How can the workers’ compensation industry get injured employees to participate in their own recovery? This is a question that’s top of mind for many program managers. Aside from the rare occasion when an individual might be trying to game the system, most injured employees want to progress in their treatment, so they can function optimally and return to work. However, there can be a myriad of obstacles along this path.
One of the key hurdles is ensuring injured employees have accurate medical information, so they can engage in their treatment — for example, this might include knowing how to take a medication safely, being able to properly follow self-care guidelines or understanding why it’s important to adhere to a prescribed home exercise regimen.
Key challenges in patient education
Health care has been pushed to its limits with factors originating with the COVID-19 pandemic. Many patients who deferred nonurgent care may now require more serious medical attention. We’ve all heard stories or experienced firsthand how hospitals, clinics, and doctors’ offices are now busier than ever — and, in many cases, short-staffed.
Even before the pandemic, the average visit with a physician had whittled down to just six minutes. In other words, in half the time it takes to hard-boil an egg, patients have to grasp the significance of their injury and its impact on their overall health and well-being; obtain step-by-step guidance on treatment and ask questions regarding their care. Needless to say, it hasn’t been feasible to cram all of the patient’s educational needs into such a short span of time.
When navigating the workers’ comp system, injured employees face the following challenges:
- Low health literacy: This type of literacy has to do with the degree to which individuals have the capacity to obtain, process and understand basic health information in order to make appropriate health decisions. Many groups—such as older employees, minorities and those living in underserved areas—may be more at risk for low health literacy. The United States Department of Health and Human Services reports that 1 in 3 adults has a basic or below basic level understanding of health information.
- Health misinformation & disinformation: As we experienced during the pandemic, misinformation and disinformation can be serious threats to a person’s health. Health misinformation is information that is false, inaccurate or misleading. Disinformation is misinformation that is spread intentionally to serve a malicious purpose, such as to trick people into believing something for someone’s financial gain or political advantage. Oftentimes, misinformation and disinformation are framed in a highly sensational and emotional manner, making it easy to spread quickly or go “viral.” Social media platforms and search engines have also contributed to the rapid spread of this type of information. One study found that false news stories were 70 percent more likely to be shared on social media than true stories.
- Complex clinical information collides with chronic conditions: More Americans are living with chronic conditions, such as diabetes, obesity and high blood pressure. This trend impacts injured employees as well. According to the National Council on Compensation Insurance (NCCI), the average cost of workers’ compensation claims connected to a comorbid condition is almost twice as much as that of comparable claims that do not involve comorbidities.
When employees are dealing with a chronic condition alongside a workplace injury, it can be much more difficult for them to navigate their own care. They need to track how their condition interacts with their injury, treatment, recovery and medications — for example, having a preexisting disease can often delay the recovery process.
- Fast pace of change in clinical understanding: The COVID-19 virus is still relatively new to researchers. The number of discoveries that scientists have made regarding the virus has been astounding and fast-paced — and, as such, our knowledge, protocols and safety measures have all had to evolve as new information has emerged.
Even within our own organization, we experienced first-hand the accelerated rate of clinical advancements. When the pandemic initially hit, we established proprietary COVID-19 guidelines, which served as an invaluable resource for our case managers and customers. But since their initial development, these protocols have had to evolve to include over 30 updates. This illustrates the constantly evolving nature of scientific and medical knowledge and, as an industry, we need to stay abreast of such developments in order to utilize the most up-to-date information.
- Social determinants may throw a curveball: Cultural differences, language barriers, and a host of other social determinants can also make it challenging for injured employees to navigate their care. For example, let’s consider some of today’s generational issues. Scheduling and attending appointments have gone virtual thanks in large part to the pandemic leading to a rapid adoption of telemedicine. But this trend also requires some proficiency with technology.
In other cases, being able to engage in a person’s own care means the individual must feel comfortable enough to question a physician, and at times, even challenge that physician’s treatment plan. But certain generations highly respect physicians and their medical opinions, so they won’t second guess their recommendations.
With these types of examples in mind, we must be able to adapt clinical information, patient education, and a treatment approach to an individual and his or her unique psychosocial issues.
Resources for patient education
If we can help injured employees by providing them with quality clinical information, they can be better equipped to engage in the medical process. Reliable clinical information can help them think of questions they want to ask or, if they have preexisting conditions, alert them to risks and potential concerns. These are issues they can then bring up during their appointments with their treating physicians. Besides physicians and other specialists who they may be referred to, additional resources include:
- Patient portals: Today, many workers’ comp programs are striving to offer patient portals that provide access to reliable clinical information. Such portals have long been made available to medical professionals, but now versions of these databases are being translated and distilled for the layperson. Injured employees can then use these portals to research and better understand their condition and treatment plan.
Physician offices and medical institutions often offer their own patient portals, but this leads to a decentralized way of disseminating information. And their databases are often geared toward group health, so they emphasize strategies such as preventive medicine and population management –rather than aligning with workers’ comp priorities, such as minimizing the risk of reinjury and setting return-to-work expectations. In other words, an industry-specific version must be curated from an occupational health perspective.
- Education & advocacy with case managers: In many cases, injured employees may need more than just information; they may need a personal health advocate. This is where case managers can be particularly helpful, and employers may need to determine whether their individual programs require more case management resources to help fill existing gaps given today’s overtaxed and understaffed health care environment.
We may have emerged from what’s been the worst part of the pandemic, but the health care industry is still experiencing challenges – chief among them is a significant nurse and physician shortage. Data intelligence company Morning Consult surveyed health care professionals and found 19% had quit their jobs since Feb. 14, 2020.
Case managers can play a pivotal role in patient education. They can also help identify comorbid conditions and psychosocial factors — all of which may require more strategizing and problem solving to achieve a safe and timely recovery. A case manager’s approach to patient education is also delivered in a more personalized, one-on-one fashion, which can help improve patient compliance and medical outcomes.
An educated patient is an empowered one
In a 2020 Genex Services patient education study, 97% of injured employees reported that patient education was one of the most important factors in their ability to recover. This shows that employees understand the importance of receiving the right information.
They need the right tools, such as patient portals, to help them understand their injuries, how to get on a path to recovery, and the ability to grasp all options — even if those options fall outside the scope of workers’ compensation.
The process also relies on compassionate health professionals, such as case managers, who can provide guidance when employees need it. Case managers will listen to their needs, wants and fears. They also help by teaching patients about their condition, advocating on their behalf, and giving them a sense of control and empowerment over their health, recovery and return to work.
Ron Skrocki is a leading authority in disability management and medical bill review services, with more than 30 years’ experience in medical management. As senior vice president of product management and development, Skrocki is instrumental in developing analytics-driven, flexible medical management strategies that implement utilization controls and data support to meet the current needs of today’s health care programs.
Opinions expressed here are the author’s own.