Value-based care, party changes in several states, as well as a holistic view when it comes to patient injuries will have a significant impact on the workers’ compensation industry this year, according to hosts of the Out Front Ideas webinar series, Mark Walls and Kimberly George.
The two workers’ comp industry experts continue their monthly webinar series, kicking off the New Year with a webinar on the “20 Issues to Watch in 2019” in workers’ compensation.
George, chief healthcare officer for Sedgwick, said to expect continuing healthcare discussions now that the Affordable Care Act (ACA) was ruled unconstitutional. States will continue to expand Medicare programs with a focus on addressing costs of prescription costs, she added.
“Big pharma is bracing for smaller, but significant, regulatory changes,” George said.
There will also be greater focus on value-based care – with the goal of improving health outcomes and quality of care.
“Elections in 2018 may have a big impact on the workers’ compensation landscape in 2020,” said Walls.
Governor changes in eight states – Alaska, Illinois, Kansas, Maine, Michigan, Nevada, New Mexico and Wisconsin, according to Walls, vice president of Communications and Strategic Analysis at Safety National, means new regulators and administrative law judges could significantly impact workers’ compensation practices in individual states.
In addition, the industry could see legislative changes resulting from the six states (Democrats: California, Alabama, Illinois, Mississippi and Florida. Republicans: Alaska) where one party has total control of the governorship and both legislative branches.
“I would put all of these states on the watch list for potential workers’ compensation legislation,” Walls said.
With the American Medical Association sixth edition guidelines to consider, Walls said states will need to address whether subjective factors should be considered in permanent impairment ratings.
Perhaps the most pervasive trend to watch is the overarching focus on the injured employee. Not only in the customer service sense, but there will also be continued emphasis on offering a personalized experience, with stakeholders increasingly viewing injured workers as consumers instead of claimants.
There will, George said, be a move to include the voice of the injured worker in the handling of their claims.
In addition, there will be increased focus on the social determinants of health, she said. The impact of loneliness, safe housing, employment and transportation concerns on a patient’s ability to heal and return to work will be examined. Workers’ comp payors are already addressing these issues by offering meal replacement delivery services post-surgery and offering caregiver services for food preparation and companionship.
The “psychology of pain” according to George is the biological, emotional and social factors that impact pain. When patients focus on pain, studies indicate their pain worsens. Employers and claims teams can address the issue by introducing a pain philosophy into their programs, she said. This includes creating pain assessment tools and identifying a pain expert that can consult on more complex cases.
Employee health models are another area gaining traction among employers.
“Employee health models are evolving with employer-purchased care, in part, because health insurers are not negotiating and managing costs in a way that employers can do so directly,” said George.
Other areas to watch include mega claims, natural disaster planning and dealing with impairment at work related to legalized marijuana.
This article was first published by Claims Journal.
