Health reform is affecting and changing healthcare deliverymodels, however, there is a large gap between the healthcarerelated to Workers' Compensation and the group health approach.

As a result of health reform, the industry has experiencedsignificant consolidation of health systems and medical practices,with an added emphasis on patients as consumers of healthcare, andproviders continue to evolve.

As employers, though, our message is confused. We tell employeesthat we have a great healthcare system set up for them, encouragethem to choose the best physician to meet their needs and to getregular checkups. However, if an employee gets injured, we have aseparate system with a separate set of doctors and a separate setof rules.

If employers can find better doctors to treat workers, they canimprove the quality of the Workers’ Compensation system itself.Employers are not going to get better doctors if they pay more, butif you can identify which doctors are doing a better job and rewardthem, results improve.

The holistic approach

California’s model has been experimenting with the concept ofincentivizing and rewarding doctors for providing superior care.This has resulted in significant cost reduction. Great doctors areactually reducing the amount of medical attention required and,overall, Workers’ compensation claims costs. As a result of bettercare and employee satisfaction, this has also helped to reducelitigation costs. Quality matters.

With advancements in technology, reimbursement models, focus onquality and the movement of connected care, health systems acrossthe United States are offering accountable care organizations foremployer benefit solutions. Many think that mergers andconsolidation are a bad thing, however, in this consolidated worldwhere health systems have changed, they are changing well care tosick care. By taking a holistic approach, you are able to take apatient from wellness to injury care. Workers' Compensation needsto be part of this discussion. If not, we cause an even greaterdivide.

This is not a new concept. In the 1990s, there were three24-hour care pilot programs that tried this approach and resultedin lowered cost and improved medical control. Ten states at thetime also mandated 24-hour pilot studies. Employers generally likedthe pilot programs that resulted in benefits such as increasedmedical control and reduced costs. On the national front today, theNational Institute for Occupational Safety and Health has a totalworker health program that considers the total person and thefactors that affect the individual’s health. The Workers'Compensation system could borrow and apply successful elements fromthese programs.

When you send an injured worker to the best and brightest, youmake the workers and their families feel like you are treating themwell. This gets the patient to do what the doctor wants them to doand stops the unfortunate spiral of delays in care.

Importance of technology

Technology is going to refine this even further. Technology willenable patients to get in touch with doctors immediately and willmake the worker feel like they were properly taken care of. Thiscould be extremely effective and efficient for the system.

When a connected care system is not in place, the gaps in careare leading to needless disability and extended absence. Technologyand telemedicine are essential components of this connected care.Gathering and analyzing health data is also important to drivepositive behavior and improve overall quality of care.

The patient base is also more complicated, and that is wherefinding the great doctor comes into play. Today, if you have apatient with a broken arm, you may also have a patient with abroken arm and diabetes, which is much more difficult to treat. Weneed to find these great doctors and find systems for them to workwith that operate far more efficiently. Technology is a very bigpart of that.

Overcoming the silos

The Workers' Compensation system currently is not set up toreimburse for this new model, including the use of nursepractitioners and physician assistants. The system needs to move inthis direction. There are simply not enough physicians to seeeveryone. These healthcare professionals are essential elements ofthe group system, and the Workers’ Compensation system could beimproved significantly by recognizing the need for these importantproviders.

Workers' compensation currently works in silos and that is anobstacle. The health system accountable care organization model iscommunicating directly to the employers. As this model becomesadopted, the board room is not seeing the financial benefits of itjust yet. However, when employers decide that they want change,change happens. It is just a matter of getting their attention. Wecannot stress the importance of heath, encourage employees to finda primary physician, and then tell the employee that they cannot goto their primary physician if they become injured on the job.

Employers are paying attention to the data that they receive onthe types of health systems. If the data around what is working ingroup health becomes available to employers, they will evolve.

Holistic care is certainly a trend that is largely becoming areality. Workers with sedentary lifestyles that become injured onthe job bring complicated connections between injury andpre-existing conditions that are hard to separate out. It makessense to treat the person as they are – as a whole person. It isvery important to try to get all of the systems to work together totreat the employee as one person.

We need a network that drives total employee health, and we canonly have that if group health and Workers' Compensation can talkto each other. Data is going to drive this evolution. The best-casescenario is if all of this wonderful science and data can be put touse to help patients and merge what currently are parallelsystems.

Kimberly George is a senior vice president at Memphis,Tenn.-based Sedgwick Claims Management Services Inc., and MarkWalls is a vice president with St. Louis-based alternative riskfunder Safety National. They host a webinar called “Out Front Ideaswith Kimberly and Mark.”