What Does Medical Care for Workers’ Compensation Look Like in the Future?
The medical care and recovery environment of an injured worker largely determines the outcome of a workers’ compensation claim. New medical technology, expanded telehealth, and AI have all contributed to the effectiveness of this process, offering a more holistic approach. In this session at WCI’s 2023 Workers’ Compensation Educational Conference, a panel discussed what medical care for workers’ compensation might look like in the future and what issues to monitor in the months ahead. Speakers included:
- Virginia Baba – Senior Manager – Claims – Risk Management | PetSmart
- Teresa Bartlett – Managing Director, Senior Medical Officer | Sedgwick
- Michele Maffei – Director of Workers’ Compensation | Publix
- Nancy Strubler – Director of Workers’ Compensation | National Express, LLC
COVID-19 Impact
Unfortunately, with the rise of the new Covid variant EG.5 (Eris), hospitalizations are up 20%. This variant is much more contagious, but overall not associated with worsening symptoms. A recently released study examining 300,000 medical files, found that 30-day-long hospitalizations with Covid are 2-3 times higher than the flu. While Covid claims make up less than 1% of workers’ compensation claims, long-Covid is the significant driver of these claims, represented in workers between the ages of 18-60. Symptoms include high blood pressure, fatigue, high pulse rates, clotting, diabetes, and neurological issues like brain fog. These cases are not represented largely in the older generation.
Healthcare Crises
The pandemic has caused a huge mistrust of the medical profession. Healthcare workers are now experiencing more combativeness and violence in their workplace when treating patients. Patients are not allowing treatment, however preventative or evidence-based. They are also rejecting the advice of their caretakers due to this.
The healthcare industry is also at a critical junction, with 20% of healthcare employees leaving the industry during the pandemic. An estimated 18 million workers will leave the industry by 2030 with 10 million being nurses. That leaves little time for training, creating a hiring crisis. The Baby Boomers will bear the burden of this, leaving them with little medical care in their later years.
Return-to-Work Challenges
There is a concern that some of the extensive, expensive procedures that doctors are requiring for an injury may not be necessary. Additionally, a lack of specialists, or the inability to seek additional resources may prevent employers from finding a better alternative for the injured worker. Light duty work can help bring an injured worker back to work faster and with better accommodations, but it creates a void in their previously-filled position. Employers with budget constraints may not be able to easily backfill these positions.
Employers with younger workforces need constant communication throughout the recovery process. Nurse triage lines can help direct appropriate care, with telemedicine providing a more convenient approach. Many of the cases with younger employees end up in litigation due to the unfamiliarity of workers’ compensation and because these individuals rely on the advice of friends and family, who may advise them to seek an attorney. This makes effective communication and timely payments incredibly important.
Technology Advances
Advances in AI are opening a world of opportunities. AI is currently being used to help determine the most effective pharmaceuticals for the best possible outcome, particularly in cancer patients. ChatGPT is also reading existing medical journals to analyze and investigate risks and solutions to diseases and conditions. AI can can also assist in automatic reserving by examining case history. However, AI does not capture certain claims elements including nuanced human interactions, and can detract from achieving the most effective recovery.
Pharmaceutical Trends
Semaglutide is finding another use outside of its original intent to treat diabetes, finding massive success in obesity treatment. Could it be used to help assist in the recovery of an injured worker? While it can initially help an individual lose weight, the long-lasting risks are unknown, including how the body will rebound once the drug leaves their system. It also does not motivate an injured worker to be healthy outside of weight loss through dietary changes and physical activity.
Zuranolone is a new postpartum depression neurosteroid medication, that could open up doors for those not responding to antidepressants. Even more incredible is the length of treatment being only two weeks.
Psychedelics are also in the wave of future therapeutics. Psilocybin is included in the Right to Try Act in the U.S., so it could be used in cases of recurring depression where antidepressants are not working. These treatments are administered by professionals, with patients receiving care accompanied through a specific path of care.