Today and tomorrow, the Training Daily Advisor presents an article by Dr. Gerard Malanga, MD, and Robert D. Woods Jr. with five tips on keeping wellness at your organization on point. Malanga is the founder and partner of New Jersey Sports Medicine, LLC, and New Jersey Regenerative Institute in Cedar Knolls, New Jersey. He also serves as the medical director at Horizon Casualty Services. Woods has over 40 years of claim experience, including all areas of commercial and personal lines, and has held senior claim leadership roles at OneBeacon Insurance Group, CNA® Insurance companies and, most recently, Energi Insurance Services, Inc. Below, we go over the first two of their five tips concerning wellness in the workplace.
Chronic over-prescription of opioid painkillers is fostering a culture of “sickness” in the American workplace. This was the conclusion drawn by a recent panel discussion of experts with deep experience in workplace injury, health care, insurance, and pain management.
News accounts support this dire claim, including current stories chronicling the increase in heroin use among sufferers looking for a cheap alternative to prescription meds, and the recent Mayo Clinic study that found that one in four people prescribed opioids progressed to longer-term prescriptions.
Historically, prescribing physicians have had few viable alternatives to painkillers which, short-term, are certainly effective for many. But now, practices find themselves challenged to come up with new ways to treat pain sufferers, particularly those with workplace injuries that the workers’ comp system refers to as catastrophic—overburdening the system and remaining largely unresolved.
Working in concert with employers, the insurance community, and other healthcare professionals, practices have the potential to resolve patient injuries more effectively and return patients to “normal” safely and more quickly. Stakeholders in the system must embrace these five essential changes that have the potential to curtail this continuing “sickness.”
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1. Eliminate Unproven Therapies in Favor of Accurate Diagnosis Followed by Evidence-Based Treatment
Proper diagnosis is closely linked to proper treatment, and providers need to focus more heavily on accurate diagnosis to deliver appropriate care. Yet some 30% of patients are misdiagnosed. In the worst cases, what could have been an injury that might heal within weeks with proper treatment can, if improperly diagnosed and treated, snowball into a life-altering, permanent injury that prevents that worker from ever going back to work.
Too often, providers choose a conservative intervention in the beginning of a workers’ compensation case, usually due to its low cost. But when applied in the wrong circumstances, conservative treatment can cost more in the long run, as later, more costly treatment is required.
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2. Identify At-Risk Workers Early, and Invest in Wellness as Well as Sickness
At the same time, preventing patients from spiraling downward at the onset of injury is crucial. Energi, Inc. has had demonstrable success with use of nurse case managers (NCMs) for those entering the workers’ comp system. Energi assigns NCMs to every patient, providing services from filing the claim, helping guide treatment and care, and accompanying patients to doctor visits.
Energi retained Risk Navigation Group, LLC, to conduct an analysis of medical management outcomes in two samples of claims. Risk Navigation examined incurred losses to determine if there was a distinction in the disability duration outcomes between two programs—one using NCMs for all claims and the other using NCMs in less than 40% of claims.
Use of NCMs demonstrated a materially and financially advantageous effect on both overall medical management and, more particularly, a diminution of disability duration in similar claims. Specifically, “days of disability” were reduced from 316.9 to 85.65 when NCMs were activated from day one. According to study authors, some companies consider it an extra cost, but NCMs have been known to help close workers’ compensation cases at 70 percent of what they would normally cost.
Another example of a company investing in wellness is Horizon Casualty’s innovative Pain Management Medical Home. Anecdotally speaking, patients with an unhealthy lifestyle (e.g., smokers, overweight/obese) combined with the psychosocial aspects of negative relationships at work or at home tend to be more likely to have a negative postinjury experience.
Strategic new initiatives such as the Pain Management Medical Home approach put patients on the best therapeutic course early in their care by implementing a care team approach. The care team consists of a diverse set of healthcare providers, including a physical medicine and rehabilitation physician, a functional rehabilitation provider, and a psychologist. This holistic approach to the patient’s care applies a biopsychosocial model to health care.
In tomorrow’s Advisor, we present the final three tips from Malanga and Woods.