2020 clinical roadmap...sleep enough; more than half of u.s. adults with mental illness go...

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.


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.


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


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


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.


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


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


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


Digital Engagement

PeerWell patient centered condition management platform for musculoskeletal health


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


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



• 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



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



Source: http://atm.amegroups,com/article/view/22734/pdf


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

http://atm.amegroups,com/article/view/22734/pdf

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


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


Integrated Clinical Platform Timeline


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


2020 clinical roadmap...sleep enough; more than half of u.s. adults with mental illness go...

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