issue 006, 2016 q4

Building telemedicine programs for workers’ compensation 006

BY TERESA BARTLETT, M.D. SVP, Medical Quality, Sedgwick

Telemedicine services designed for workers’ compensation and group health plans will have similar benefits, but there are many additional components that must be included to provide a quality program for patients with workplace injuries.

Telemedicine services designed for workers’ compensation and group health plans will have similar benefits, but there are many additional components that must be included to provide a quality program for patients with workplace injuries.

Telemedicine services include clinical consultations with nurses via telephone and virtual physician visits using online video technology. Many workers’ compensation claims administrators and managed care companies currently provide telehealth services including 24/7 nurse triage and prescription drug reviews. Telemedicine services for workers’ compensation engage physicians for medical examinations. These services require physicians who have the knowledge and experience to deliver occupational injury care and meet applicable regulatory requirements. We have seen several failed starts in telemedicine for workers’ compensation due to insufficient coordination and connectivity across technology platforms, providers and claims administrators. An important component is flexibility in the network composition and design, which includes all types of ancillary providers to enable opportunities to grow as the needs of the injured employees change.

Telemedicine offers advantages for patients and today’s technology ensures doctors can obtain the information they need. For injured employees, the use of telemedicine eliminates the drive time and office wait time for themselves and others who may need to take them to appointments. With the technology and ancillary devices that are currently available, doctors can take blood pressure, complete an electrocardiogram and do various other tests remotely. With the advent of electronic records, physicians often find themselves documenting symptoms and treatment information on their computers during office visits with patients, a task that would be exactly the same with the use of telemedicine.

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CONNECTED SERVICES HELP ENSURE QUALITY CARE
A successful telemedicine program for workers’ compensation patients can connect everyone involved in the overall process – nurses, physicians, pharmacists, behavioral health specialists, physical therapists and all other clinicians. It is important to thoughtfully connect specific, crucial areas to deliver quality care. When they are all connected across shared systems, with common goals, it improves the employee experience and supports a smooth, efficient process for everyone assisting with the claim.

The industry lacks solutions that can deliver cost benefits to employers or quality care that equals onsite occupational medicine, with real-time support from pharmacists, nurses, behavioral health specialists and other clinicians. A successful program must also put the injured employee first. It is crucial to connect the entire treatment experience from the employee’s perspective to ensure they are getting quality care and the best possible outcome.

ESSENTIAL COMPONENTS OF A SUCCESSFUL TELEMEDICINE PROGRAM 
There are several critical elements necessary to support good outcomes and quality care – and they apply to both online and office visits. A key part of the process is managing logistics to ensure shorter wait times, provider availability, etc. It is also important to use occupational medicine physicians with proven, quality outcomes, and connect with an experienced workers’ compensation network to support billing efficiency and provider management. In addition, to assure patient and data privacy, managed care technology must be protected under the laws established by the Health Insurance Portability and Accountability Act.

A successful telemedicine program for workers’ compensation patients should include:

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telemedicine plus Technology and logistics – The right platform can ensure easy access, shorter wait times, provider availability and accurate, efficient billing; below is a list of the technology features needed:

  • Rapid virtual access to physicians experienced in occupational healthcare
  • Virtual access to specialists
  • Connectivity to national occupational medicine groups and specialty networks
  • Virtual follow-up care
  • Logistics necessary to prevent long wait times and to connect callers to the right resources
  • Technology existing in the workplace or within the workforce necessary to connect injured employees with telemedicine providers

telemedicine plus Experience and results – One of the keys to improved health and return to work results in workers’ compensation is having access to the best-performing occupational medicine providers available around the clock

telemedicine plus Network connectivity – The networks entering into this new approach will need to be organized and trained to meet the needs of providers, employers and injured employees

telemedicine plus Fully transparent pricing – Telemedicine is a form of healthcare enabled by technology, so the cost of services should be fully transparent

telemedicine plus Regulatory compliance – The services must be fully compliant with applicable regulatory requirements, including state reporting, related jurisdictional laws and billing for services

Many of these components are currently missing across the marketplace. Connecting these critical areas will eliminate travel time, and can help reduce lost productivity and lower medical costs associated with occupational injuries, while extending access to high-quality care. The right medical and clinical resources, combined with the necessary technology, can provide significant enhancements for employers and improve the experience for injured employees.

Employers wanting to engage this developing solution for their employees should make sure that the solution will deliver quality care first, followed by convenience.

Additional Resources
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