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Innovation in work comp – part 2

Yes, there is some “innovation” in workers’ comp – but none that’s “disruptive.”

Not yet.

and it’s because too many of us are like the hitter below.

After yesterday’s post, I received a slew of emails from folks detailing their innovative approaches/systems/applications, some of which are noted below. I much appreciate this.

That said, I would suggest that while to the folks involved their efforts may seem innovative, that innovation is limited to a pretty narrow segment of the work comp world. What is missing is disruptive innovation – game changing, real disruption.

Think smartphones – they’ve totally changed how we communicate, drive, get information, use telecommunications.

Here is an example of what I see as truly significant innovation.  Next week I’ll be digging into a couple more.


Make no mistake, the combination of broadband, smartphones, and new programming languages will disrupt how healthcare is delivered, managed, and reimbursed. For workers’ comp, this goes well beyond telemedicine – doctor visits enabled by the internet. Here are just a few ways “telepresence” will be used in workers’ comp,,,

  • Tele-triage, with the triage nurse interviewing the patient, observing the accident site, and using professional judgment enhanced by artificial intelligence to recommend next steps
  • Follow-up doctor visits delivered via telemedicine, enabling script re-fills, monitoring of functionality improvement, and eliminating travel and out-of-work time and expense
  • “Tele-presence” case management – think a hybrid between telephonic and field, without the windshield time but with the real nurse-to-patient-to-provider-to-employer face-to-face interaction.

And all interactions are recorded, stored, indexed, and available to all parties instantly. Adjusters get notified instantly of potential issues, don’t have to wait for email downloads, or wonder if an “office visit” happened, or try to figure out on their own if the patient is “compliant”.

Think about this – workers’ comp is a declining industry – injury rates have dropped about 60% over the last 25 years – and will continue to drop. Whether you’re a bill review company, case management firm, occupational medicine provider, or TPA, you’re going to be fighting over a slice of a smaller and smaller pie.

A provider network can get into the care delivery business, gaining top line revenue by actually providing “office visits.”

A case management firm can deliver more value and gain revenue – with higher margins, across a broader spectrum of services. Directing patients to specific (affiliated or contracted) providers, documenting same, and actually providing that initial physician’s evaluation via telemedicine. More revenue, stronger ties to customers, and better margins.

A peer review firm can do face-to-face meetings between the peer reviewer and treating physician/patient/provider, gaining a better understanding of the issue, while documenting same for the claims handler’s use.

A catastrophic case can be routed to a physician expert in the diagnosis, who can provide insight into optimal treatment plans, evaluate the medical condition, and assist the local provider to ensure the right care is provided – immediately.

What’s standing in the way of widespread use of tele- in workers’ comp is what we talked about yesterday – our culture.

Fear of innovation; obsessive focus on “proof” something works before implementing it widely; complacency; deep-rooted comfort with the status-quo, all are why work comp is adopting tele- much more slowly than group health.

What does this mean for you?

If you never take the bat off your shoulder, you may earn a walk – but you’ll never get a hit and you will strike out a lot.


8 thoughts on “Innovation in work comp – part 2”

  1. What’s more sad is the telemedicine in all other facets of healthcare is old news. There are so many other forms of technology where tele is just a small piece of the puzzle; care plans along with increased patient engagement (educational text messages for instance) is the real game changer due to the fact that co-morbidities like heart disease, diabetes and mental health impact the success or failure of injuries or other health issues.

  2. Sedgwick has a tele-medicine pilot program going on now out in California. They are planning on adding other offices over next 3-4 months as they develop the program and get the kinks out. So, hopefully, we are on the cutting edge of things…

  3. Then there is the resistance to my idea to solve the physician and nurse shortage predicted. And to save money.

  4. Joe,

    Really!? The Mets! Talk about a broken system but, we will save that for another time.

    I do want to challenge you on the notion of WC as a declining industry. Not to sound like a broken record but, the claim “volume” in WC is not declining nor are the loss costs which are factors that affect service providers. There is no question that the Rates on the other hand are but, that is a math problem. if you look at the “volume” over the last 5 years you could say it was flat or slightly increasing. One good report to check out is the CHSWC 2016 Annual Report. It is one of the few reports that gives actual claim counts (not sure why many others don’t but C’est La Vie). It shows that over the last 5 years in CA that claim counts have risen slightly even though “rates per” have been declining.

    Don’t get me wrong, there has been a decline in overall claim volume over the last 25 years but, more recently I would argue that it remains flat. While being flat for service providers or even increasing slightly is not a great thing, it is not in decline.

    John Burton did a great piece on claim count decline, finding that a good deal of the change previously was due to a change in causation standard. Since most states have already made that change (IL is one of the few who haven’t and based on the political stalemate going on there not likely to soon) so, the well is dry there.

    I also think the litigation around Uber and some other gig economy companies may change the tide on “who is an employee” and what WC benefits are required.

    Last but, certainly not least, is the fraud component which you and others have raised as serious concern more recently. You can’t have claims if there is no WC coverage or owners are playing games with the injured workers. As states step up enforcement, I think we will find all sorts of interesting things start crawling out from under this rock.

    My point in all this is that I don’t believe, based on the claim volume data, that the WC industry is in a decline for service providers and that claim volume will increase over time albeit slowly.

    1. Ken – thanks for the comment. Looks lke there is a difference as you are referring to total volume and I’m focused on frequency. According to NCCI frequency has been down every year save 2 since 1995. Also, I’m in the midst of my annual survey of drug management in work comp, and the vast majority of respondents are telling me their claim volume has decreased.NCCI AIS 2017

  5. Joe, this is a great follow up post from your blog yesterday. Your description almost mirrors the white paper Consumer Health Connections (CHC) just released. We are excited to offer a solid, reliable and scalable telepresence platform to streamline the claims and case management process! Offering transparency and accuracy via a recorded telepresence intake saves time and money while providing a personal touch. Thank you for sharing your thoughts and opinions on how important innovation is in this industry. Companies have an opportunity to lead or follow!

  6. Joe – It’s a long shot getting in touch with someone of your stature. I reached out to you on Linkedin. I am an A player getting into the industry. Your article was exactly the thing I was looking for. I would be honored if you would allow me to follow up with you.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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