Who is best to conduct the RTW orchestra?26 Mar 2018, Posted by WHS in
On Saturday I gave a seminar to AFOEM NSW. 42 people registered, 32 in the room and 10 online. My topic was Emerging best practice for case management by insurance schemes: Implications for occupational physicians (you can view the presentation here). The bulk of the presentation was on the best practice framework Safe Work Australia released in Dec. This was adapted by them from the framework for the life insurance industry SuperFriend released in 2016 (I led a consultancy team that did this work). However I spoke about the Collaborative Partnership for Improving Work Participation as well. There were two discussion points where people broke into groups and talked about the following:
- What would be the optimum relative roles of treating doctors, IMEs, claims managers, vocational rehab advisors (insurers), vocational rehab advisors (employers) in RAW, RTW?
- Which of the following trends will have most impact on your work, and how?
- PoC centred management led by claims manager
- Enhanced support for employers by insurers
- Greater co-ordination of key players using case conferencing, face to face meetings, online platforms
- Expectation of evidence-based healthcare from health providers by insurers
- Triaging and decision support tools/automation
- Integrated work disability management
- Better measurement of health, social and financial outcomes.
The audience were engaged, and the discussion was good. We were fortunate to have a senior claims manager from iCare, the rest occupational physicians. A summary of discussion outcomes is below. Note the idea that we need a flexible case by case approach, depending on the capacity and capability of the various players, but there is a need to define who is going to be the conductor.
Relative roles of GPs to insurers and employers
- Role for GPs is diagnosis, treatment, prognosis and management
- Most GPs don’t understand workplaces, so whilst they have a role in RTW, they need help from case managers, either co-ordinators in workplaces or claims managers in insurers. These decisions are not medical. Recognition that some GPs do have skills in workplace health and rehabilitation, so they may be able to play a greater role in co-ordination, but most do not and do not want this role
- They need to contribute to communication
- Occupational physicians could be playing a bigger role – especially in complex cases. Referral to them by GPs and others much earlier for treatment and management of complex cases would be a good use of occupational physicians
- Idea proposed that a flexible approach is required in that the treating doctors may or may not have skills, the employer may or may not have capacity – this would point to rather than having fixed rules about who does what, we need to a define a system where someone is ‘conducting’ the ‘orchestra’, and making decisions about how best to apply available resources. The question was posed ‘Should the conductor be the claims manager, or should it be someone else?’
- Recognised that the aim is for the insurer, the employer, the GP and the worker to all be happy
- Discussion of advocacy by GP, definitely will advocate for patient and family, not a broker between employer and employee
- Lack of confidence in claims managers, most of them seen to be unskilled, junior – occupational physicians get annoyed when they are told what to do by them
- Comment made that insurers should have lists of preferred providers in physio and psych, and use them.
Which trends will have the most impact on occupational physicians?
All three groups nominated  (greater co-ordination of stakeholders) and  (expectation of evidence based health care). They saw this in terms of an opportunity for occupational physicians. Whether people would pay for occupational physicians (an expensive resource) to co-ordinate was raised by me, but the group considered that until online platforms are better developed they can play a useful role, particularly in relation to liaison with other health providers. The move towards greater expectations of evidence-based care was seen as a good opportunity for occupational physicians, in terms of determining guides on evidence-based care. It was recognised AFOEM could play a role here potentially.
 (integrated approach to work disability) was nominated by two groups
 (person on claim centred management),  (increased support for employers), and  (measurement of health and social outcomes) were each nominated by a group.