The Case for Exoskeletons
I hope more workers’ compensation insurers seriously evaluate paying for exoskeletons that allow patients with certain spinal cord injuries to rise from their wheelchairs and walk.
Exoskeletons are assistive devices often described as “wearable robots” or “Segways with legs.” Since 2014, the Food and Drug Administration has approved two models for personal use, including one earlier this year.
Some workers’ comp insurers have already approved a few claims for the motorized devices and the cost of training. Other underwriters have declined to fund them.
The battery-powered devices cost at least $80,000 plus additional training. Safety questions remain and some doctors who agree on the medical benefits they provide are still wary of certifying them as “medically necessary.”
But the products are among technological advancements in patient care — like increasingly sophisticated prosthesis — that payers should learn about to adequately weigh the exoskeleton’s price tag against potential medical care and medication expense reductions resulting from their benefits.
“Psychological benefits also result from standing, walking and looking others eye to eye. Well-being impacts claims expense.” – Clare Hartigan, physical therapist, exoskeleton clinical trail leader at Shepherd Center
Attendees at the National Workers’ Compensation and Disability Conference® & Expo in New Orleans can watch an injured worker’s exoskeleton demonstration during a session titled “The Bionic Claimant: Emerging Medical Technology’s Impact on Care and Cost.”
Clare Hartigan, a physical therapist who will speak during the session, has led clinical trials on exoskeletons at the Shepherd Center, a rehab hospital in Atlanta. She will be joined by Mark Sidney, VP of claims at Midwest Employers Casualty Co.
Exoskeletons’ well-documented medical benefits for spinal injury patients include improved bowel and bladder function, weight loss and better glucose test results, Hartigan said.
“Psychological benefits also result from standing, walking and looking others eye to eye,” Hartigan said. “Well-being impacts claims expense.”
Apart from clinical uses and workers’ comp, other exoskeleton applications are emerging. The military is testing robotic-like suits that could help soldiers carry more weight and reach the battleground less fatigued.
The National Institute for Occupational Safety and Health expects rapid growth in industrial wearable exoskeleton suits that can help workers lift greater loads or hold up heavier tools for longer periods.
But it would also be great to see more workers who have lost their mobility in workplace accidents benefit from the health and quality-of-life improvements exoskeletons offer. Perhaps that will come as more insurers learn about exoskeletons and begin evaluating their unit costs against their impact on medical expenses.
We can also hope for decreases in exoskeletons’ cost as commonly occurs with most technology products. But the companies offering them will need to recoup their R&D expenses. &
NWCDC: Connecting Body and Mind
Employers are increasingly adopting strategies to alleviate mental health issues influencing their employees’ disability and workers’ compensation claims.
Employer interest in doing so is emerging alongside technology’s advancing ability to analyze big data for insight into how mental health conditions impact disabilities and work absences, whether driven by occupational or nonoccupational causes, said Scott Daniels, director of disability at Comcast.
“You have the ability to see what the actual impact is of behavioral health conditions,” Daniels said. “When you can correlate the impact of behavioral health with absenteeism, presenteeism and productivity gains or losses it has opened the eyes of a lot of employers. Certainly, we are one of them.”
Daniels will discuss Comcast’s results after it eased employee access to mental health services during the 25th Annual Workers’ Compensation and Disability Conference® & Expo. The conference will be held Nov. 30 to Dec. 2 at the New Orleans Ernest N. Morial Convention Center.
Presenting session panels that integrate employer speakers with other claims experts to deliver real-life case studies highlighting practical solutions for workers’ comp and disability’s toughest challenges is an NWCDC hallmark, said Denise Algire, director of managed care and disability corporate risk at Albertsons Cos.
Structuring NWCDC’s program that way makes the conference agenda meaningful for employers, other claims payers, brokers, third-party administrators and insurers, Algire added.
“I am really excited about the focus on a case-study approach detailing how an organization implemented a particular program and solution,” Algire said. “It’s more than just a talking head approach” to conference presentations.
Algire is NWCDC program co-chair along with William Wainscott, manager of workers’ comp and occupational health at International Paper.
The two played key roles in selecting this year’s conference topics and speakers, including panel sessions addressing mental health’s impact on worker disability.
“Employers are recognizing that mental health issues associated with occupational injuries are real issues and must be dealt with,” Wainscott said.
“You have the ability to see what the actual impact is of behavioral health conditions [on injured workers’ recoveries].” — Scott Daniels, director of disability, Comcast
“But most importantly, employers are coming to realize the impact mental health issues might have on the injured employee’s recovery and return to work, and they recognize the impact on claims costs and productivity.”
There are several reasons for growing employer interest in mental health issues, Wainscott added. Mental health is now a more visible and increasingly acceptable discussion topic. It is also better understood while access to services and resources has dramatically improved.
As Daniels at Comcast asserts, mental health’s impact on claims has also become easier for employers to mine from data.
During a 2016 NWCDC presentation titled “Mental Matters: How Mental Health Impacts Productivity and Performance,” Daniels will be joined by Hilary Mitchell, director of employee health services at Pitney Bowes, and Darrell Brown, executive VP and chief claims officer at Sedgwick Claims Management Services.
About a year ago, Comcast strengthened its disability offerings by easing employee access to mental health resources rather than structuring its program with a strict focus on return on investment, Daniels said.
“It is aligned with our return-to-work [efforts] but getting employees better first by getting them the right care and treatment is much more important for the employee experience,” he said.
Another scheduled 2016 NWCDC session on worker mental health will focus on an analysis of Aetna’s short-term disability claims data, coupled with a case study of how employer UPS teamed with the insurer to reduce behavioral health disability claims, such as depression.
The presentation will be delivered by Donna Morrison, corporate healthcare director at UPS, and Michael Lacroix, associate medical director and director of behavioral health at Aetna and its subsidiary, Coventry Workers’ Comp Services.
Both mental health presentations mentioned above will be part of NWCDC’s Disability Management track. The conference includes 31 breakout sessions under five tracks, including Medical Management, Claims Management, Program Management and a Legal/Regulatory track.
The conference agenda also includes two additional Mega Sessions, a general session, and the opening keynote address.
Tim East, a corporate director of risk management at The Walt Disney Co., will deliver the opening keynote titled “Fueling Injury Recovery with Engaged Workers.”
A veteran workers’ comp practitioner, East also chairs the California Self-Insurers’ Security Fund and is a past chair of California Coalition on Workers’ Compensation, an employer group.
His speech will examine the importance of engaging injured workers to resolve claims and how evolving technology is shifting worker expectations for communicating and partnering with them.
Just as a major theme park can’t rely on attractions or entertainment using outdated technology that captivated prior generations, employers can’t apply outdated practices to engage today’s workforce.
For an all-at-once look at how several companies successfully manage their workers’ comp risks and safety programs, NWCDC is bringing back its popular session featuring 2016’s winners of Risk & Insurance®’s prestigious Teddy Award.
The award winners will share their techniques and advice for other risk managers during one of the conference’s Mega Sessions, titled “Steal These Ideas! Teddy Award-Wining Employers Showcase Their Successful Strategies.”
Dr. Marcos Iglesias, VP and medical director at The Hartford, will helm the conference’s other Mega Session. A popular speaker, Iglesias will discuss using tools such as a biopsychosocial approach to manage risk factors that predispose injured workers to experience disparate recovery durations and functional outcomes.
NWCDC’s Program Management track, meanwhile, will offer up more employer case studies.
For example, Mitchell Chastain, manager of logistics safety, loss prevention and security at Mohawk Industries, will join Keith W. Myers, regional director at BenchMark Rehab Partners, to describe how Mohawk combined safety practices and immediate access to injury care to improve metrics for outcomes.
The flooring manufacturer’s integrated health and safety practices include pre-employment testing, body-stress level assessments, and the use of athletic trainers and physical therapists.
Another Program Management track session will consider alternative arrangements for financing workers’ comp risks and structuring claims management operations as a company’s risk management needs grow increasingly complex.
A Mega Session with Dr. Marcos Iglesias, VP and medical director at The Hartford, focuses on using tools such as a biopsychosocial approach to help injured workers.
Pamela F. Ferrandino, EVP & senior principal, national casualty at Willis Towers Watson, along with Debbie Michel, EVP at Liberty Mutual and president of the insurer’s third-party administrator, Helmsman Management Services, will join Ronda Ostrander, manager of integrated disability management programs at Ascension Health, to deliver the session.
Other Program Management track topics include developing an employee advocacy program, building a separate safety program focused only on accidents causing severe claims, and a return-to-work case study.
The Claims Management track will include a look at how American Airlines’ Jennifer Saddy, the company’s workers’ comp director, adopted aggressive strategies that resolved thousands of complex legacy claims following a large merger. The strategies included eliminating inappropriate medical and pharmaceutical use, evaluating claims to judge when immediate settlements were preferred over intervention, and addressing Medicare set-aside cost drivers.
Titled “Fostering a Claims Closure Culture to Swiftly Resolve the Difficult Challenges,” the presentation includes speaker Mark Pew, senior VP at PRIUM.
Another employer case study within the Claims Management track will look at how Barnabas Health’s strategies slashed lost-time claims and millions of dollars in costs across dispersed corporate locations. Barnabas is a New Jersey-based integrated health care delivery system with 22,000 employees.
Caryl Russo, senior VP at Barnabas, and Caroline “Cari” Burhenne, regional claims service manager at PMA Cos., will lead the session titled “Transforming Your Workers’ Compensation Program for Outstanding Results.”
Other topics scheduled for the Claims Management track include telephonic case management, on-site physical therapy models, and a breakout session titled “Lessons Learned From Fighting Drug Abuse in the Opioid Crisis Epicenter.” The speakers will examine tactics a Kentucky insurer deployed to counter addiction in the Appalachian region.
For NWCDC’s Medical Management track, The Hartford’s Iglesias will join Robert Hall, corporate medical director at Optum, to deliver a session titled “Medical Directors’ Perspective: Restoring Function and Returning to Work.” They will discuss barriers, like co-morbid conditions that hamper return-to-work, as well as review measures for improving outcomes and managing RTW expectations.
Another Medical Management track session will consider the appropriate use of urine drug screening, which is an increasingly applied tool in the fight against opioid misuse. Maria Chianta, director, clinical and strategy programs at Millennium Health, and Randi Kretchman, regional head, medical management services, claims at AIG, will describe the insurer’s efforts to ensure appropriate levels of urine drug testing.
Breakout sessions under the conference’s Legal/Regulatory track will include a look at how Alsco Inc., a worldwide linen and uniform services company, improved its litigation-management practices to improve claims outcomes.
Suzanne Ormond, Alsco’s risk manager, along with Glenn Backus, president of Alternative Services Concepts, and Karen Stankevitz, director of consulting services at Adelson Teston Brundo Novell & Jimenez, will deliver the presentation.
Other NWCDC Legal/Regulatory track topics include a state-by-state look at legal trends, using medical experts for causation arguments, understanding prescription formularies, and alternatives to Medicare set-asides.
There is also a pre-conference event, the Third Annual Women’s Leadership Forum organized by The Alliance of Women in Workers’ Compensation.
The entire agenda is available on the conference website. &
Quality Care Outside the ER
A recent trip to the hospital provided a clearer understanding of why I am seeing more employers offer services that prevent minor workplace injuries from leading to unnecessary emergency room visits.
It was 6 a.m. the morning after my wife underwent an outpatient hospital procedure to remove fluid accumulating around a lung. She was experiencing shortness of breath and pain, but we didn’t know whether the symptoms were expected or needed attention.
Better hospital discharge instructions the prior day would have prevented our dilemma at an hour when the emergency room was our only source for medical answers.
We debated the necessity of the ER as we drove to the hospital and even as we walked in the door. We just needed someone to put our minds at rest.
Employees were shocked when they heard the real cost of emergency room care. The exercise gained their cooperation in reducing ER visits.
But walking into an emergency room claiming shortness of breath lands a patient in a bed followed by an intravenous fluid line insertion, a chest X-ray, an MRI and an EKG before the doctor feels safe offering a simple assurance that the problem is only residual symptoms from the earlier procedure.
Our visit illuminated why more employers are turning to triage nurses to determine whether a hospital emergency room visit is necessary or if simple first aid will suffice.
I help select winners of the Risk & Insurance® Teddy Award, given to employers with outstanding safety and workers’ comp programs. Among the 2016 Teddy Award applicants, I see more employers working to eliminate unnecessary emergency room visits.
One creative employer asked workers to submit guesses for the cost of receiving a few stitches during an ER visit. The closest guess to the actual cost received a gift card.
The employees were shocked when they heard the real cost. The exercise gained their cooperation in reducing emergency department visits.
Of course, employers must be wise about deploying strategies that reduce hospital visits. No one wants to risk exacerbating an injured colleague’s condition by discouraging necessary acute care.
Nor do employers want to run afoul of regulators.
Yet, more can be done to reduce unnecessary emergency room use, according to a 2013 RAND Corp. study. Better access to non-emergent care could help.
Interestingly, however, RAND found that while emergency rooms are often “targeted as the most expensive place to get medical care,” they actually play a part in slowing health care cost growth by preventing avoidable hospital admissions.
Emergency departments are playing a larger role in overall U.S. health care treatment as their complex diagnostic evaluation capabilities are increasingly used to support primary care doctors.
Though in our case, better discharge instructions would have helped us avoid the ER. &