By Silvia Sacalis, BS, PharmD, VP of Clinical Services, Healthesystems
In my many years leading a clinical team at a pharmacy benefit manager, I’ve seen firsthand how drug therapy, when misapplied, can be a stumbling block to successful injured worker recovery and resolution of workers’ compensation claims. As AI technology became a key focus in our industry, I approached it with a balance of excitement and careful deliberation. Excitement for what this could mean for supporting my team of pharmacists and the valuable work they do in promoting therapeutic safety and effectiveness. But caution that, by embracing it, we ensure we don’t compromise the very human, and very vital aspects of managing the injured worker.
Human decision-making and empathy will always take the lead in managing any patient, including injured worker patients. They must. These competencies are, after all, what put the “care” in healthcare.
When it comes to care, where exactly does AI fit in? In my opinion, it is in supporting people in areas where they already excel, helping to amplify and scale their clinical superpowers.
Unwinding from Therapeutic Complexity
As a clinical pharmacist, I believe in the potential for drug therapy to help and heal. But all too often I have seen the other side of the coin; the detrimental effects of excessive or inappropriate prescribing. Too many cases still occur where the injured worker’s safety and recovery are compromised due to missteps in their drug regimen. The positive side of drug therapy is that when identified early, in many cases it can be modified. Medications can be gradually reduced, polypharmacy managed, pill loads decreased, and side effects alleviated.
This however is not a simple undertaking. Often there are other factors intertwined with therapeutic complexity. Comorbidities. Substance misuse. Mental health concerns. Managing these highly complex claims requires a high-touch approach, as well as highly informed decision-making.
It’s not just about the numbers; it’s about understanding the intricate details of each case. As clinical pharmacists, we bring our expertise and clinical experience to the table, making recommendations that can significantly impact the course of a claim and, most importantly, the injured worker at the heart of it.
Our role is crucial. We provide clinical guidance and support, ensuring patient safety, appropriateness of care, and cost-effectiveness. We dive deep into medical records and prescriber progress notes, identifying potential risks and recommending therapeutic changes based on current clinical guidelines.
It’s a meticulous process, but it’s incredibly rewarding to see the positive outcomes for injured workers.
The Power of AI and Technology
Now, let’s talk about AI. While the pharmacist’s expertise is irreplaceable, AI adds a powerful layer of support. It can help inform the direction of our reviews, identify and confirm red flags, and provide added context to our analysis.
For instance, AI can sift through pages of medical records, uncovering medical and behavioral insights much more efficiently than any human could. This synergy between human expertise and AI is a game-changer in managing complex claims.
Human Expertise and AI in Action
The integration of human expertise and AI represents a powerful approach. For example, AI can help identify and confirm an injured worker’s status as a concurrent smoker. Or a comorbid diagnosis of hypertension. Or identify multiple flags for anxiety. The pharmacist can then consume this expanded context and deliver personalized recommendations that will optimize therapy, reduce therapeutic complexity, and improve the safety and effectiveness of treatment for that particular individual. In this way, AI is helping management of the injured worker become even more personalized.
The other exciting part about this? The efficiencies gained with AI means the ability to scale. In pharmacist terms, what that really means is the ability to impact more people. And we can’t think of a more worthy cause to deploy our superpowers, with AI as our sidekick.
This article originally appeared on WorkCompWire.
