of how an injury or illness occurs.

Workers' compensation medical treatment is a dribble in the overall healthcare equation (something like only two percent of the overall health care spend in this country). I still believe that assimilation is inevitable and I came away from CWCI even more convinced of this argument.