2015 NWCDC

Shaping the Future of Workers’ Comp

Boeing is innovating to improve both its workers’ comp outcomes and the quality of health care delivered to its workers.
By: | November 13, 2015 • 2 min read

The reforms of the Affordable Care Act continue to transform models of health care delivery, and it’s only a matter of time before that transformation impacts workers’ comp medical management as well.

Chicago-based Boeing is trying to get ahead of the curve, embracing the reform tenets of accountable care, value-based pricing, and patient engagement.

Boeing’s Senior Workers’ Compensation Manager Lisa Kelly discussed the company’s efforts during a November 12 session at the National Workers’ Compensation and Disability Conference® and Expo in Las Vegas.

Boeing has since been able to realize significantly improved outcomes and lower costs by working to direct injured employees to five-star ranked doctors.

She was joined by Greg Moore, founder of Harbor Health Systems and senior vice president of innovation with One Call Care Management, as well as Sedgwick’s Kimberly George, SVP, and senior healthcare advisor.

In 2010, Boeing partnered with Harbor Health and Sedgwick to get a better handle on the quality of care delivered to injured employees. They developed a scorecard to measure their doctors by factors including total costs, claim duration, litigation rate, TTD and recidivism.

Doctors were given rankings from one to five stars. The disparity across the scorecard was sobering.

Boeing has since been able to realize significantly improved outcomes and lower costs by working to direct injured employees to five-star ranked doctors.

Additionally, Boeing recognized how the overall health of employees impacted its workers’ comp costs and overall productivity, and created partnerships to form two accountable care organizations to provide quality care and truly affordable coverage.

The relationship between comp and health care is changing, the presenters said, and it’s important for the workers’ comp world to play an active role in shaping the future direction of medical-care delivery.

“This change is going to happen, whether we bury our heads in the sand or not,” said Moore.

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]
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Insider's Perspective

CareRise on the Rise

CareRise Founder and CEO Tim Goux answers R&I's questions on the motivation to form his company and its growth prospects in the coming year.
By: | October 12, 2015 • 3 min read

The Affordable Care Act is creating a new landscape of health care risks. Risk & Insurance® talked to Tim Goux, the founder and CEO of CareRise, to get his take on some of the challenges post-acute health care facilities are facing and his motivation for forming his company.


Tim, we know you have a background in health care and that your family has owned and operated post-acute care facilities for more than 40 years. What was your motivation for starting CareRise?

I literally grew up in the business. My father purchased his first skilled nursing facility in 1968, the year I was born.  In the fall of 1999, I got a call from my insurance broker telling me that the General Liability premium for our 200-bed facility was going to more than triple. My heart felt like it went down to my stomach. The down payment for the entire year was equal to the previous year’s premium. It didn’t take me long to figure out that due to judgments in Florida and Texas on fall cases and wound care cases the insurance industry’s response was to triple and quintuple the premium.

What was one of your first steps?

In April of 2000 I wrote the business plan for CareRise. Through a family friend, I was able to get it to a semi-retired executive at Lloyd’s of London. He said ‘Tim this makes complete sense I want to come over to the states to see how you plan to implement this.’

That was followed by my own visit to Lloyd’s. I went to London at the age of 33 with a laptop and a notebook. After a week in the Lloyd’s tower talking to syndicate after syndicate I realized that what I was suggesting to them didn’t exist.

So that was back in 2000. It’s quite a stretch between then and now, when many of us are hearing about your company for the first time. Can you help us understand why all this took so long?

I kept CareRise quiet for years.  I had my other companies and I didn’t need the capital. I purposefully did not advertise. I didn’t want to go national, at least not at the beginning. It wasn’t until 2008 when we got notification that we were getting our first patent that I started reaching out to carriers to try and take our program national.

So how did that work? Who did you first contact?

When I learned that we were going to get the patent I wrote to the four largest players in this space. I didn’t know them. I sent a letter to Lexington and three other companies. The day after they got my letter, Lexington called me. Within weeks I was in Boston for meetings with them and they subsequently vetted us for seven to eight months. We then partnered with them and now CareRise is in 20 states and 135 cities.

What’s at the core of what you’re doing? What industry need are you fulfilling?


A number of things really. The Affordable Care Act is pushing patient days from the hospitals to the post-acute care facilities. The other piece is that administrative turnover in post-acute care facilities is quite high, as much as 50 percent annually on average. We’re providing registered nurses on the ground, working with our proprietary software, to provide consistent, effective risk management in these facilities. You have to have independent risk management that can add some long-term stability to the health care delivery system. CareRise is that independent intermediary, if you will.

So what can we expect from you in coming months, or for the year ahead? What’s your growth arc look like?

You’re going to think I’m crazy but moving forward with a new program that we are going to announce in a matter of weeks, it wouldn’t surprise me if we experienced 100 percent growth in the next year.

The R&I Editorial Team may be reached at [email protected]
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Sponsored Content by CorVel

Telehealth: The Wait is Over

Telehealth delivers access to the work comp industry.
By: | November 2, 2015 • 5 min read


From Early Intervention To Immediate Intervention

Reducing medical lag times and initiating early intervention are some of the cornerstones to a successful claims management program. A key element in refining those metrics is improving access to appropriate care.

Telehealth is the use of electronic communications to facilitate interaction between a patient and a physician. With today’s technology and mass presence of mobile devices, injured workers can be connected to providers instantaneously via virtual visits. Early intervention offers time and cost saving benefits, and emerging technology presents the capability for immediate intervention.

Telehealth creates an opportunity to reduce overall claim duration by putting an injured worker in touch with a doctor including a prescription or referral to physical therapy when needed. On demand, secure and cost efficient, telehealth offers significant benefits to both payors and patients.

The Doctor Will See You Now

Major healthcare players like Aetna and Blue Cross Blue Shield are adding telehealth as part of their program standards. This comes as no surprise as multiple studies have found a correlation between improved outcomes and patients taking responsibility for their treatment with communications outside of the doctor’s office. CorVel has launched the new technology within the workers’ compensation industry as part of their service offering.

“Telehealth is an exciting enhancement for the Workers’ Compensation industry and our program. By piloting this new technology with CorVel, we hope to impact our program by streamlining communication and facilitating injured worker care more efficiently,” said one of CorVel’s clients.

SponsoredContent_Corvel“We expect to add convenience for the injured worker while significantly reducing lag times from the injury to initiating treatment. The goal is to continue to merge the ecosystems of providers, injured workers and payors.”

— David Lupinsky, Vice President, Medical Review Services, CorVel Corporation

As with all new solutions, there are some questions about telehealth. Regarding privacy concerns, telehealth is held to the same standards of HIPAA and all similar rules and regulations regarding health information technology and patients’ personal information. Telehealth offers secure, one on one interactions between the doctor and the injured worker, maintaining patient confidentiality.

The integrity of the patient-physician relationship often fuels debates against technology in healthcare. Conversely, telehealth may facilitate the undivided attention patients seek. In office physicians’ actual facetime with patients is continually decreasing, citing an average of eight minutes per patient, according to a 2013 New York Times article. Telehealth may offer an alternative.

Virtual visits last about 10 to 15 minutes, offering more one on one time with physicians than a standard visit. Patients also can physically participate in the physician examination. When consulting with a telehealth physician, the patient can enter their vital signs like heart rate, blood pressure, and temperature and follow physical cues from the doctor to help determine the diagnosis. This gives patients an active role in their treatment.

Additionally, a 2010 BioMed Central Health Services Research Report is helping to dispel any questions regarding telehealth quality of care, stating “91% of health outcomes were as good or better via telehealth.”

Care: On Demand

By leveraging technology, claims professionals can enhance an already proactive claims model. Mobile phones and tablets provide access anywhere an injured worker may be and break previous barriers set by after hours injuries, incidents occurring in rural areas, or being out of a familiar place (i.e. employees in the transportation industry).

With telehealth, CorVel eliminates travel and wait times. The injured worker meets virtually with an in-network physician via his or her computer, smart phone or tablet device.

As most injuries reported in workers’ compensation are musculoskeletal injuries – soft tissue injuries that may not need escalation – the industry can benefit from telehealth since many times the initial physician visit ends with either a pharmacy or physical therapy script.

In CorVel’s model, because all communication is conducted electronically, the physician receives the patient’s information transmitted from the triage nurse via email and/or electronic data feeds. This saves time and eliminates the patient having to sit in a crowded waiting room trying to fill out a form with information they may not know.

Through electronic correspondence, the physician will also be alerted that the injured worker is a workers’ compensation patient with the goal of returning to work, helping to dictate treatment just as it would for an in office doctor.

In the scope of workers’ compensation, active participation in telehealth examinations, accompanied by convenience, is beneficial for payors. As the physician understands return to work goals, they can ensure follow up care like physical therapy is channeled within the network and can also help determine modified duty and other means to assist the patient to return to work quickly.


Convenience Costs Less

Today, convenience can often be synonymous with costly. While it may be believed that an on demand, physician’s visit would cost more than seeing your regular physician; perceptions can be deceiving. One of the goals of telehealth is to provide quality care with convenience and a fair cost.

Telehealth virtual visits cost on average 30% less than brick and mortar doctor’s office visits, according to California state fee schedule. In addition, “health plans and employers see telehealth as a significant cost savings since as many as 10% of virtual visits replace emergency room visits which cost hundreds, if not thousands, of dollars for relatively minor complaints” according to a study by American Well.

“Telehealth is an exciting enhancement for the Workers’ Compensation industry and our program. By piloting this new technology with CorVel, we hope to impact our program by streamlining communication and facilitating injured worker care more efficiently,” said one of CorVel’s clients.

Benefits For All

Substantial evidence supports that better outcomes are produced the sooner an injured worker seeks care. Layered into CorVel’s proactive claims and medical management model, telehealth can upgrade early intervention to immediate intervention and is crucial for program success.

“We expect to add convenience for the injured worker while significantly reducing lag times from the injury to initiating treatment,” said David Lupinsky, Vice President, Medical Review Services.

“The goal is to continue to merge the ecosystems of providers, injured workers and payors.”

With a people first philosophy and an emphasis on immediacy, CorVel’s telehealth services reduce lag time and connect patients to convenient, quality care. It’s a win-win.

This article was produced by CorVel Corporation and not the Risk & Insurance® editorial team.

CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.
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