Alex is the CEO and co-founder of Arbicare, a URAC accredited workers’ compensation-focused utilization management and peer review organization. He believes in the importance of individualizing the workers’ compensation domain to better serve the needs of the injured parties.

In this interview with me, he talks about his experience with the fragmented system and his role in taking important medical necessity decisions that impact the recovery of the injured person.

Starting in Workers’ Compensation

In 2010, Alex had the opportunity to work for a company involved in chronic opioid therapy in the workers’ compensation space. The focus was on ensuring injured workers who were addicted and dependent on opioid therapy, were receiving the right care. This was not an easy thing for people to understand from the treating provider community to the injured worker community to the payer community.

The potential for help and the possibility of innovative ideas for an emerging issue resonated with Alex causing him to dive in. At the time, he recalls the system was highly complex and fragmented. Every state had its own set of rules intertwined with the highly fragmented regulatory environment, the casualty insurance sector and the complexities of the US healthcare system.

He spent a decade of his professional career in the opioid therapy space. He believed his interaction with numerous people and his learnings from that role helped built much of the foundation of his professional development. It encouraged him to look for innovative ways to help people and to better serve the workers’ compensation community.

 ‘When it comes to medical spend, workers’ compensation is quite literally a rounding error when compared to the rest of the healthcare system.’ 

Alex believes this comparative difference makes the workers’ compensation less attractive for some people. The push for innovation isn’t as readily available in workers’ compensation because it is relatively speaking a smaller industry as compared to the rest of the healthcare space. He realized that the same organizations that were involved in natural disasters and the homeowner’s insurance were also in charge of workers’ compensation, which involved highly sophisticated medical care. The complexities of the system and the potential for finding solutions for the myriad of problems were a huge attraction for Alex. He believed he could help people improve their lives while also growing as a professional in the field.

‘Working to solve problems as complex as the opioid epidemic and seeing the positive stories that could be born when clinical care is improved led to the birth of Arbicare.’

Landing his First Account

Talking about signing up for his account Alex recalls their client’s concern regarding the lack of service and customization in the industry. Over multiple years in the industry and after coloration with multiple partners, the client felt that there several basic elements lacking. Things like consistency and quality and ensuring compliance with jurisdictional regulations and timelines, etc. were missing.

Errors in these aspects could lead to a claim where the client is required to pay a huge amount of money for a surgery that was never medically appropriate to begin with- an example when dealing with complex utilization review decisions. This is when Alex took over through Arbicare, delivered on their commitments and their success allowed them to expand nationwide.

Current Business Structure and Organization

Alex started Arbicare in 2019 with a mission to improve clinical care, foster great relationships, and restore lives post injury. 

At Arbicare, utilization review is a primary focus but it can also mean different things to different people in the workers’ compensation space. Utilization review which is statutorily recognized and required by different states around the country is at the core of the work done at Arbicare. There are also other services including peer review and complex care intervention that are a part of the suite of services undertaken by the company.

‘We believe strongly in focus and we think that the more managed care services you attempt to provide, the harder it is to become an expert in any one of them.’

At Arbicare, Alex is focused on customizing programs in a way that helps each individual as compared to having them try to adapt to one single across-the-county program. There are no two utilization review programs that look the same.  The unique circumstances of each client are necessary to effectively implement a program.

‘Healthcare and employment are two of the most important things to anybody in any part of the country and that’s something that we don’t take lightly. We want to make sure that we are doing the very best to provide the right care at the right time for each injured worker.’

Arbicare is currently serving clients around the country.  Each state in the USA has its own set of rules and regulations which are constantly changing. This makes it difficult for payer organizations to understand and implement programs which highlights the need for Arbicare’s professional guidance. The company serves employers, some of the industry’s largest insurance carriers as well as some of the well-known TPAs around the country.

‘Everybody’s problems are uniquely their own and we look to help solve problems for our clients.  We talk about where we can improve outcomes for them, what’s most important to them and how can we help them achieve their goals.’

Formative Moments on this Journey

Alex credits the people he has met over his years to aid a significant part of his professional growth. A lot of people helped him long and grow both personally and professionally to kind of gain the confidence necessary to take on these tasks, to stop observing and start solving problems that are out there.

He believes that credit is still due to the people who helped identify and solve the problem of the opioid crisis. He looks back at his years spent in this aspect with pride knowing that he played some role in overcoming that which helped people live healthier and happier lives.

Launching Arbicare was a moment that was a dream come true for Alex and co-founder Haldavid Cope.  They were able to observe and identify several issues that were taking place inside of the industry and felt like that there was a niche for them. 

Keeping Service at the Core

At the most fundamental level, Arbicare is a service company. Alex believes that the company exists to serve their clients which are workers’ compensation employers, insurers, TPAs and other payers within the space. 

However, it isn’t limited to external clients but is instead, inherent in the culture of the company. Every task, be it a conversation, an operational decision, a technology framework-everything is done with the idea of being able to serve each stakeholder involved in the process. 

‘The utilization review process if done well and done effectively is a win-win situation for all parties. Either you are approving and confirming good quality evidence-based care or you’re pressing the pause button and you’re saying why are we going down this route?  Does this make sense?  Can we have communication and talk about it and see what’s best for the injured employee?’ 

Overcoming Challenges in the Workers’ Compensation Domain

Lack of communication, ineffective collaboration and friction are massive challenges in this domain. Alex believes it is important for advocacy to be built into the process to ensure all parties are being taken care of, especially the injured worker.

Communication was often a challenge as physicians are mostly busy and rarely have time to come to the home. Instead, the company has been able to adopt modern communication methods to connect with the treating physicians and keep the process moving.

As long as the company is able to keep the communication channels open and collect all the information necessary for sound medical decisions, it paves the way for an effective solution.

Another challenge that Alex has been able to improve upon is with the claims professional. The company’s processes help simplify things for the claims professional so that in a matter of seconds to minutes, they can easily consume what occurred, why it occurred, what are the next steps and what are some communication tips to speak to that injured worker.

One aspect that Alex talks about is the rise in opioids during the COVID-19 pandemic. Arbicare has made innovative changes to its programs to help with the utilization reviews at such a difficult time. They have been able to warn patients and providers of the risks of sudden discontinuation of these medications that require weaning and even be able to guide informed medical decisions.

Revamping Utilization Review with Innovative Processes

Every single task at Arbicare is built around simplifying things for the reviewing physician. It is important for them to quickly be able to understand what’s happened, how to move forward, the information available and the medical decision for the worker. Without accurate information, the physician is not going to have a great experience which is going to flow downhill to the client.

To counter this, Arbicare has several processes that ensure when medical records come in, whether small or large numbers, they are processed before being transferred to the physician.

The records are collected, placed in chronological order, duplicates are removed, irrelevant content is moved aside, clinical documentation is focussed upon and bookmarks are created for physicians to easily navigate through various treatment notes. This helps provide the physician with all the information necessary for an informed medical decision or conversation with the treating physician.

Alex states that it is important to treat reviewing physicians with respect and strong consideration that they are a primary part of delivering a quality service for all stakeholders. This mandates the need for a process to be setup that allows them to succeed, and that is what Arbicare has managed to do.

Business Plans for the Future

At Arbicare the focus is on tackling problems with the right services at the right time. Moving forward Alex hopes to position the firm as a trusted advisor in the industry, and continue to guide and educate on things that are changing in the industry.

There are so many pieces that go into any payer’s managed care program, and utilization is among the most critical ones.  It ensures that the care is medically appropriate before they go down that path and the right or wrong decision at that time point can have a tremendous impact. 

‘We are going to become trusted and indispensable partners and help our clients in more ways inside of their organizations. We want to help as many people as possible and have fun doing it along the way.’

Top Philosophies and Core Values

A top philosophy that Alex maintains is focus on strategic decision. The culture at Arbicare is built around service excellence and that in turn needs a strategic focus. It is important not to overwhelm yourself, your leadership team and your entire team with a million different things.

Once you have a strategic focus set in and you are committed to that, it paves the way for great customer experience and service excellence.

‘This is more than just a mission for us. It is a promise that we’re going to deliver. And when we go into a client meeting or a prospective client meeting, we talk about what things that we do operationally that may be new and contribute to that customer experience.’

Advice for Newcomers entering the Workers’ Compensation Domain

The first thing for new entrants is to find their way into this space. Another aspect to remember is that one will never be done learning. Alex recommends that newcomers should try and embrace the complexity involved in workers’ compensation.  There will be opportunities to help solve complex problems which could ultimately help a person live a better life. 

‘You will grow professionally, you will grow personally, you will meet some of the greatest smartest people that you’ve ever known and it will be fulfilling to do that.  If and when you have the opportunity to be introduced to the workers’ compensation space, don’t be intimidated.’ 

Key Benefits of Arbicare Services

A major benefit at Arbicare is the way medications that need to be weaned or safely weaned to be able to be discontinued are handled. The focus is on how the information and notifications are shared with providers and patients. 

The experience of the claim professional and how they receive the final document is critically important.  It should be concise and hit the primary outcomes of the service instead of a multi-page complex report. When you’re managing as many cases as these claims professionals and nurses do, every minute saved by accessing consolidated information is a huge win.  That’s a productivity win for Arbicare clients.

Another benefit is that of customization.  Specific tasks are built into the technology system that helps track the process for different clients.  This effectively offers a comparative analysis when needed. Anytime customization is required or is necessary, which it always will be, it is not going to take the company months of talking about it, but instead, a day to implement it and get it involved within the flow. 

Vision for the Future of the Industry

Alex believes there are a lot of things that are going to continue to change.  The stigma surrounding the lack of care for an injured worker is likely to shift. Advocacy for the patient or the injured worker is going to increase to let them know they are cared for.

An injury can have devastating effects not only on the worker, health and their employment, but on their families and communities. That extends across several directions and bringing in the advocacy model to the space to let them know there is help available is becoming increasingly important. That comes from compassion, empathy, listening, having conversations with people, and making sure that their thoughts and needs are taken care of well.

Leadership Lessons Learned along the Way

The most important thing Alex believes is to continue learning more and more every day. Having a strategic focus has helped Alex as every day he is working on and looking at innovative solutions for the same service at its impact on different people.

‘At Arbicare, I have the opportunity to really help invest in people and I think that’s perhaps the most important lesson.’

Another is being available.  There are a lot of subtle cues that come from leadership that is not necessarily expressed in the day. Nothing is more important, in most cases, than being able to be available for a person reaching out for help because they wouldn’t be calling you for advice if they didn’t need it. 

Active listening is another crucial component is being a successful leader. Listen to what is needed. Truly listen and understand to help fulfil their needs rather than looking at things at the surface level and coming up with a quick answer.

‘If somebody has come to you, you’ve made yourself available, listened to them and understood what they need help with-you’ve developed a relationship. Now, invest in that relationship, invest in that time especially if there’s somebody that you work with day in and day out.’ People are the most valuable resources in any organization-they drive change, they drive customer experience, they drive everything.  Don’t try to make them into a version of yourself, but give them the information and make sure that they can be their very own leader themselves.

Follow Alex O’Neal On : LinkedIn