The New Normal
Four years after a firefighter sustained third degree burns over 95 percent of his body, he’s not just alive, but he’s counseling other burn victims.
And several years after a 40-something forklift operator suffered a pelvic fracture, a traumatic brain injury and a spinal cord injury, the karate black belt returned to his dojo and hopes to teach karate from his wheelchair.
Five or 10 years ago, these injured workers wouldn’t have lived a week after their injuries, say their medical teams. Thanks to recent advances in medicine and technology, more catastrophically injured workers are surviving and, while not returning to their former functionality, are leading productive lives, said Sherri Hickey, director, medical management, Safety National.
As a result, the workers’ compensation community is “dealing with more, and longer, and more expensive claims,” Hickey said.
A virtue of workers’ compensation coverage, said Dr. Michael Choo, chief medical officer, Paradigm Outcomes, is that it “takes the long view” of the injured worker’s needs. “Generally, health care focuses on the first few weeks, a month, or a year, but effects from burns, spinal cord and traumatic brain injuries last forever.”
Because catastrophic injury claims often last for decades, the goal should be the best functional outcome possible in each case, said Choo, both for the patient’s quality of life and as a claims management strategy. “The best functional outcome translates to the lowest level of disability,” which itself translates to greater independence and lower care costs.
The best care doesn’t come cheap, said Michael Coupland, psychologist and rehabilitation counselor, network medical director, IMCS Group, but it’s cheaper in the long run than cheap care.
“Carriers and employers typically want the best doctors, the best rehab facilities, the best equipment, the best care management because they want to do the right thing for their workers and because the best care prevents returns to the hospital for complications such as skin wounds and infections” — the kinds of ailments that arise from fragmented care, oversight or neglect, said Choo, formerly CEO of a for-profit hospital before joining Paradigm.
“The financial payoff comes down the road.”
Management of these cases can be infinitely complex, he said, as medical conditions may change constantly, affected by comorbidities (such as high blood pressure and obesity, secondary effects of physical inactivity), psychological/social health (which can decline with pain, depression and isolation) and past medical issues.
They also involve a multitude of providers — all the physicians, therapists, home health aides, equipment suppliers and transport services — engaged in the patient’s care. A “big believer in teamwork,” Choo recommends keeping all stakeholders aligned to the same goal, an achievable degree of functionality.
When the financial payoff comes, Choo said, “we get five times better results at 40 percent medical cost savings,” than catastrophically injured patients who receive à la carte care.
Because of the huge volume of traumatic brain injuries, burns, spinal cord injuries and amputations resulting from military engagements, companies have been researching and creating function-restoring technologies, Hickey said.
The results would stun a science fiction writer: skin grafts grown in the laboratory from the patients’ own DNA; drones launched from wheelchairs to conduct surveillance on the surrounding topography; brain-controlled robotic suits that restore some neurological function; exoskeletons.
Most technology is not the gee-whiz stuff. For example, the Apple watch will soon track fitness for wheelchair users. And a device called Pants Up Easy helps wheelchair users and people with spinal cord injuries get dressed.
Effective, low-cost technologies borrowed from smart phone fitness apps are producing a huge shift in patient monitoring, Coupland said.
For example, biofeedback apps measure heart rate variability, an indicator of stress and mood, and provide a mechanism for controlling them. Pain and mood diarizing are moving toward these technologies, as are sleep and activity tracking.
Telehealth technology can help providers manage vital signs all day, not just during an office visit by identifying changes from the baseline, said Kevin Glennon, vice president, home health and complex care services, One Call Care Management. And they’re useful for tracking medications.
“Patients hit a button when they take their meds,” he said, informing providers that they remain on schedule.
While technology can enable more independence, it can also contribute to more sedentary lives. Social media may contribute to inactivity — and obesity.
Obese people need greater doses of medications, and those who are also disabled may need a higher level of care for mobility, bathing and toileting. They may need bariatric or heavy-duty equipment. “If the patient weighs 300 pounds and the power chair weighs 325, the home would need assessment” for weight-bearing capacity, Glennon said.
“Generally, health care focuses on the first few weeks, a month, or a year, but effects from burns, spinal cord and traumatic brain injuries last forever.” — Dr. Michael Choo, chief medical officer, Paradigm Outcomes
On the other hand, technologies such as high-end prosthetics may allow greater independence and activity. “If the patient was a runner before the accident, we’ll buy running as well as walking prosthetics,” Hickey said.
Will carriers pay, especially for new technologies? With input from research and medical experts, payers review on a case-by-case basis, said Maureen McCarthy, senior vice president, claims, Liberty Mutual. “We seek input on experimental devices and treatments. Payment isn’t a barrier to care in the workers’ compensation environment.”
Many factors contribute to a well-planned discharge plan, said Scott Peters, clinical director, neurorehabilitation and neurobehavioral system, ReMed: the worker’s abilities and prognosis, the medical and therapeutic treatment, home modifications, and family support as well as the worker’s outlook on life, ambitions before and after the injury, and likes and dislikes.
For example, said Zack Craft, vice president, rehab solutions, One Call Care Management, while the injured forklift operator — we’ll call him Job for his tribulations and the vigor of his spirit — was still in his high-end inpatient rehab facility, One Call started planning for discharge.
Job wanted to go home and re-engage in the community — itself a predictor of success — not to a step-down facility. However, his return to the split-level home he shared with his wife was impractical because of the cost of modifications; it would require an elevator. Besides, his wife had left him, leaving him with a single income equal to 66 percent of his former salary.
One Call arranged for a year’s lease on an apartment that needed only minor modifications and for a 24/7 home health aide while he sold his house. He applied the sale proceeds to buy a new house.
And he needed transportation. The transport van, although medically justifiable, was very expensive and didn’t fit Job’s idea of himself as a motorcycle and pickup truck sort of guy. A new van would cost a prohibitive $70,000 to $95,000.
Using its network of used vehicles, One Call located a year-old, pre-modified van for $40,000. It applied for and received approval from the Washington State workers’ compensation regulators.
Was Job happy?
“He wanted to return home and get back to living,” Glennon said. “Often, when workers can’t get past the depression and denial, they lose their will to strive for independence.” &
Facing the Unthinkable: What happens in the hours, days and weeks following a sudden, disabling injury?
Road to Recovery: When it’s time to send patients home, there are new challenges to tackle, for both patients and payers.
Creeping Catastrophes: The final story of the series (coming in November) focuses on “creeping” catastrophic claims.
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. &
Sparking Innovation and Motivating Millennials
Two trends in the insurance industry, if they continue, could compromise its vitality in today’s fast-paced, technology-driven business world: slow innovation and a scarcity of millennial talent.
The quests to develop innovative solutions and services and to recruit young people to the field have raised concerns in the industry for several years, causing some insurers to think about how they will stay viable in the future when senior-level managers begin to retire.
But Lexington Insurance Company, a member of AIG, may have found a way to spark innovation that also engages millennial minds.
Innovation Boot Camp started three years ago as a one-off project meant to identify young, high-potential employees, give them exposure to senior management and evaluate their teamwork and leadership capabilities.
“The original concept was fairly straightforward. We would bring together a group of about 30 high potential employees for some semblance of team project work and it would allow management to gauge and assess talent,” said Matt Power, Executive Vice President, Head of Strategic Development, Lexington Insurance.
Little did he know how well the program would not only generate a plethora of innovative ideas that would drive the company forward, but also reinvigorate younger employees.
“The boot camps would be focused on innovation, with the idea that if we ended up with a concept or product that we could commercialize, then the boot camp would have been effectively self-funded. When they came back at the end of the 12 weeks, we were absolutely shocked because they produced about half a dozen products that have since been commercialized and are in some phase of being rolled out.”
— Matt Power, Executive Vice President, Head of Strategic Development, Lexington Insurance
New Ideas Emerge
The inaugural Innovation Boot Camp began with a two-day kick off meeting for participants— consisting of six teams with five or six participants. Each team was tasked with developing a business plan, and began to connect virtually over the next 12 weeks. The plan would culminate in a presentation to a senior management judging panel at the program’s conclusion.
“The boot camps would be focused on innovation, with the idea that if we ended up with a concept or product that we could commercialize, then the boot camp would have been effectively self-funded,” Power said. “When they came back at the end of the 12 weeks, we were absolutely shocked because they produced about half a dozen products that have since been commercialized and are in some phase of being rolled out.”
Power credits the program’s success in part to the participants’ youth. They were tuned in to different trends and issues than their more experienced counterparts.
Cyberbullying, for example, was a problem that didn’t exist for Power and his contemporaries as they grew up, but was salient for millennials. Based on the presentation of one group, Lexington developed coverage on their personalized portfolio for exposures associated with cyberbullying.
Likewise, “they educated us on the emergence of the craft brewing industry and how rapidly it was growing in the U.S.,” Power said. “That led to us launching a whole suite of products for craft brewers.”
Another team brought forth the concept of how rapid sequencing laser photography could be used to create a three-dimensional picture of a construction work site. That would allow contractors or claims managers to virtually walk through the site at a given point in the construction process to identify deviations from the original blueprint plans.
The images could memorialize the building process down to the millimeter, to every screw and wire. If a loss emerges later on due to a construction defect, the 3D map would be a valuable investigation tool.
Innovation Boot Camp proved so successful that Lexington expanded it to other arms of AIG all over the world.
“Suddenly we started getting calls from London, Copenhagen, Brazil,” Power said. “We were doing these programs for our global casualty team, for our lead attorneys in New York, for our financial lines group, and so on. We recently embarked on the 16th iteration of this program in London, with additional programs in the works.
“It’s a journey that has evolved from trying different things and not being afraid to fail, not being afraid to try new ways of thinking about the business.”
Engaging Millennial Minds
In addition to generating new product ideas, Innovation Boot Camp also engages younger employees more fully by offering the opportunity to make meaningful contributions to the company through independent work that requires some creative thinking.
Past participants are often great crusaders for the program.
“A program like IBC is something rarely seen at a large corporate conglomerate, and really a concept for new age startup companies,” said Alyson R. Jacobs, Vice President, Broker and Client Engagement Leader in AIG’s Energy & Construction Industry Segment. “But we were given a chance to work with people of all different professional backgrounds, and that environment unearthed concepts and solutions that have made a significant impact in the lives of our insureds and their employees.”
The chance to do work that makes a difference, both for the success of their company as well as the clients its serves, is what attracts millennial employees to the program and motivates them to devote their best effort to the project.
“Millennials want to be able to share their ideas and make meaningful contributions at work,” Power said. “Innovation Boot Camp has evolved into the perfect forum for that.”
David Kennedy, Esq., Product Development Manager for Lexington Insurance and former Coach for two Innovation Boot Camps, said the program engenders an “entrepreneurial spirit of developing something new, of applying analytical rigor to emerging risks to create unique and timely solutions for our clients and the marketplace.”
Exposure to senior executives doesn’t hurt either.
“It provided a platform for me to not just interact with our Senior Executive leadership but present a concept that could potentially be adopted by our company in the future,” said Ryan Pitterson, Assistant Vice President, AIG. “It helps to build your internal network, elevate your profile in the company and connects you with our client base as well.”
At a time when recent college graduates choose employers based on how much opportunity they’ll be given to have meaningful input — as well as opportunities for advancement — projects like Innovation Boot Camp could be the answer to the insurance industry’s struggle to pull in millennials.
“We give them the time, space and resources to create something new,” Power said. “When employee engagement is done right, it inspires passion and creativity.”
As multiple arms of AIG adopt Innovation Boot Camp around the globe, both the quantity and quality of new ideas are bound to flourish.
“The bottom line is, many heads are greater than one, and AIG has figured out how to leverage this. AIG hears their employees’ voices and enables those ideas to take our company into the future,” Jacobs said.
To learn more about Lexington Insurance, visit http://www.lexingtoninsurance.com/home.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Lexington Insurance. The editorial staff of Risk & Insurance had no role in its preparation.