In a year like no other, COVID-19 pushed aside many of the concerns and initiatives we expected to focus on in workers’ comp during 2020. The demands of the pandemic brought unexpected changes in several areas, some for the better and some for the worse. Moving forward into 2021, Healthesystems is watching four major trends:
In response to COVID-19 risks, over 20 states relaxed restrictions on the use of telemedicine for workers’ comp patients and most of those temporary rules have been extended into 2021. Telemedicine use has surged since the start of the pandemic, and workers’ compensation stakeholders have had telemedicine on their radar for some time. Based on results from Healthesystems’ industry survey telemedicine is the most important technology for workers comp and the use of telemedicine was the #1 change made by workers’ comp organizations in 2020 with 30% reporting that they also used tele-rehab services. As with most industries, over 50% of workers’ comp organizations have employees working remotely and the use of video conferencing software is spreading not just for internal meetings, but also for case management meetings and patient engagement.
Why this matters:
In some areas of the country, access to care was a serious issue for workers’ comp patients even before the pandemic, and the pending physician shortage (due to an aging healthcare workforce and anticipated retirements) will only exacerbate the problem. And even in areas where physicians are plentiful, telemedicine expands capacity and makes it easier for patients to get appointments. Not to mention that the same type of virtual visits can be used for other services, such as physical medicine and mental/behavioral health therapy. While a number of regulatory and practical challenges remain, remote/tele technologies offers many benefits to patients, providers, and payers.
Going hand-in-hand with tele/remote technology is a move to mobile. Industry stakeholders are discovering that we don’t all need to be in offices to get our work done and that we don’t need to stay in one place in order to stay connected. Mobile technology was cited as the second most important technology for workers’ comp in Healthesystems’ industry survey and the number of participants who see mobile as important increased by 10% over last year. In a recent Healthesystems’ study, 84% of injured workers reported that they were very comfortable using mobile devices, and 94% said they use their mobile phones often, preferring text messaging and email to communicate.
Why this matters:
More flexible and convenient communication channels for injured workers can accelerate the exchange of information and facilitate more timely approvals and care delivery. Mobile technology can also help expand outreach and patient engagement efforts. Patients and employees alike have grown accustomed to using mobile devices in other aspects of their lives, so the slower pace and additional labor required to employ older communication methods can encumber, rather than enhance, effective communications between stakeholders
Psychosocial and Mental Health Concerns
Psychosocial factors and mental/behavioral health were numbers 2 and 3 on the list of top disruptors to workers’ comp organizations, according to participants in the annual Healthesystems’ survey. Greater attention to mental health concerns has been building for several years in workers’ compensation with much of the initial focus on coverage for PTSD and other conditions that commonly afflict first responders. In 2020, five additional states enacted legislation to cover mental injuries, bringing the total number of states that have passed such legislation to 14 with another 16 states considering expanded coverage for mental injuries. In addition, awareness of how psychosocial and mental health issues can impact recovery has been growing. In Healthesystems’ most recent industry survey, 46% of survey respondents considered psychosocial factors an early warning sign of complex claims and 40% thought mental health conditions were the most concerning type of claim complexity.
Why this matters:
Psychosocial factors and unaddressed mental health concerns, such as extreme stress and anxiety, can hinder an injured worker’s recovery and lead to further complications, including depression and substance abuse. The many challenges of the COVID-19 pandemic have caused increased isolation and stress, making a bad situation worse for many injured workers. A growing movement toward empathy and engagement to ensure that we are treating the whole patient is a welcome development in workers’ comp that could help speed recovery and return to work.
Opioids: Ambiguity and Alarm
In June of 2020, the American Medical Association (AMA) submitted a public comments letter to the Centers for Disease Control and Prevention (CDC) asking them to remove limits and restrictions placed on opioid prescribing. Although drug overdose deaths increased by nearly 5% to 70,980 in 2019, including a record 50,042 deaths involving opioids, the AMA made the point that most deaths were due to illicit drugs, such as fentanyl, rather than prescribed opioids. And in a report on Physicians’ progress toward ending the nation’s drug overdose and death epidemic, the AMA noted that opioid prescriptions dropped by 37% from 2014 to 2019.
In workers’ comp, concern about opioids also appears to be on the decline. Only 14% of respondents to Healthesystems’ survey identified opioids as a disruptor in 2020, and only 33% considered opioids a concerning claim complexity. However, during the International Association of Industrial Accident Boards and Commissions (IAIABC) annual conference in September, panelists agreed that the prescription opioid crisis in workers’ comp is far from over.
Why this matters:
Opioid use disorders have long plagued the workers’ comp industry and, while we have made considerable progress in reducing opioid prescriptions, any increase in opioid deaths is a stark reminder of the risk these drugs pose. Even if most opioid deaths are caused by illicit drugs, it bears reminding that 80 percent of people who have used heroin first misused prescription opioids. The pandemic has largely been blamed for the increases we are seeing in opioid abuse and deaths, but the addictive properties of opioids make it unlikely that the problem will go away when the pandemic does and we must maintain safe and appropriate policies to protect injured workers.