Claim and Medical Management in MyAbilities
Written by Jacob Lazarovic, MD, FAAFP, MyAbilities Chief Medical Officer
MyAbilities is an innovative new integrated platform which, at its core, offers employers an opportunity to create a database of comprehensive,objective digital job profiles (DJPs) describing the functional characteristics of every job type at their company. This offers an employer key benefits including more efficient hiring and training practices, ergonomic improvements aimed at mitigating higher-risk physical demands, and a wide array of preventive and fitness applications, designed to “harden” employees’ capacity to better sustain their current job activities without injury . This product allows employers to better manage their valuable human resources, and to do so using state-of-the -art technologies such as video kinematics and artificial intelligence.
What added-value does MyAbilities offer if and when there is a filed claim for an injury or illness covered by workers compensation, disability, auto and general liability and other insurance programs?
Simply put, our platform revolutionizes claim and medical management processes. The DJP can be quickly developed or selected, and instantly and securely shared with all stakeholders with platform access: claim adjusters, case managers, physicians, physical therapists, etc. This provides users with a user-friendly, standardized graphic or video depiction of quantitative job demands, replacing inadequate old-school, paper-based job descriptions.
Why is this important? Determinations about return-to-work (RTW), restrictions and limitations, maximum medical improvement status, and residual impairment can now be informed by timely and objective metrics, and become more accurate, defensible and easily retrievable. Additionally, serial functional assessments are available to guide clinical management, monitoring progress ( or lack thereof) towards recovery,restoration and RTW. This can encourage treatment plan modifications that may be more successful in achieving rehabilitation goals and reduced absence durations. And, ultimately, this data facilitates successful and automated “job matching”, identifying suitable jobs consistent with an employee’s post-morbid functionality. Job matching may identify a position within his/her current company, or a fit with any of the 32,000 DJPs housed in the MyAbilities database. Finally, significant administrative efficiencies are gained via the online stakeholder communications enabled by the MyAbilities platform.
But wait, there’s more! The MyAbilities platform has incorporated several tools that can be used in tandem with the DJP to optimally manage a claim. The first of these is our proprietary causation analysis. Deciding whether a particular injury or illness is of occupational or non-occupational origin can be difficult, and, unfortunately, errors are often made in this critical process, with costly repercussions. Based on evidence-based medical research, this tool offers a series of questions, customized to any of thirty diagnoses, which yield an automated, online display of the factors favoring either occ or non-occ causation, as well as their relative strength. This can alert claim adjusters to claims that may require additional scrutiny before being deemed compensable.
Next is the “yellow flag” questionnaire, another online, automated tool which consists of a brief series of questions focused on psychosocial issues. It is well accepted in our industry that biological factors alone do not explain wide variations in recovery and RTW among claimants with similar injuries and illnesses. This validated tool identifies those individuals with high-risk scores who may benefit from intensified management, and consideration of psychological interventions such as cognitive behavior therapy.
In due course an online cognitive test will be available on the platform as well, which will screen for deficiencies due to traumatic brain injury or comorbid medical/neurodegenerative conditions. This will round out the full scope of performance assessment modalities offered by MyAbilities: physical, psychosocial and cognitive.
In addition to its ground-breaking practical applications for employers and payers, MyAbilities data will offer unique opportunities for analytical research into the variables that impact claim outcomes, and the development of industry best-practices.