Building a Home for Injured Workers: The foundation is patient-centered telemedicine
The American College of Physicians defines a Patient Centered Medical Home (PCMH) as a care delivery model whereby patient treatment is coordinated through their primary treating physician (PTP) to ensure they receive the necessary care when and where they need it, in a manner they can understand. The five distinct elements that contribute to an effective PCMH are the delivery of comprehensive care, provision of patient-centered partnerships, effective management and coordination of care across different healthcare settings, the creation and maintenance of easily accessible and understandable services, and the assurance of quality of care and patient safety throughout the care continuum. For the primary treating physician to offer this type of comprehensive care it requires that they have the well-trained support staff and necessary technology to improve patient engagement and understanding of prescribed treatment plans and alternatives.
The benefits of a patient-centered model of care delivery are many and include improved communication and patient involvement, leading to improved patient outcomes, and decreased costs due to better coordination of care. Despite all the well-documented benefits of this model, many physicians in private practice find implementing the necessary changes is a costly endeavor. The advantage a telemedicine based practice has in creating a patient centered medical home is that services and providers are made available to patients when and where it is convenient for them, and in most cases, these services are available 24 hours a day, 7 days a week.
Using technology as a foundation, a patient centered medical home model for injured workers can be built from the ground up, with dedicated physicians as the support beams, surrounded by a team of empathetic and compassionate care-coordinators to support injured workers at each step, and connecting patients and everyone involved in their care in a simple and dynamic environment that can be accessed anywhere and at any time.
Empower Patients with Information
Designing a technology that is easy to use and provides a wealth of information and resources is the foundation of building a patient-centered model for workers’ compensation.
One major advantage of a well-designed technology platform is that it can improve communication between patients, physicians, and claims administrators. Patients are encouraged to send messages to their providers or can reach a care-coordinator by phone 24/7 to ask questions or schedule an urgent appointment with their PTP. This improves accessibility to care and alleviates the difficulty of obtaining additional information about their injury, treatment plan, and progress.
Improved communication also mitigates the most common frustration of patients and providers working within the workers’ compensation system, which is they are unclear of the status of a request for authorization once it has been submitted to the insurance provider. When a system is created to be transparent and communication is encouraged through an information sharing technology system, there is increased partnership with the claims administrator. When barriers to communication are removed, the process becomes less frustrating for all parties.
Patient resources are also delivered to the patient through their own care portal, when and where it is convenient for them. Everything that is relevant to the treatment of the injury from physical therapy, to social support, and diet and nutrition guidelines can be available to the patient in a format that is easy to understand, in the patient’s native language, and organized to be easily accessible, relevant, and useful to the patient.
Finally, feedback can be provided to the injured worker so that s/he can be engaged in their own improvement. Patients are encouraged to interact with their personal medical portal, provide daily feedback on their progress, and track their advancement toward previously defined goals. This type of patient engagement and encouragement leads to patients who feel more motivated to make incremental progress and will eventually lead to greater overall improvement in symptoms and decreased costs.
Compassionate Physicians Set the Framework
In the patient-centered care delivery model primary treating physicians act as the primary patient advocate and partner in care of the injured worker. Physicians are given access to all evidence-based care guidelines so that they can direct the care of necessary medical treatment to the injured worker, as well as provide the worker with information on various options for developing an evidence-based treatment plan. It is important to understand that although patient-centered care allows patients to have more autonomy in their care, it does not give them carte blanche to demand treatment that is not necessary nor meets agreed upon evidence-based guidelines set forth by the American College of Environmental and Occupational Medicine or within the Official Disability Guidelines. When these guidelines are made available to the primary treating physician, s/he is empowered to have discussions with the patient about the risks and benefits of various treatment options as well as the ability to correct patient perceptions when what they want may not be what they need.
Empathic and compassion holistic care is another tenet of the patient-centered care model. Training in empathic verbal and non-verbal communication skills has been shown to improve all aspects of the patient-physician interaction by facilitating effective transmission of information, improving the effectiveness of questioning, improving patient perceptions of the interaction, and encouraging partnerships and participatory decision-making. For a physician who uses televideo as a tool to improve access to healthcare services there is increased face-to-face time with a patient and a necessary emphasis on accurate and compassionate history taking as an adjunct to the physical exam. Technology now becomes a facilitator of empathic communication rather than an impediment. Physician-patient partnerships are created and strengthened through this adherence to positive and affirming communication, direct questions, genuine care and concern in providing patient answers, identifying patient emotional responses, recognizing patient needs and values, and providing patients with increased education and autonomy to act as partners in their own healthcare. A good PTP understands that giving patients autonomy in their own care does not mean giving in to patient demands, but rather educating and empowering patients to participate in the evidence-based treatment plans that will result in optimal outcomes.
The primary treating physician also takes the lead in guiding the patient through the different settings of care delivery. Many patients with severe injuries may initiate care at an emergency department or may at some point require surgery, but care does not end there, nor do specialists or Emergency physicians assume the role of PTP for many of these patients. It is the role of the Occupational Medicine PTP to manage the recommendations of specialists and consultants, to make judicious and evidence-based decisions when it comes to the care of the patient, and to guide and educate the patient on the risks and benefits of the different treatment options. By setting expectations, using effective empathic communication, and providing resources and education, the PTP becomes the corner post of care for the injured worker.
Care-coordinators Provide Immediate Support
A dedicated team of care-coordinators are also available 24/7 to answer patient questions, connect the injured worker with their PTP, and to provide ongoing support throughout the care continuum. Care-coordinators are most often the ones who will be available when an injured worker calls in to discuss their frustrations. Like the physicians, care-coordinators are well trained to use empathic communication to help diffuse patient frustrations and will work to resolve conflicts as they arise.
Care-coordinators also work behind the scenes to ensure that the treatment plans outlined by the physician are communicated to the injured worker and that the proper certifications and authorizations are sent to consultants and other care providers. They also collect treatment notes and other data from participating care providers and store that information where it is easily accessible to patients and the PTP.
It is the role of the care-coordinator to ensure that the patient-centered medical home is solid and reliable, and that all the goals are accomplished.
When we do the right thing for injured workers everyone wins. Doctors are less frustrated, insurance companies save money, and best outcomes for injured workers are achieved. Creation of a telemedicine based patient-centered medical home in workers’ compensation is not only achievable, but it is the best practice for effective care delivery that benefits everyone.