Perhaps the most insightful presentation of the entire WCRI conference was this morning’s session, where Dr Kathryn Mueller of the University of Colorado gave a detailed summary of the current, rather pathetic (my word not her’s) state of the medical care delivery system, population health, and the health care financing system. Dr Mueller’s central contention (and one with which I wholeheartedly agree) is that health reform is coming, and with it will come fundamental changes in the way health care is delivered, the virtual ‘location’ delivering that care, and the evaluation of care.
And this is going to dramatically affect workers comp.
Dr Mueller noted that today health care is delivered episode by episode; diagnosis, care plan, treatment, assessment, and repeat steps 2-4 until the situation is resolved (again, my summary of episodic care, not her’s). Her view is that this episodic model of care will change to one based on functional outcome management – care focused on returning the patient to functionality, and maintaining that functionality.
This will be in large part driven by the growing influence of chronic care and need to develop a better care model to address chronic care, one that will heavily emphasize patient education and monitoring. It will also require a different ‘location’ of care – more on that in a minute.
Where the mainstream, i.e. non-workers compensation health care delivery system has not been focused on function or outcomes, these issues have been central to workers comp. Dr Mueller observed that physicians are not trained to deal with functional recovery, and don’t take this rather significant issue into consideration when treating patients.
As my kids would say, ‘True that’.
She also believes, with reason, that most high cost claims are not medically catastrophic, but rather are chronic, high cost cases due to the management of the case. (see Bernacki JOEM 2007 July).
Think about this. While there are undoubtedly really horrible injuries – significant third degree burns over a large part of the body, crushing injuries, multiple trauma, some of the more potent blood-borne disorders caused by needle sticks – most of the high cost claims are not ‘high cost’ due to the medical condition itself, but because we in the workers comp industry just don’t manage medical well.
Dr Mueller sees the medical home model as a big part of the solution in workers compensation, as the medical home will be the dominant model for delivery of care throughout the health system in years to come. Studies indicate the home decreases medical errors and improves the quality of care delivered. Notably, the medical home model is NOT a primary-care gatekeeper model – but rather a model wherein the physician is tasked with and responsible for coordinating care and educating the patient.
One other takeaway from Dr Mueller’s talk. She noted that “provider networks are not necessarily medical homes”; to date, provider networks have been based on changing/reducing fees, and have not been based on “quality”.
Amen.
Nov
14
