Benefits and Compensation

Leave Your Wellness Comfort Zone—More Tips for Employers

Yesterday’s Advisor
presented the first two of five ways to invest in wellness from Dr. Gerard Malanga, MD, and Robert D. Woods Jr. Today, Malanga and Woods cover the final three.

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.

3. Embrace Innovative Treatment Solutions

The panelists agreed that physicians have limited options when it comes to treating musculoskeletal pain, the most common form of workplace injury. Today, treatments are geared towards what’s reimbursable rather than what is best for the patient. According to Ralph Ortiz, MD, “Pills, passive physical therapy, and injections only mask the pain—there are newer therapies available, showing real patient improvement—let’s get rid of the red tape, be the innovators, and try them.”

Dr. Ortiz is mainly speaking of innovative, new treatments currently available, but not yet considered part of the generally accepted standard treatment protocol (and thus unlikely to be covered) by the insurance industry. However, more progressive workers’ compensation providers are opening the door for patients to have access to new and innovative treatment options because they recognize the importance of the quality of care, and appreciate each injured worker as a patient, not just a line item.

Some of the novel therapies that may be useful in some circumstances that were discussed by the panel include four distinct therapeutics that enhance the human body’s natural healing processes:

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4. Advocate for a Paradigm Shift That Alleviates the Implications of Current Public Policy

The Affordable Care Act (ACA) had one key change that, intentionally or not, had major ramifications for the workers’ compensation industry. Historically, group health and workers’ compensation were billed as “fee for service,” meaning healthcare providers were reimbursed based on the services provided for a patient (including diagnostics, procedures, and office visits).

But post-ACA, workers’ compensation remains fee for service while group health switched over to capitation, in which doctors are reimbursed a lump sum per patient based on their diagnosis and thus must manage the patient’s healthcare within a fixed budget. The result: For patients with chronic degenerative conditions—a bad knee, a bad shoulder, a bad back—it’s more efficient and more financially sound for insurance and medical professionals if patients can be classified under workers’ compensation because the patient’s cost of care is not capped.

While the primary goal of all stakeholders should be to ensure quality patient care, the financial motivations (Where can a provider make the most money?) and budget considerations (How can a payer save the most money?) are real. Says panel participant and employer, David Cohen, “What all involved must keep in mind is, getting a patient back to good health—and work—faster, will always be the ultimate money saver.”

Reversing this trend requires the collaborative efforts of key stakeholders: workers’ compensation insurance carriers, employers, and providers. Through productive and transparent collaboration, evidence-based coverage policies can be established to support diagnostic and therapeutic products and services that deliver high-quality health outcomes. This represents a shift in the workers’ compensation industry from “fee for service” to “pay for performance,” in which financial rewards are only realized upon production of quality health outcomes.

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5. Move Out of Your Comfort Zone

True, disruptive change in any industry comes when the participants move beyond their comfort zones. To break the cycle of ineffective pain treatment and workplace injuries that go unresolved for years, medical professionals need to stop treating patients according to old patterns. All players should take a fresh and unbiased look at evidence-based medicine and adopt a more open attitude to promising new therapies. Taken together, these recommendations have the potential to unlock a bright new future for all who are involved in treating workplace injury.