Written by Adjunct Professor Niki Ellis
Recently I was appointed as the Work for Health Advisor for Comcare. My role is to promote this evidence and, guided by an Advisory Group, take a broader, cross-sectoral view to improving return to work than has been taken previously.
Or as Dr Brandon Carp, Executive Chairman of Unified Healthcare Group (UHG), put it to me one wet afternoon, “take all that non-Medicare distraction for the doctor and put it into a single process”.
Carp was training to be a dermatologist when in 1996, while working part time in his father’s medical practice, a patient came in requesting a pre-employment medical exam for Crown. He rang Crown to check what they wanted and was told they just wanted the information to confirm the guy was medically fit to work as a dealer.
Carp spotted the opportunity to improve the process with a consistent approach and suggested he manage all their pre-employment medicals that were previously spread across hundreds of different doctors.
When Crown said yes, Carp didn’t have the doctors or the facility to accommodate this large project. But with the help of his wife they quickly put it together – got a caravan, recruited medical colleagues and did about 3 000 medical examinations in months. UHG was born.
Automated e-reporting integrated with leading medical software
“UHG’s purpose is to connect businesses and health care providers to improve their interactions and maximise the outcomes,” Carp said. This connection is through use of technology, good communication and cultural understanding of both sides. UHG is big in the life insurance sector and is now focussing on workers’ compensation.
The heart of their business, medEbridge, is a platform that is used to send requests for medical reports and files from their client insurers to doctors. This can be done in various ways to accommodate the GPs but the most efficient is direct electronic exchange. This can be achieved via integration with the leading software programs used in medical practice in Australia, eg Best Practice and Medical Director.
The reports come back to them, ideally electronically, but sometimes by fax or courier pigeon (I am pretty sure he was joking). However irrespective of how they come back to UHG they are sent to the business electronically in a consistent format.
‘Bespoke’ red tape reduction
UHG uses its systems and communications to manage the consistency, quality and timeliness of the medical reports. Carp says they have built a business with a network effect. “The more information requests we manage on behalf of insurers and other agencies the more value we offer a doctor. We do so in a way that is bespoke to the doctor and the clinic. This has been proven to reduce the red tape burden on the doctors and maximise the productivity of the medical clinics” he says. “It is like SEEK, the more employers and workers are using SEEK the more effective it is. If there were three SEEKs it would not work so well.”
It sees its role as being a connector, an intermediary, between businesses and health care providers, who can assist to even out the variation in performance of both claims assessors and health care providers.
I, along with Anne-Marie Feyer and Jane Palmer, have just finished some work for SuperFriend on best practice for the management of psychological claims in the group life insurance sector, due for release in late August/early September.
Lines drawn between doctor & claims assessor
An idea that emerged from the rapid review of best practice claims management we undertook was better demarcation of the role of the doctor and the role of the claims assessor.
Our review found that doctors should provide information related to the following questions:
- What is the diagnosis?
- What is the treatment? Is it evidence based?
- What is it that the claimant can and can’t do?
- What are their job duties?
- What is the employer attitude to RTW?
But decisions about disability and liability belonged with the insurer.
By that evidence, best practice claims management sees the claims assessor role being enhanced, with greater delegation, greater development and greater decision-support so that they, working closely with an empowered claimant, can make decisions and are assessed by their progress towards outcomes.
Carp has a more pragmatic view. He thinks you will always have variation in performance and that intermediary organisations like his can work to manage that and get desired outcomes, such as return to work.
Last year Carp was a nominee for Ernst & Young’s Entrepreneur of the Year. In 2013, UHG was the 19th most innovative company as rated by BRW and in 2014 it had climbed to the 15th position.
Getting smart with forms
Having improved the connection between businesses and health care providers, where communication is initiated by the business, insurer or employer, depending on the service, Carp is now turning his attention to the vexed question of improving communication between health care providers and businesses when it is initiated by one of 50,000 doctors, in the form of a medical certificate.
“Why”, he asked me, “don’t we just adopt a fitness certificate like the one Dame Carol Black developed in the UK, digitise it and use it for all circumstances”. By that he means not have separate certificate requirements for Centrelink, workers compensation, motor accident, DVA, insurers and employers but one smart form.
Carp sees the doctors as his real clients. He recognises that typically workers’ compensation patients form a small part of medical practices and we need to make it as easy as possible for practices to comply.
And what about after that?
I spoke to UHG’s Executive Manager Technology & Digital Innovation, Grant Williamson, when being taken on a tour of its premises in an old warehouse on Chapel St in Prahran.
Williamson can see great potential in analysing de-identified data from the millions of records that have passed through medEbridge and learning from it, such as ways to develop criteria for triaging cases or providing decision support for injury management.
This is another area that emerged in our work for SuperFriend’s best practice claims management rapid review. I hope he can do it within existing resources, as his boss didn’t seem so sure, saying, “I have found it is usually easier to fix a problem with the existing process than to introduce something new but we are always looking to innovate.”
At the end of the afternoon Carp said to me, “You and I are on the same page. It is just that you are driving innovative change through policy and we are working at it practically, on the ground”.
Indeed you are Dr Brandon Carp, you, and other innovators, are changing our world from the ground up.
UHG’s 10 guiding principles
- Live by our values
- Growth is a measure of strength & a requirement for survival
- Business to business health services are our focus
- Information is wisdom & valuable
- Seek blue oceans, disrupt existing markets & always look for a better way
- Focus on the customer & all else will follow
- Innovative technology is a core enabler & differentiator
- Positively impact the medical community
- Enjoy the journey
- Act with professional integrity
 By the way Comcare is about to go with such an approach in the ACT.
Niki Ellis, Adjunct Professor, Institute for Safety, Compensation and Recovery Research and Department of Epidemiology and Preventive Medicine, Monash University.
www.nikiellis.com.au Twitter @ProfNikiEllis
First published in Inside OHS 091, 4/08/2015.
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