When we think of innovation in healthcare delivery, our thoughts do not naturally turn to the private medical insurance industry.
However, slowly but surely over the past few years, Aviva UK Health has embarked upon a journey and made significant strides in putting early intervention and rapid access to physiotherapy at the heart of their rehabilitation services.
‘Pretty much every customer who uses their Aviva scheme with an MSK problem will now either see or speak to a physiotherapist first’ says Mark Sharpe, Rehabilitation Clinical Lead at Aviva.
‘This wasn’t always the case a few years ago when I started here, as most would see an orthopaedic specialist. But a thorough review of the clinical evidence and in depth analysis of our own experience indicated a new approach was required.
‘Within Aviva, we have chosen to put high quality clinical decision making at the forefront of our services.
To succeed it was essential to make it quicker and easier to access the expertise offered by physiotherapists who excel in MSK management, so customers are now able to self refer to our telephone triage service.
‘The physiotherapist conducts a thorough, in-depth assessment of the individual’s needs and determines the most appropriate pathway of care using evidence based guidelines, tightly governed by a Medical Advisory Board of professional rehabilitation experts.
This triage takes a bio-psychosocial approach, so as well as a clear understanding of the physical symptoms and history (including red flags), there is a strong focus on identifying potential barriers to recovery such as adverse health beliefs and other behaviours that also need to be addressed.
They then act as case managers to help the customer throughout their recovery and help them make informed decisions about the care options available, as well as offering sound advice and education.’
Mr Sharpe, who is a chartered physiotherapist, feels that the role physiotherapists play in the management of MSK conditions is crucial.
Having worked in both the public and private sector as a physiotherapist, he knew it was obvious that the earlier a patient is referred, the more likely they are to get better quickly.
‘It’s a very simple science, but one that is now increasingly born out in the evidence. There is an increasing number of self-referral and fast track physiotherapy services available.
‘The recent BMJ article (doi/10.1136/bmj.f43) further underlined the safety and efficacy of telephony-based physiotherapy services.
‘However, we also recognise that early access to expertise means people are less likely to go on to develop more severe or long term problems that may require onward referral,’ Mr Sharpe states.
‘Our approach is as much about prevention as rehabilitation.’
The results of this approach have been impressive.
Analysis of around 40,000 cases handled by Aviva has shown that, since introducing this service in 2009, referral rates to specialists have reduced from more than 70 per cent to fewer than 40 per cent and are as low as 21 per cent for back problems.
Customers are now fast tracked to physiotherapy with extremely good outcomes.
‘We place a lot of emphasis on function and the positive benefits of being active and at work,’ says Mr Sharpe.
‘Often when customers contact our service, they simply want more information and to understand what they can do to help themselves and as a result a small proportion of customers are able to self-manage their conditions from the outset.
‘Most, however, are referred to a physiotherapist and do extremely well because their symptoms are being treated earlier.
A smaller percentage are carefully identified as appropriate to see a specialist, either at the point of triage through careful assessment by the telephone based clinician or through further examination by the treating physiotherapist.
These customers are then carefully case managed to ensure they are fully informed on their treatment options.’
In keeping with this approach, Aviva has significantly strengthened its clinical governance function.
It also works in very close partnership with a select number of independent clinical partners to deliver safe and effective rapid access services that incorporate a case management approach for more complex cases.
‘We spend a lot of time ensuring our customers understand this new approach and inviting their feedback on improvements,’ says Mr Sharpe.
‘We’re also increasingly interested in what we can learn from physiotherapists on the frontline.’
One is Martin Docherty, an independent physiotherapist and expert witness based in the seaside town of Bournemouth, ‘My experience of treating clients referred via the Aviva Back Up service is certainly positive,’ says Mr Docherty.
‘Clients often comment that early access to a physiotherapist with the relevant expertise, without the hassle of being referred via their GP, is invaluable.
‘And from a therapist’s perspective,’ says Mr Docherty, ‘it’s great to be able to address problems such as back and neck pain in the acute or sub-acute phase which often means clients are able to return to work sooner than they anticipated.
Mr Docherty adds: ‘Providing targeted, evidence-based physiotherapy in this way invariably yields commercial benefits for insurers which is probably why we’ve seen a significant growth in “managed care physiotherapy” models over the last few years.’
Aviva has recently begun a three-year partnership with the Chartered Society of Physiotherapy (CSP) across the Society’s Fit for Work initiative, which includes a programme of activity and resources designed to improve the wellbeing of the UK workforce and to highlight the importance of physiotherapy in preventing and reducing work related ill-health and sickness absence.
Mark Sharpe, MCSP BSc (Hons) BPharm (Hons),
is a chartered physiotherapist who qualified in 1999 and spent a number of years working in the NHS and then latterly in private practice, specialising in MSK and occupational health.
He is currently Rehabilitation Clinical Lead with Aviva UK Health.
A Board Member of the UK Rehabilitation Council and member of the Association of British Insurers’ Rehabilitation Working Party, Mark’s role in Aviva is leading the development and delivery of rehabilitation services and solutions across both its Health and General Insurance business.