2020 clinical roadmap...sleep enough; more than half of u.s. adults with mental illness go...
TRANSCRIPT
2020 Clinical Roadmap & 2019 Accomplishments
Market Trends
The World Around You
Every day, we awake to a world altered in some way. Technology ushers in much of this change yet so do shifting expectations for how we interact and evolving societal norms.
Confidential & Proprietary 3
Technology is changing how we go about our livesPhone-first has become the default for how U.S. consumers interact with the world. We use our digital extremities to perform myriad tasks, track our health statistics, interact on social, pay for goods and services, and to marshal smartwatches, Bluetooth-enabled sensors, home-automation technology, and even medical devices.
Excellent service is no longer a delighter; it’s the expectationThe customer is always right. That hasn’t changed. What's different is how much consumers now expect every time we tap for a service or function in an on-demand, just-in-time world. We've grown accustomed to seamless service from our apps or from Amazon or from Netflix. Injured workers and our clients likewise expect interactions that are simple and satisfactory every time.
Medical marijuana is now legal in 33 states & Washington, D.C.Medical marijuana is becoming more widespread. It is legal 33 states, the nation’s capital, and several U.S. territories. Some states have sanctioned dispensaries and growing it at home while other states allow only home cultivation or only dispensaries. Research has found that greater legalization can drive usage rates higher. It remains illegal under federal law despite states’ actions.
Achieving Your Best Health
In health care, we’re broadening our understanding of what it means to be healthy by factoring in more psychosocial factors that are critical to well-being.
Confidential & Proprietary 4
Comorbid conditions complicate the treatment of injured workersClaims with a comorbidity diagnosis are growing and have about twice the medical costs of otherwise comparable claims, according to NCCI. Consider weight: Nearly 40 percent of U.S. adults are obese. By 2030, this could rise to half. Meantime, U.S. diabetes rates have nearly doubled in the past 20 years. The CDC predicts that one-third of U.S. adults could have diabetes by 2050.
Social determinants of health draw added scrutinyMuch of what drives health goes beyond fighting disease. More than one-third of workers don’t sleep enough; more than half of U.S. adults with mental illness go untreated. Financial worries cause anxiety and illness. Loneliness is also rising. So-called diseases of despair—drugs, drinking, and suicide — are driving unprecedented growth in mortality among some middle-aged workers.
PTSD can compound the challenges injured workers faceWorkers who suffer post-traumatic stress disorder have greater rates of absenteeism, more medical visits, an increased likelihood of unemployment or underemployment, lower hourly pay, and increased difficulty meeting work-related demands. While PTSD and other mental injuries aren’t widespread in workers’ comp, some experts warn that frequency could increase because of unreasonable workloads, long hours, and poor work-life balance.
Changes In How You Get Care
Thanks to technology and evolving business models, there are more means than ever for understanding, tracking, and promoting our health.
Confidential & Proprietary 5
Data analytics are helping better manage worker healthMachine learning and artificial intelligence are allowing for improved management of populations of workers and injured workers. These tools incorporate new and deeper data to render more detailed insights about groups of workers and individuals. This might mean broad information about a workplace’s safety or more precise predictions of adverse surprise claims.
Access to care is essential for avoiding poor outcomesWith a looming shortage of both primary care physicians and specialists, it will be necessary to identify added means for delivering care. Some treatment will be self-directed with things like smart speakers triaging injuries. And consumers will have more choices — closer to where they live — for meeting many everyday needs such as urgent care centers and pharmacy clinics.
Virtual care moves beyond simple triage to actual treatmentHarnessing technology to connect clinician and patient is becoming more widespread. Phone calls have evolved into sophisticated video chats using smartphones. Beyond simply diagnosing problems, caregivers can now conduct treatments in areas ranging from mental health to physical therapy in ways that are more convenient and less expensive for consumers.
Trends Impacting Clinical Products
Confidential & Proprietary 6
Social determinants of health
Increase in psychological
diagnoses in WC
Opioid epidemic
Employment outlook
Workforce diversity
Artificial Intelligence
Co-morbid impact on recovery
Engagement Advocacy
Social Determinants of Health
Confidential & Proprietary 7
Health Care System Economic Stability Neighborhood & Physical Environment
Community and Social Context
Food Education
• Health coverage• Provider availability• Provider linguistic & cultural
competency• Quality of care
• Employment• Income• Expenses
• Debt• Medical bills• Support
• Housing• Transportation• Safety• ZIP code/
geography
• Parks• Playgrounds• Walkability
• Stress• Social integration• Support systems• Community engagement
• Hunger• Access to healthy options
• Literacy• Language• Early childhood education• Vocational training• Higher education
Social Determinants of Healthcare
Source: Kaiser Family Foundation issue brief
30%
20%
40%
10%
30% of impactable healthcare outcomes are determined by healthy behaviors choices we make as individuals
20% - Access to quality healthcare
40% - Socioeconomic conditions
10% - Living environment (air & water quality, availability of food, transportation, safe housing, etc.
Confidential & Proprietary 8
70% of impactable healthcare outcomes are determined by what are deemed the social determinants of health. They are:
Clinical Product Development Update
2019 Clinical Product Accomplishments
Surgical Liaison
TechnologyEnhancements
Integrated Clinical
Platform
Confidential & Proprietary 10
Injury Advocacy Program
New Tasks and Limited Assignments
• ODG Upgrade• Virtual
Connections -Video conferencing for triage and TCM
• Healthwise Enhancements
• Clinical Decision Support
TCM• RXRN• Wellness Check• Medical
Assessment
FCM• RTW Coach• Crisis
Intervention telephonic delivery
• Injury Advocate provides support
to injured employee through
early outreach to offer support and
ensure employee is satisfied with
current medical care.
• One system for all clinical products.
• Phase I – NT24 -ability to view all transactions throughout the life of the claim
• Drives ease of use leading to employee satisfaction and retention
• Simplified data collection and reporting
• Coventry’s surgical liaison delivers timely coordination of surgery and post-op recovery
• Acting as an advocate for the injured person, the surgical liaison provides emotional support, education, and assistance in navigating the workers’ compensation health system
2020 Clinical Product Initiatives
Behavioral Health
Clinical Best Practice
Clinical Decision Support
Integrated Clinical
Platform
Confidential & Proprietary 11
Digital/Virtual
Engagement
Technology Enhancement
• Healthwise Enhancements -3,500 new patient instructions
• Clinical Decision Support
• Expand ergonomic offering to include ergonomic triage –virtual and telephonic
• One system for all clinical
• Phase I – NT24• Phase II – billing
application Case Management
• Phase III – UR • Ability to view all
transactions throughout the life of the claim
• Drives ease of use leading to employee satisfaction and retention
• Simplified data collection and reporting
• Develop a behavioral health clinical program to support growing need for BH case management
• Patient centered condition management application (platform) for musculoskeletal health
Behavioral Health Best Practice
• Develop best practice for management of behavioral health conditions
• Create behavioral health special training focusing on common BH conditions becoming more prevalent in workers’ compensation
• PTSD
• Depression
• Compliments Behavior Health Specialty Network
Confidential & Proprietary 12
Digital Engagement
PeerWell patient centered condition management platform for musculoskeletal health
Confidential & Proprietary 13
Digital Engagement – PeerWell
• Daily customized program pre and post surgery allowing people to work through an evidenced based program from the comfort of their home while tracking their progress and guiding them through the episode of care• Pre-hab
• Re-hab
• Physical therapy
• Nutrition
• Pain/Anxiety
• Health literacy
• Environmental Assessment
Confidential & Proprietary 14
70% weekly
engagement rate
Digital Engagement - PeerWell
LOWER EXTREMIY
Total hip
Total knee
Meniscectomy
ACL reconstruction
UPPER EXTREMITY
Rotator Cuff Repair
SLAP
Biceps tenodesis
Biceps repair
BACK
Spinal fusion cervical/lumbar
Discectomy cervical/lumbar
Laminectomy cervical/lumbar
Non-surgical pain control
Confidential & Proprietary 15
Digital Engagement - PeerWell
• Detailed, customized reporting• Online dashboard
• Downloadable PDF
• API integration
• CSV/Excel Worksheet
• Compliments Clinical Programs
• Surgical Nurse Liaison
• Case Management
• Coventry concierge??????
• Also available as a standalone service
Confidential & Proprietary 16
Digital Engagement - PeerWell
PeerWell’s technology is designed intentionally to help patients understand their status and what they can do to improve• No external devices required
• Available for anyone with a smartphone
• Easy to collect daily measurements pre and post op
• Monitors progress and engagement
• Alerts to Coventry clinical team when assigned
Confidential & Proprietary 17
Digital Engagement - PeerWell
Source: http://atm.amegroups,com/article/view/22734/pdf
Confidential & Proprietary 18
38% reduction in medical spend
45% reduction in pharmacy spend
25% reduction in hospital
length of stay
80% increase in discharge home w/o assistance
22% reduction
in PT
92% reduction in SNF
Engagement Through Health Coaching
Healthwise Coach & Communicate provides access to:
7,300+ health topics
600 medical tests &
procedures
3,500 patient
instructions
3,000 medications
Confidential & Proprietary 19
Expanding language options to include:Arabic, Bengali, Bosnian, Chinese (Simplified), Farsi, French (U.S.), Haitian Creole, Korean, Nepali, Polish, Portuguese (Brazil), Russian, Somali, Tagalog, and Vietnamese
Clinical Decision Support
• Near real time notifications to case managers from pharmacy point of sale
• Update bench marking of claim experience against treatment guidelines
Confidential & Proprietary 20
Integrated Clinical Platform Timeline
Confidential & Proprietary 21
Oct 1, 2018 April 1, 2022
New Triage Oct 1, 2018 – June 30, 2020
Sept 12, 2019 – Jan 7, 2021
Case Management Apr 5, 2020 – May 25, 2021
Integrated Clinical DesignDec 9, 2018 – March 29, 2020
Utilization ReviewApril 21, 2021 – March 15, 2022
Single Clinical System
Jan 1, 2020 Jan 1, 2021Jan 1, 2019 April 2022
Ergonomic Triage
The Ergonomic Triage Line (ETL) offers timely ergonomic consulting for employees at their workplace. Our trained specialists can address the most basic of ergonomic questions as well as provides coaching services to support your organization’s health and wellness goals.
• To answer questions about proper workstation set up, body dynamics, and equipment or furniture needs
• For employees experiencing pain or discomfort as a result of an ergonomically challenging workstation
• For employees who need verification and validation to ensure they have an ergonomically correct workspace
• For employees who are returning to work after a disability event and need assistance to ensure they are properly set up for a successful return
Confidential & Proprietary 22