Helen Merfield says rehab providers must not lose sight of the primary goal: implementation and management of the process

' In his article 'A time and a place' (Features, 9 March), Rob Turner expressed his cynicism on the benefits of rehabilitation. Although his views are misguided and probably seen as such by the majority of his colleagues, he did make some valid comments.

Let us be clear about this: rehabilitation/ case management providers place the injured party at the centre of the process but if rehabilitation is not implemented and managed correctly it will not be effective. Likewise, if rehab providers do not demonstrate the value they provide, insurance companies will not understand the potential savings to bottom line profits or the increased competitive advantage rehabilitation can afford.

The more commercially aware rehab providers understand this and invest heavily in educating their insurer clients on what can and should be measured. The challenge now is for more insurance companies to work with their rehab providers, to set guidelines and jointly promote independently benchmarked data that can ultimately prove the benefit of case management.

There is a strong industry-wide willingness to further quantify the benefits of rehab intervention. The frustration is that many insurance companies are uncertain on what can be measured. We have already demonstrated quantifiable benefits such as a 60% reduction in the average lifecycle of a mid-value claim but it is the overall operational costs that require the support of the insurer.

The physical and psychological benefits to the injured person are important but so too are operational cost savings. It is evident that insurers have not been able to transfer rehab data into these statistics. The beauty of rehab is that if it is done well it really is win-win.

I agree that too often money is spent on misplaced judgments and ill advised or badly timed treatment that helps no one. But Turner's comments demonstrate that a few unenlightened insurers still think rehab is only about monitoring treatment rather than appropriate intervention.

Practically, case management involves assessing the injured person, planning and implementation.

Well-managed physiotherapy does have a vital role to play but one of the problems we often encounter is when insurers with the best intentions, prescribe a standard course of physiotherapy to minor musculoskeletal injuries. This rarely saves money and is often not the most appropriate treatment.

If treatment does not assist in recovery the injured person is likely to experience psychological consequences that appear out of proportion to the pathology of the original illness/injury and will require further management and additional treatment.

Recent findings suggest that it is the social and psychological factors that are the determinants of higher degrees of disability and that these factors are rarely addressed. Education will help demedicalise the injury and help people to self manage their symptoms.

There is no covert alliance between the government and rehab providers to divert resources away from the NHS as Turner suggests. Providing the NHS can deliver the right treatment at the right time, a competent rehab provider will always use their services.

Partnership is the key. Delay between injury and referral to insurer, subsequent referral to a rehab provider and then treatment can cause detrimental physical and emotional effects.

In some regions, the waiting list for physiotherapy can be over 12 weeks. However negative psychological responses to illness/injury can begin after three weeks. We ensure that psychosocial factors that may increase the risk of long-term disability and work loss are identified early and prevented from escalating.

For example, we are currently partnering with a large insurer on an independently benchmarked rehab solution based on best practice clinical guidelines for these types of minor injury and maladaptive psychological and behavioural adjustment. The pilot is close to conclusion and results have so far demonstrated a sharp reduction in treatment sessions, average lifecycle and the total average cost of a claim.

A cost benefit analysis is imperative to understand if the NHS will provide appropriate and timely treatment. The NHS is also not a back-to-work solution even though we would like it to be.

So the message is clear: insurance companies are uncertain on how to convert the benefits of vocational rehab into actual figures and the rehab industry must educate insurers and initiate a shared knowledge approach to benefit analysis.

This type of commercial partnership and value demonstration can validate the win-win achievements that quality rehab case management can provide.

We must also ensure that case managers are commercially aware and understand their role within the wider claims process. This does not mean a complete understanding of the compensation system but that a rehab case manager appreciates the impact of their work within a wider business context.

A true partnership approach is required to look beyond the value we can calculate ourselves and demonstrate real bottom line profit. This is where the more forward thinking and competitive insurance organisations are already excelling. IT

' Helen Merfield is CEO of HCML