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By DR. EDWARD CROUCH

An insurer's clinical experts can play a key role in working with treating physicians to deliver better disability outcomes. Brokers, consultants and employers can encourage such dialogue to improve disability durations and speed return to work.

Time. A great deal is asked of medical providers that has little to do with direct patient care. Time constraints may preclude providers from addressing issues that are not directly symptomatic, yet if recognized could greatly improve outcomes.

Expertise. The typical provider does not have the disability-management training to assess a patient's functional capacity; understand the nuances of job requirements; or appreciate the impact that workplace issues can have on their patients.

The complete clinical picture. An individual provider may be just one of many caregivers seen by a patient. Particularly for the most complex disability claims, it is easy for a provider to have an incomplete understanding of all of the results and opinions affecting a patient.

Communication. Communication between a patient and his or her doctor may be an issue. Because of physician time constraints in actually visiting with patients, and because of stress a patient may feel about their medical issues, there is a real risk of miscommunication. Failure to communicate may result in the patient leaving the appointment without fully understanding instructions or next steps.

Trust and credibility. Unfortunately, communication between attending physicians and insurers is not always a collegial dialogue between peers. It is recognized that some providers would bend the truth about a patient's condition if they thought it would protect their patients' best interests. Physicians in the employ of an insurance carrier are sometimes viewed as agents of the carrier, at the expense of their credibility.

Brokers, consultants, and employers are uniquely positioned to work with their disability insurer to overcome these challenges. Liberty Mutual has identified four best practices for building effective interactions between treating physicians and insurers which is critical to improving outcomes for both claimants and employers in disability-management programs.

Offer expertise. Providers benefit from education on key disability-specific topics, such as better understanding functional capacity, the importance of job descriptions and requirements in planning an employee's return, the impact of prescription drugs on certain job duties and how workplace challenges can affect patient wellbeing.

Few providers have the time to read and assimilate the wealth of available information regarding successfully returning their patients to work. But what if another physician with academic affiliation, relevant specialty expertise and a wealth of disability perspective were to contact the provider?

We've found that specialist expertise is welcomed, and collaboration often ensues. We have successfully partnered with attending doctors by utilizing independent consultant physicians from some of the best institutions in America.

Understand causes as well as symptoms. A provider may encounter a patient complaining of poorly articulated symptoms of anxiety or depression, or vague physical ones, and conclude that all a patient really needs is a break from it all -- a vacation.

The provider may not appreciate that workplace demands, performance issues or personal conflict won't resolve with time alone, and that the patient needs a better way of managing these problems in order to function more productively and to feel better.

If a credible peer is able to speak with the provider about such workplace issues, an opportunity arises to improve the patient's coping skills. Would the patient benefit from psychotherapy or cognitive behavioral therapy? Might it be better to remain at work while the necessary interventions occur? We have found that many disability outcomes are improved by identifying and addressing workplace or social issues; and the patient's provider welcomes the opportunity to collaborate.

Peer-to-peer communication. Foster a more effective exchange of opinions and data. Providers frequently work in isolation from other caregivers with little opportunity to interact. This fragmented approach may result in a lack of coordinated treatment planning, or even a lack of awareness of important tests result or diagnosis by a peer, especially for the most complex cases.

The disability insurer is in a unique position to offer a broad perspective about a given patient as they review records and results. A provider accustomed to a health plan's questioning utilization may be astounded when an insurer calls to discuss how to achieve a better patient outcome.

Highly trained care providers considering alternatives in a collegial way can be hugely beneficial, whether reinforcing an existing diagnosis and treatment plan or exploring alternatives.

Most providers want the best possible outcome and, in our experience, welcome discussions with an expert who shares this goal. A "curbside consultation" may lead to new perspectives and better opportunities.

Arm the patient. Patients that are ill or injured are frequently tense and possibly distracted. They want to get better and return to work, but may fail to address all of the issues associated with their disability or fully understand a provider's recommendations.

Good nurse case management helps patients understand their treatment, and stay organized to get the maximum benefit from their provider encounter. An organizational tool, such as a checklist can be provided to a patient by the nurse, claim manager or employer. A Consumer Reports magazine study showed that 89 percent of doctors surveyed approved of patients maintaining a notebook or diary of tests, procedures and appointments. A little upfront preparation and some good note taking during the visit can potentially affect the outcome.

Brokers, consultants and employers can contribute to improving disability outcomes and controlling costs by looking for insurers that actively build effective relationships between providers and specialists. Improved collaboration between carrier specialists and treating physicians might lead to a shorter disability, a more permanent return to work, more effective use of health care dollars, less future morbidity and mortality, and better engagement in programs that promote wellness or disease management.

Dr. Edward Crouch is vice president and national medical director for Liberty Mutual's Group Benefits area, which provides group disability, group life and absence management products to midsize and large employers through brokers and consultants.

November 21, 2011

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