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Jan
24

Telemedicine – Coventry’s approach

A few weeks ago I had the opportunity to virtually sit down with Coventry’s product development folks to hear what they’ve been doing with tele-. 

I checked in again this week, and here’s what they’ve been up to. Quick take – tele-triage is gaining traction, while patients are slower to agree to do virtual office visits.

Coventry, a provider of services ranging from networks to pharmacy benefit management, case management to durable medical equipment, is well into Phase One, of their telemedicine offering which is tied into Coventry’s Nurse Triage program, NT24.

Working with technology vendor KuraMD  Coventry’s nurse triage staff connects with the patient, evaluates the injury or illness, and, based on their findings, recommends an appropriate level of care whether it be self-care, a “live” visit with a clinician, or a telemedicine visit (urgent and emergent cases are identified at call onset). Diagnosis and other factors drive the recommendation.

While the program has been in place for the better part of a year, Coventry has found many customers have yet to embrace the telemedicine office visit. Customers have “a tough time thinking of this as an office visit.” Telemedicine providers provide initial visits where they can send patients to physical locations for physical therapy or for imaging studies. While TM follow-up visits are offered, to date most employers want patients to visit a provider for those follow-up visits.

The program is live with two TPAs; a total of 10 employers have been implemented to date nationally with 4 in single states. Employers are quite diverse, including labor, retail, temp staffing, and construction.

For those patients able and willing to use telemedicine for a virtual initial visit, Coventry uses providers contracted with KuraMD. Care coordinators initiate the tele-visit, ensuring the patient has the right technology, walking the patient through the set-up and sign-on process, then passing the patient to the clinician for the visit.

Concentra will also be working with Coventry in the future

Phase Two involves broadening the number of clinicians that can provide telemedicine and also offering telemedicine visits without the nurse triage component. As one of, if not the largest workers’ comp PPOs, Coventry is working to get information to the company’s contracted network physicians to educate them about the service and requirements, discuss compensation, and provide training. The credentialing process and standards are identical to the company’s “regular” network but there are more questions regarding state licensing to ensure compliance with state regulations.

Down the road, Coventry is looking to incorporate tele- into case management. Ideally, case managers would connect with the patient, provider, and/or employer via video conference and enter information in real-time into the company’s proprietary CM IT system. There’s much work to be done connecting with claims systems to identify the types of and format of information needed by adjusters, build data feeds, and separate out key bits of data that need an adjuster’s attention.

What does this mean for you?

Expect tele-visits to gain traction as patients use similar services for family members and their own care. Telemedicine is moving quickly in group health, and this will accelerate adoption in comp.

 


5 thoughts on “Telemedicine – Coventry’s approach”

  1. While I think tele-medicine has a place in WC, I do not believe it will be to the level that can be achieved in GH.

    It is easy in GH where you have a lot of colds, flu, rashes, infections and such to use the convenience of tele-visits.

    In WC most of the injuries are muscular skeletal injuries. These type of injuries are more subjective – determining the degree of impairment, range of motion, pain levels – how serious is the injury and the degree to which it effects the persons ability to function in their job. This is a lot more difficult to diagnosis electronically with the capabilities of todays technology than a cold, rash, infection, etc. How can you determine the degree to which a ligament has been sprained over the phone or a video conference. I think most doctors would tell you that they would have a very difficult time expressing an opinion on the degree of the injury without a physical exam for a muscular skeletal injury.

    I think Triage is a great use of telemedicine in WC. It helps determine who can self treat and who needs to be seen by a physician. Today that “decision” is being made by HR or the injured workers Supervisor – both ill equipped and uncomfortable in making those decisions. This can provided needed support in determining initial treatment and follow-up is always available.

    However, beyond that, it is going to be a difficult change in the mindset of employers to move to telemedicine for office visits in general. They will want the person seen by a physician in-person. There are a large number of employers who do not trust the employees in the WC process and allowing them to tele-commute to a doctor visit is going to be a tough sell. They want them moving and not getting comfortable with hanging out at home. The last thing the employer wants is for them to get comfortable not having to leave the house on a regular basis as part of their WC process – it will add to the disability mindset. I am not saying this is the right approach but, practically speaking, it is they way things are today.

    I also think in disputed cases, bringing in Tele-Medical records vs. medical records from a physician who has seen the patient are not going to carry the same weight with a WC judge. Like it or not, a physician who has never seen the patient in-person is going to be dismissed by the WC judge.

    Let’s not forget that Prato’s rule applies in WC. Those 20% of the claims are going to be a hard sell for tele-medicine with the technology and process that exists today.

    1. Hello Ken,
      While I appreciate your well thought out answer, as the medical director of KuraMD, with multiple concurrent continuum of care visits happening with a large retail group, I would respectfully beg to differ.

      1. Brittany,

        I am glad you have gained traction in using Telemedicine in WC. As I noted, I think it has an opportunity and place in WC – just not mainstream. .

        However, in the complex claims and litigated claims – the ones that drive 80+% of the cost – I do not see this being a viable service with today’s technology and rules & regulations in WC. The requirements for documentation in the WC process (which are much different than GH process) are such that this will not be able to meet the “burden” required for evaluation, treatment and rating in WC.

        Unfortunately, WC moves at a much slower pace than most other industries. The complexity makes it more difficult to disrupt.

        I know that lots of people will say that I am too “old school” and have blinders on when it comes to progress. Maybe so, I just know what I know about WC.

  2. Joe, call me an old-fashioned country doctor (ok, suburban), but I think evaluation of musculoskeletal injuries without a hands-on physical exam is potentially problematic. I did a mock telemedicine visit with one of our providers a few months back, and while it was very slick, the lack of hands-on is a concern. Also, I do think that this service may be a challenge for some injured workers who are not tech savvy. I see these as the main practical obstacles.

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Joe Paduda is the principal of Health Strategy Associates

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