Here are 4 trends in worker compensation that payers and providers should keep on their radar: Risk and Insurance

Improving workers’ compensation processes becomes vital as service providers grapple with their own staffing issues.

The insurance industry faces a toll in the wake of the pandemic, talent acquisition issues and market uncertainty – and workers’ compensation is no different.

As leaders are forced to adapt, operational challenges have become opportunities, especially in the area of ​​empathetic care models like the much-loved psychosocial approachand in new value-added risk management strategies for clients and policyholders.

Mike Zblewski, Director of Security Services for National Accounts, Sentry, believes the new value-added services his company has developed during the pandemic have had major benefits for policyholders, but was also surprised to learn how his organization has benefited.

“Our services and the things we provide, we were there and provided risk management value that way. The COVID pandemic has forced us to step back and rethink. For us, we ended up adopting the virtual platform. It forced us to be more creative in looking at resources that we would never have leveraged internally. From there, we found areas that we didn’t know we could tap into and that we never knew we were good at,” he said.

Sentry now hosts monthly webinars to expand and reach customers, which have been popular with policyholders and which they plan to continue.

“The key word in all of this is creativity,” said Jeff Cole, assistant vice president of national accounts and FEMP at Sentry.

“If we look at our biggest customers, they’ve been dealing with supply chain issues, the need to change products and, even more so, staffing issues. So, out of necessity, many of our customers have become very creative in order to survive. In response to that, we did that too.

Anne Marie May of Amerisure Insurance, regional vice president – ​​risk management, saw similar results with the necessary COVID pivots.

“Fully operational technology programs include commercial automotive telematics/use-based insurance to modify driving behaviors, digitally connected wearable devices to help monitor, analyze and reduce ergonomic injuries while workers perform their jobs , and virtual reality training to enhance employee learning in a safe environment,” she says.

As the world continues to rapidly change due to the pandemic and other factors, here are four evolving worker compensation trends to watch.

1) Virtual reality is coming for Comp

Anne Marie May, Regional Vice President, Risk Management, Amerisure Insurance

Market to research suggests that virtual reality platforms in the healthcare sector are growing rapidly as technology develops and are expected to reach 18.7 billion by 2028. Patient rehabilitation is part of this market, composition workers providing near-perfect test cases of how to help control pain.

This growth has compounded the pressures of clinical management, as these companies face an unprecedented shortage of suppliers. A recent study of the American Medical Association predicted a shortage of 37,800 to 124,000 physicians within 12 years, with specialists leading the deficit.

For Kathryn Farley-Agee, vice president, provider network product development in Coventry, this has forced conversations about how to create networks for ideal care scenarios.

“On the network side, the question becomes, which providers do you need?” asked Farley Agee.

“Are they really doctors? Not today. They’re psychologists, they’re clinical social workers—mid-level providers. An example is California. Just last month they passed a law that said you could have LCSWs [licensed clinical social workers] in the network of medical providers, this is a major change. I think we’re going to start seeing more of that, because what states are hearing is that we need access.

2) MSA: another major concern

The added complexity is also fueling the Medicare placeholder, with astronomical MSAs forcing insurers to leave medical care open indefinitely in an effort to resolve cases. Jeff Stinson, an attorney at Swift Currie, says his clients are feeling that pinch with a term cap on medical benefits in his state.

“There’s not a lot of consistency to getting accepted onto the MSA,” he explained.

“There are reviewers who will say it’s signed by a judge so it’s approved, and you have taken our best interests into consideration. The person in the booth next to this reviewer might reject it. There is no consistency and so there is no way to give specific advice with certainty.

Coupled with an increasingly complicated medical picture, the workers’ compensation industry faces a long-term decline in claims, necessitating the increase in the value proposition in the medical and loss control. The latest news from the NCCI Line Status Report shows that lost-time claims frequency data suggests that the long-term decline has continued in 2021, despite a slight increase in frequency over the year.

“Lower claims frequency is the new norm, to the credit of risk managers who continue to implement policies, procedures and programs to prevent accidents and events that lead to workers’ compensation claims. “, said Del Doherty, founder and CEO of Prodigy. Rx.

“Organizations with the old model of success based on volume of claims will continue to struggle in this new normal.”

3) The big resignation

A big part of this new normal in a post-COVID world is the existential threat faced by the Great Resignation. The “quit rate,” as tracked by the U.S. Department of Labor’s Bureau of Labor Statistics Job Vacancies and Labor Turnover Survey (JOLTS) again at the top of the rankings, with 3% of voluntary departures at the initiative of employees, the highest rate observed in the series.

For Stephanie Arkelian, senior director of product management at Healthesystems, that means strengthening key areas of the business to weather the storm.

“For us, it is a question of doubling our efforts in areas where we have always endeavored to support our partners. For claims staff challenges, this means providing easy-to-use technology and workflow automation that removes the burden on claims staff, creates efficiencies, and enables claims organizations to do more with less,” she explained.

It also means integrating clinical decision support into tools to help claims staff who may be newly hired or less experienced. How can you provide a technology infrastructure that your partners can draw on without taking on this technology burden themselves? »

4) More empathetic handling of complaints remains important

Despite macroeconomic changes, claims management continues to evolve towards a more empathetic practice.

“The job of a claims adjuster is not easy. Being able to go from serving with a smile to being confrontational all the time under very real pressures makes the role a challenge,” Arkelian said.

Steve Donnelly, claims manager at Amerisure Insurance. “I can think of few things more rewarding for these experts than helping an injured worker overcome the many challenges of a serious injury and become a healthy, productive person again. In my experience, people just want to be able to make a difference.

Navigating this dichotomy is an area that experienced claims professionals in the space see continuing to improve as the psychosocial care model develops and its acceptance grows.

“Insurers at the time thought they needed to protect their space, and that didn’t lend itself to trust,” explained Matthew Zender, SVP work comp strategy, AmTrust Financial Services.

“If you offered trust, you were often betrayed. This led to a downward vicious circle. When we started moving towards the psychosocial approach, we moved away from treating injured workers as claimants to seeing compensation as a benefit. It’s a real difference in mentality. A benefit is something owed to you and a claim is something you request.

This extends in particular to the integration of mental health treatment, a key element of psychosocial approaches that the industry claims leads to better outcomes.

Tammy Bradly, Senior Director of Clinical Product Marketing, Genex

“We are now seeing a lot of interest from claims organizations in finding ways to better integrate behavioral health into the workers’ compensation claims management ecosystem,” Arkelian said.

“How can we help claims personnel, especially new or less experienced claims adjusters, navigate the sometimes complex claims decisions? This has always been important, and is even more so, in today’s staffing environment.

Tammy Bradly, senior director of clinical product marketing, Genex, agrees. “From a claims perspective, this has really driven the need for innovation and automation. Many companies are suffering from staff shortages, so any process improvements that can increase efficiency should be considered and I believe are being considered now.

Lower claims frequency, complicated medical issues, and the will to stem the bleeding of the Great Resignation may prove to be the crucible that allows the industry to evolve toward meaningful, compassionate work and better outcomes. . Only time will tell. &

Nina Luckman is a business journalist based in New Orleans, focusing primarily on the workers’ compensation industry. For the past few years, Nina has served as editor of Louisiana Comp Blog, a news site she launched in 2014 under the auspices of a group self-insurance fund. She can be reached at [email protected]

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