Two sessions from the 2017 RIMS were closely related to stories we have carried before in the Journal - wearables and telematics. We have included those in this issue along with some highly charged new insights into provider direction in workers comp. Note that all handouts from this year's RIMS sessions are available at www.RIMS.org/ASC for further reading and research.
Does this Computer Make Me Look Fat? The Sequel
The session titled "Cover Yourself with Wearables: Harness the Technology While Managing Its Risks" covered a wide range of topics all related to wearable technology which can be broadly defined as anything you put on your body - from headsets to safety vests to boots - that includes integrated circuits (mini-computers) which monitor specific activities by the wearer. Only about 40% of wearables are intended for long term use. Most are used for training purposes. The session included a demonstration of a vest which sounds an alarm when the user bends over incorrectly to pick up a package. This is designed to be worn by new employees for their first few weeks as materials handlers until they get used to lifting correctly.
Some wearables are still for long-term use, however. For example, a headset which (among other tasks) monitors whether the wearer is getting sleepy and literally nodding off may be a long-term accommodation for a driver. The session established how wearables fit in a hierarchy of solutions for specific safety-related or loss engineering problems. As noted above, one popular use is to help reduce the risk of lower back injuries since even an apparently simple low back strain can mushroom into a major workers' comp claim.
Wearables can also be used to analyze job routines to spot potential hazards ahead of time. Claims are, as one speaker pointed out, lagging indicators. The right wearable can help risk managers get ahead of the curve in understanding risks before they manifest as claims.
On the other hand, wearables do present certain possible risks of their own. Some have malfunctioned with various consequences, including burns in the case of some smart watches (with dumb batteries). The data produced by wearables can present a puzzle as well. How much of this might be termed "protected health information" for privacy purposes?
Finally, wearables, like telematics discussed below, present the possibility of information overload. How do you use the reams of data intelligently? Are you negligent if you miss something? This is another fast-moving area of technology, which is generating new questions as fast as it offers answers to old questions.
Vehicle Telematics: How Much Information is Too Much?
Telematics for vehicles is another exploding area of new information. Simple, inexpensive devices can monitor and record acceleration, braking, maneuvering, and speeding - just about every aspect of vehicle operation. Add one or more cameras (front facing and driver facing) and you can effectively recreate every minute of over the road operation of every vehicle in your fleet. What are the consequences of this flood of documentation?
Consider some mega trends impacting fleet operations. First, we have more and more "nuclear" court verdicts in which company fleet accidents result in huge judgments that can impair the viability of some businesses. Second, consider the shortage of good drivers with superior safety records. Finally, think about how the cost of even simple property damage events keeps going up as new vehicles become ever more expensive to repair. Managing a fleet in this environment on our ever more crowded roads demands data.
The presentation included recordings of actual accidents to drive home a major point. Good telematics will make it instantly obvious who is at fault. The evidence is all discoverable, so if you see your vehicle run a red light (forward facing camera) while your driver is busy texting (driver facing camera) and exceeding the speed limit (GPS), reach for the settlement lever immediately. A quick agreement is the only way to control the cost. This requires a new way of thinking from what many fleet managers learned back in the days of "he said, but she said..."
Vehicle telematics puts real engineering into loss engineering and also allows the manager to understand loss drivers (pun intended) and to institute new fixes such as "seeing machines" that monitor driver fatigue and collision avoidance technologies built into new vehicles. One taxi company noted in the session that the rigorous deployment and application of telematics and collision avoidance coupled with better driver training reduced accident frequency by 75%.
One new risk that telematics brings to the fore is the danger of collecting data which is then not acted on. While the video files generated by cameras, as of the moment, can only be reviewed on a random, spot check basis (absent a specific incident), data from accelerometers and GPS trackers can be analyzed like any other data source. Not doing so could be construed by a civil jury as negligence, at least in some jurisdictions. What you don't know, but should, can come back to haunt you.
What is Provider Direction Actually Work in Managing Workers' Comp Costs? (It Depends.)
Do workers' comp claims actually cost less in states where the employer can direct care as opposed to those states where the injured worker has a free choice of provider? Historically, the assumption has been that employers (and their carrier and TPA surrogates) will direct injured workers to those providers with the best outcomes and the best available discounts.
A new study from the esteemed Worker's Compensation Research Institute (excellent summary on WorkersCompensation.com) looked at actual results in some 25 states with a mix of strong employer control and strong employee choice rules. Their conclusion? It may not make that much difference.
The study says in summary, "...we conclude that there is by no means an overwhelming case for concluding that overall medical costs per claim are higher when policies give workers more control over the choice of provider. However, there is fairly strong evidence that medical costs are higher for certain injury groups, including back and neck sprains, strains, and non-specific pain, or neurologic spine pain." Much the same appeared to be true for indemnity costs as well.
Whoa - not so fast, says Joe Paduda in his commentary in Managed Care Matters. Now Joe is one of the sharpest minds in the care management business, so his comment that the WCRI summation is "superficially right - but actually wrong" needs to be read carefully. Joe points out that provider choice is really a matter of infinite shades of gray between direction and choice and that claims that are harder to diagnose and where there is less unanimity in agreement on preferred treatment (see italics above) tend to be more expensive in employee-choice states.
Joe's conclusion is a strong one: "My main takeaway is as it's been for years - employers should do their damndest to get their employees to high quality physicians who know and understand workers comp. And then get out of their way." Got that?