Lori Daugherty: A gun was fired somewhere nearby. The person driving the car reacted. They stepped on the gas. The car lurched forward. The nurse was drug with the car thrown down on the ground, and almost run over by this car. When she fell, she broke her arm and her shoulder. She had a really hard time recovering because of the trauma that was involved in the incident.
Meg Escobosa: Welcome to the Game Changing Women of Healthcare, a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them.
I'm Meg Escobosa. Join me in conversation with some of the many brilliant, courageous women on the front lines of the future of health.
Welcome back to The Game Changing Women of Healthcare. I'm your host, Meg Esobosa. Today on the show we have Lori Daugherty, the CEO of Ascellus, which is an organization providing mental health services to injured workers because they have recognized that getting back to work after an injury entails a lot more than simply healing physically.
Welcome, Lori.
Lori Daugherty: Thank you very much, Meg. I'm happy to be here.
Meg Escobosa: So great to have this conversation. I feel like we are all becoming so much more aware of mental health issues and just the broad reach of mental health needs. Like there are more people addressing mental health challenges every day, and so an injured worker is just shedding new light on that particular issue. Help us understand the scope of this problem. How big of a problem is it in the US?
Lori Daugherty: Sure. So we estimate that probably 10% of injured workers have some kind of behavioral healthcare need and so when we're working with the injured workers, we're working with those individuals that have suffered an injury at work, or have witnessed a traumatic event, or have, as a result of a traumatic event, are dealing with some forms of PTSD. And so our whole goal and our programs are all centered around providing skills for that injured worker so that they can return back to a productive life within the work environment.
Meg Escobosa: Help us understand, you know, the availability of workers' comp, and is it very common to provide mental health services as part of workers' comp, or is this something new?
Lori Daugherty: No. So workers' compensation is mandated in all 50 states as well as Puerto Rico and Guam. There's also workers' compensation at the federal level for all federal employees. So workers' compensation has been around for a long time and every state administers workers' compensation a little bit differently. However, it's only been since 2009 when the AMA came out with CPT codes that allowed behavioral health to be billed in conjunction with a physical injury.
Our company was actually founded in 2009, but the awareness for mental health or behavioral health in workers' compensation is just now becoming very prevalent. And there's much more of an awareness today than there was even pre-COVID.
Meg Escobosa: How did you even get into this work?
Lori Daugherty: Yeah, that's a great question. So I started my career as an accountant. So I was working for a CPA firm and actually was getting ready to go through another tax season, and I decided that I just really didn't want to do that. So I went out and found a recruiter. I wasn't even sure what recruiters did at that point in time.
So I worked with this recruiter and she was able to place me with a company called PMSI. Back in 19, I'm gonna show my age now, back in 1987 in the accounting department of one of the very first workers' compensation providers for pharmacy benefit management in the United States.
So I worked with that company for about five years and just had a passion then for the workers' compensation industry and have pretty much been in workers' comp for 30 years now. So I had the opportunity to join Ascellus in 2018 as their CEO, knowing that it would be a very, very, very difficult road to pave in behavioral health because the adoption was not there with mental health.
But I love a challenge. And I really believed in providing behavioral health and mental health for injured workers. I felt that it was something that was missing in the continuum of care for injured workers, particularly as we talk about treating the entire person. And so we're really pioneers in this industry.
We're very much pioneers with the programs that we offer for workers compensation, for the carriers, the employers, and for the injured workers.
Meg Escobosa: Do you have any personal experience with an injured worker or dealing with the worker's compensation field, and what have you learned from that experience?
Lori Daugherty: Yeah, I actually do, so my mother, coincidentally, was an injured worker. She was a plant nurse and she was sitting in her chair, there was an emergency down in the plant, and she pushed back in her chair. The wheels broke off the chair. She flipped over, broke her back, and had four kids at home; I was in college at the time, and so my three siblings were at home, and so now all of a sudden mom's in the hospital. I had to rush home from school and help, you know, find a way to take care of everybody, you know. I took a semester off of school to do that and you know, mom went through the process. She went through the worker's compensation process. And so we, we being the four of us, experienced that and experienced what it was like to be with somebody that was on worker's compensation.
Meg Escobosa: Did she struggle with the injury and just regaining strength and physical ability? Was she ever able to move?
Lori Daugherty: She did. It was a debilitating injury. She was in severe pain. She was never able to return to work as an RN. And so she was really, really passionate about being an RN. Was never able to go back to the industry because of the injury.
And, you know, really suffered the consequences. She became very depressed and, you know, really had no, no outlet for that depression, you know, through that process.
Meg Escobosa: I'm sorry to hear that about your mom. That is really tough, and it just means that this work that you're up to now is so valuable. It's so important. And shining a light on the reality that injured workers have when trying to regain their abilities and find their way back into a workplace. So, it's beautiful that you're playing this role now. It must be very gratifying.
Lori Daugherty: It is. It's very, very, very gratifying and it's really exciting to really understand the number of injured workers that we're able to help return to work. The case studies that we have today suggest that 82% of the injured workers that we work with are returned to work ready post going through our services. And so that's pretty phenomenal.
Meg Escobosa: Yeah, it is phenomenal. That's a wonderful statistic.
Why would mental health care not be included in worker's comp, do you think? What are some of the barriers?
Lori Daugherty: Yeah, so I think the big barrier is that psych in workers' compensation is kind of the four letter word, although it might be five letters, but it's kind of the four letter word in that psych claims, historically, are runaway claims. So when somebody begins to see a psychologist or psychiatrist, oftentimes in worker's compensation, it goes on and on and on because our programs are very structured around setting the goals right up front post that assessment. We're only working towards those goals that help that individual return to work.
So first of all, I'm not a clinician. As I mentioned earlier, I'm an accountant. And so those issues that may come into play when you would normally see a behavior healthcare professional, that may pertain to early life issues or things that have happened outside the workplace, don't really come to play in the conversations.
We're very focused on those items that are prohibiting and inhibiting that person from returning to work. So what we say with our program is that there's a beginning and there's an end. It doesn't go on forever, and so it's breaking the stigma that the workers' compensation market has had around runaway claims when you involve psych.
So we're very, very focused in the duration of the program and ensuring that we've set goals.
Meg Escobosa: Why do people avoid getting this kind of treatment? Do you have any thoughts on that? And would you like to share a message to people who are looking for this kind of help but don't know how to do it.
Lori Daugherty: Sure, sure. You know, I think that there's still a lot of stigma around behavioral health and mental health. You know, I'm, you know, the old, “I don't, I'm not gonna go see a shrink”, you know, kind of, stigma. And, but that is diminishing. But there are still are a lot of, a lot of folks in the world that feel that way.
But you know, my message to the United States, to the world would be, you know it, it's a great service. It's a great benefit, and if you have the opportunity and you have a need and you're experiencing anxiety, depression, any kind of mental health need, it's better to go talk to somebody and there's help out there, whether it's with as sellers and workers' compensation providers, or it's picking up the phone and using one of the hotlines that are available.
Meg Escobosa: Yes. Ascellus is a pioneer in the industry, what are you guys doing and what are you most proud of?
Lori Daugherty: Our programs are very unique for the industry. We actually are a full-service provider, and when I say full-service provider, we're actually recruiting the clinicians. We have a network today of about 1200 clinicians throughout the United States. We're credentialing those clinicians and we're ensuring that those folks that participate in our programs, from a clinical point of view, have the skillsets that they need to work with injured workers. So we're really looking for folks that may have worked with the VA, have worked with occupational medicine, those types of environments, so that we're able to match them with the injured workers.
So post the credentialing process. Were actually coordinating the assessment for that individual. So not everybody's a candidate for our program. So when somebody's referred to Ascellus, we have them go through an assessment process. That assessment determines the appropriateness, as I mentioned, for our program, as well as it determines those things that are inhibiting or prohibiting that person from returning to work or doing their job. So we identify five goals, up to five goals for that individual. And then in the following sessions, we work to help provide the skills for that person to be able to return to work. And some of it's as simple as, not simple, but they have a fear of returning to the site of the injury.
So I don't want to go back to where I saw a traumatic event occur. I don't want to go back to work because I'm afraid that, you know, something bad will happen to me and I'll be injured again. So we're really able to help individuals overcome those fears. So then post about six or seven sessions, and on average we see an injured worker assessment and then seven sessions.
We hope that that injured worker is returned to work ready. So during the process, we involve the treating physician. We involve the nurse case manager and or adjuster. We involve our network clinician as well as a group of internal clinicians that we have that kind of keep the, I guess you could call it the guardrails of the program because our programs are very specific to utilizing work focus, cognitive behavioral therapy.
So that. The programs are, I'll use the word repeatable, but they're clinically motivated for that individual, and we use the same type of modality for every patient that we see. So it's all always workfocus, cognitive behavior therapy. And so then post-discharge, that person then should be returned to work ready.
So it's a programmatic approach where we have a lot of quality over the clinicians that are involved. We have quality over the product that's offered, and we ensure that those goals have been met and then we're able to report out to the carrier, to the employer and bring the injured worker into the conversation relative to how well they're doing, having gone through the program.
Meg Escobosa: Sounds like a really thoughtful and holistic approach to getting people back to work. Can you tell us a specific example of somebody who benefited from your program?
Lori Daugherty: Absolutely. So a case study that comes to mind was a nurse who was doing COVID testing. So, I'm sure that in every community across the United States, we had the drive up lines where you would go through the line to get your COVID test.
Well, there was a nurse that was assigned to work in one of the lines, and she was in kind of a rough part of town and she, she had reached into a car to swab somebody and as she reached into the car to swab somebody, a gun was fired somewhere nearby. The person driving the car reacted, was scared.
They stepped on the gas, the car lurched forward, the nurse was dragged with the car thrown down on the ground and almost run over by this car because, you know, the person panicked when she fell. She broke her arm and her shoulder because of the impact and the way she was, she was dragged down the road.
The ambulance comes, they take her away. And she had a really hard time recovering because of the trauma that was involved in the incident because it was a gunshot. She was standing next to a car. She was injured and she, you know, she went through a lot of anger. She couldn't go back to work.
She had been reassigned to work outside. She loved, she was an emergency room nurse. She wanted to go back to the ER. She couldn't go back to the ER because now she was injured. She couldn't lift patients because of her shoulder. Her wages were reduced down to, you know, the worker's comp wages. So she wasn't making the money that she was making, you know, pre-injury. And she became very depressed and very angry. So she went through our program and we were able to work with her to help her overcome her anger, you know, her fear of, you know, going back to the place where the incident occurred. That was another issue, is that they wanted to assign her back outside as light duty because she couldn't lift anybody. She didn't wanna do that. And so we were able to work with her and, um, get her to the point where she was now not angry with her employer anymore. She was able to go back to work, she healed, and then she was able to take a different position within the hospital until she was able to heal 100% with her shoulder. So overall, that was a success story. But I mean, it was, it was almost like three things happened at the same time to her in that,, it was the gunshot. It was the being dragged by the car and then she couldn't go back to work. It was a tough one.
Meg Escobosa: That's an unbelievable story, but it also just shows that you never know, right? These issues are so complicated and complex and unexpected. That's an accident. It is multivariate and incredible, so I'm so happy and relieved to hear that she's back to work and in a better place.
And we should all be mindful when we get any kind of healthcare support that we have no idea what journey these healthcare workers have been on in the last few years.
Meg Escobosa: How has COVID affected workplace injury or worker's comp?
Lori Daugherty: So we are seeing a lot of long-COVID cases and we actually have a program for long-COVID, but I would say the thing about COVID that was positive for Ascellus, Is the awareness that COVID created for the entire world around behavioral health.
So there's more of an awareness around behavioral health. I feel that the world as a whole, the United States in particular, is much more open to talking about behavioral healthcare issues. And so that has really bled over into the worker's compensation market where there is less fear today, less stigma about integrating behavioral health into the worker's compensation claim process. And so the adoption rate has been, you know, tremendous for our organization since post-COVID.
Meg Escobosa: I agree, it is so refreshing to see greater awareness and just less stigma around something so important to our behavioral health and mental [00:14:00] health. What are some of the most common types of injuries and, you know, is concussion one of them? And do you all look at that issue in particular?
Lori Daugherty: We do. We do. So there's a spectrum of, you know, injuries that occur, but particularly with construction workers, you know, we do see a lot of a mild TBI, mild brain trauma. So we do have programs that are specific for concussion, but we're also treating folks a lot for PTSD. We are treating folks for stress, anxiety, depression, and then a lot of pain management as well. So we have intervention programs that if somebody is prescribed an opioid, we are able to work with them so that they don't become addicted to the medication and that we can work with them t0 help explain that there are alternatives to, to medication, you know, to help with your pain. So, you know, a lot of lower back injuries in worker's compensation, as well as the concussion and head trauma.
Meg Escobosa: That's amazing. It's so refreshing to hear about this service. What are some of the challenges that you're seeing? I mean, I know it sounds like there is a shortage of mental health and behavioral health clinicians. How are you guys tackling that? Or are you suffering because of it?
Lori Daugherty: There are pockets of the United States where it's more difficult to find providers, potentially in the rural areas, but one of the other, I guess, benefits of COVID, in addition to the awareness of behavioral health was the adoption of tele-behavioral health.
So, you know pre-COVID, we were probably 95% face-to-face sessions. Post-COVID, our last look, we're 98% tele-behavioral health. So unless there's a neurological issue with the individual where we actually have to go face-to-face, most all of our sessions are via tele-behavioral health. So that has, that has helped the access issue quite a bit.
So that's number one. And then, you know, number two, because we are providing so much of the administrative work for the clinicians, and our reimbursement is very fair to those clinicians, we're able to find providers most of the time to service, the injured workers that we need to. So we're, you know, we're bringing the patients to the clinician, they're not having [00:16:30] to go out and advertise. Although, you know, post covid and the world changing, they have full, you know, full plates today. And then we're doing the transcription of all the medical notes into the format that the carrier or the employer needs for their records as well as we do the billing and collection to the insurance carrier so they have none of those administrative responsibilities to worry about. We're doing it all for them.
Meg Escobosa: Thinking about the way the US healthcare system works, what change would you like to see to facilitate greater access to these kinds of [00:18:30] services. Do you have a point of view about what we should do differently to connect the dots, whether it be with primary care physicians or as you say, even just having worker employers educate their workforce more about these services of this availability. What else could we be doing with the health system?
Lori Daugherty: Yeah, I think we've made great strides over the last 20 years with our healthcare system, but I still think the availability of being able to share medical information, you know, across disciplines is really important.
You know, you go to one provider, you have to bring your medical records, you go to the next provider, you have to take your medical records and to have, you know, electronic health record that any provider could access would, I think make our system so much easier to use and utilize.
And I think that it would take a lot of the complication out of the way it is just to go see a provider today. So that would be a wish that I would have and from a behavioral healthcare point of view, being able to access that information without having to do a medical records request to really understand the medications that an individual is on, to understand what they've gone through, you know, prior to seeing that clinician would be very, very beneficial.
Meg Escobosa: That's a really great point. What about the workplace? And what do you wish employers did differently or recommend that they do so that they create the kind of workplace that either prevents injury or supports the services that get injured workers back to work.
Lori Daugherty: There are so many things that employers could be doing, so education. You know, around the benefits that those individuals have that they can access, you know, particularly around behavioral health. So many companies have EAP programs where an individual could tap into resources to help them, you know, as a result of their as a benefit, excuse me, of their group health insurance.
Most plans have access to behavioral health or mental health. So I think a lot of injuries could be prevented by proactive treatment of whatever those issues may be. And there's reasons why people aren't sleeping and they're showing up for work and driving heavy equipment and then injuring themselves. And so, you know, a little bit of education goes a long way. And in the end mm-hmm. It would help, it would help prevent the injuries, it's being proactive with those situations before they become an issue and before an accident does happen at work.
Meg Escobosa: Do you have statistics on what it is that are the biggest causes of injury? Is it sleep deprivation?
Lori Daugherty: No, it’s…You know, you bring up an interesting point. You know, one of the things that's happened during COVID is just the fatigue that our healthcare workers have experienced. So the nurses, the physicians, the long hours that they've had to put in, you know, have caused a lot of mental health issues.
And what we're seeing in the industry and our, you know, our government is even supporting individuals to return to work or stay at work in the healthcare world. You know, by, in implementing new programs and actually mandating hospitals and different medical centers to put in programs to provide mental health to those nurses and to those physicians.
And so, you know, being a little bit more proactive, you know, around those healthcare workers would go a long way. Yeah, because the burnout's really high.
Meg Escobosa: Yeah. So high. And the work environment is so challenging. It's both from the just physical demand of being there and dealing with so many patients.
I know you were at a mental health, behavioral health, and workers comp conference last month. How was it, how was it to be in company with everybody again and was, you know, were there any big news items that came out of that event?
Lori Daugherty: Yeah, so it was interesting to us that it was the National Workers' Compensation and Disability Conference in Las Vegas.
It's our industry. It's the workers' compensation industry in the disability industry's largest conference, and it's held once a year. But it was really interesting the number of panels that there were around behavioral health and integrating behavioral health into programs in workers' compensation.
And whether it's, you know, at the coaching level or it's actually a program like Ascellus has, where we're, you know, using clinicians, psychologists, and psychiatrists and licensed clinical social workers to administer the services through a programmatic approach. The conversations were happening.
Prior to the National Workers' Comp and Disability Conference, the Workers' Comp Research Institute, WCRI came out with their behavioral healthcare primer supporting behavioral health in conjunction with the workers' compensation claims. And so we're really excited about that primer that they published.
And they're really, you know, promoting the benefits of adopting behavioral health in conjunction with the rest of the claim. And treating that injured worker. So finally, finally, our voice is being heard out there.
Meg Escobosa: I'd love to hear, you know, about your experience as a leader, a leader in healthcare, and somebody you're trying to drive, a new approach to worker's comp and mental and behavioral health. What are your own reflections on leadership? What have you learned about playing the role of CEO?
Lori Daugherty: Well, let's see. Where do I start? It's a 24/7 job. You know, I say job, but I don't, I love what I do. I'm very passionate about what I do, and I have a team that really believes in our mission and what we do and how we can impact the workers' compensation market, you know, by providing our services.
So I'm very, very fortunate to have such a passionate team. I would say, you know, to be a pioneer in the industry is a pretty lonely place. It really is. And we're really promoting, you know, the programs we're promoting our approach. We have the data that provides the clinical outcomes and provides the efficacy that can be peer reviewed to prove that our programs do work. And so I've been with the company now for four and a half years, and it's been a slow road to get where we are, you know, relative to that data collection and the proof points. But we have it now. We've had two papers published by the Journal of Occupational Environmental Medicine.
We're in the process of working on our third paper. And so I guess what. One of the things that I've learned is that you have to be patient and you have to be tedious, you know, and very, tenacious about collecting that information and pulling it together and then being able to share it with the world.
But overall, I love getting up in the morning. I love going to work. You know, I love my team and I love the dedication of the team that we have in place. Our clinicians are amazing. We have a very strong clinical team. The leadership there is top rate. And you know, they're continually evolving our programs and enhancing our programs and debating our programs and so it's really rewarding to see the company continue to evolve and blossom and grow.
Meg Escobosa: That's awesome to hear. What about you personally? Do you have a network of other CEOs that you might be a part of, or is there any support that you personally get to help you stay the course, remain confident, persist with the hard work of keeping, you know, your head down and getting through a difficult challenge and going against the grain, frankly.
Lori Daugherty: Absolutely. So, you know, we're very fortunate in that, you know, today we're a venture-owned company. And so the venture participants that have invested in Ascellus actually are very passionate about behavioral healthcare company. So two of the investors have a portfolio of behavioral healthcare companies, in addition to Ascellus. We're the only company that plays in the workers' compensation space, so that's a good thing. I have the availability to draw upon, you know, the other CEOs within their portfolio companies as well as the experiences of those sponsors within those two venture firms that are our sponsors and you know, there's a lot of great wisdom and, you know, hundreds of years of learning, you know, based on the number invest of investments that they've made.
I'm very fortunate to be able to lean on them when we're in a situation that may be new ground to us and or if we're starting to head down a path that they know that, “hey, look, we've been there, done that”, you know, they can kind of help lead, lead me down the right path.
So I feel like I have a very strong support group, you know, to really help lead the charge at Ascellus.
Meg Escobosa: That's great. Awesome to hear. How do you continuously grow and nurture your creative thinking side?
Lori Daugherty: Actually taking time away from the office is really important. You know, and not that we're in an office anymore. That sounds funny to say today.
We find ourselves bound to the computer, you know, more hours I think, than we were pre-COVID. So it's taking those breaks, stepping away from the computer, you know, going for a walk outside, you know, going on a nice vacation somewhere at least once a year.
And, you know, I have a great group of friends that, you know, remind me that you do need to do other things besides work all the time, Lori.
Meg Escobosa: Do you have any particular things that are, you know, how you like to use your time? Are you a painter, do you love novels? What is your personal passion?
Lori Daugherty: Yeah, so my personal passion is sailing. So, I love sailing. You know, I've been, I've been sailing since my late teens, and so that is, if I have an opportunity to be out on the water on a sailboat somewhere in the world, that's where you can find me.
Meg Escobosa: That sounds great…with your computer.
Lori Daugherty: Exactly. Unfortunately, it does work everywhere now. So it's a problem with the internet.
Meg Escobosa: Yeah. Well, Lori, this has been such a pleasure to speak with you. I'm so inspired by your work and the work of Ascellus.
Thank you so much for all that you guys are doing, and we wish you the very best and thanks for being on the show.
Lori Daugherty: Thank you, Meg, and thanks for letting us tell our story. We really appreciate it.
Meg Escobosa: Thanks for joining us for the Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho, Wendy Nielsen, and Meg Escobosa. This podcast is engineered, edited, mixed and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts, it really does make a difference and share the show with your friends and colleagues. If you have any questions, comments, or guest suggestions, please email me at meg@thekrinskyco.com, and you can visit us on the web at thekrinskyco.com.
