What matters more: The quality of care and outcomes your injured workers receive, or containing costs associated with medical care and workers’ compensation? There has been a major shift in the ways businesses think about their employees recently, with more and more employers finding that focusing on quality care and outcomes is not only better for the injured workers, it’s also better for the company’s bottom line.
Are your employees getting the best care available? What if traditional treatments are ineffective – do you provide access to alternative treatments?
At the 2015 Workers’ Compensation Educational Conference in Orlando last August, one key panel discussed a shift as networks start to put more emphasis on quality care and outcomes received by injured workers. Greg Moore, Kimberly George, Jacob Lazarovic, and Mark Walls outlined the most important components of an outcomes-based scoring model:
- Claim duration
- Return to work
- Recidivism (reopening rate)
- Following established treatment and return-to-work guidelines (ODG)
- Litigation rate
- Medical and indemnity paid
- Claims team surveys
- Billing, pre and post bill review
- Peer comparison
As Business Wire reports, Gregory Moore (MPH, Senior Vice President of Innovation for One Call) stated:
At this Center for Excellence discussion, we discussed provider scorecarding and the importance of getting injured workers to the best doctors, not only so they can return to work, but because of the immense financial implications inherent when someone sees a five-star doctor versus a one-star doctor. It’s critical for workers’ compensation professionals to become advocates for injured workers and focus on patient engagement for this outcomes-based model to be successful.
Physician Scorecarding
Gregory Moore’s recent article on Insurance Thought Leadership pointed out an important discovery:
During a five-year period, a Harbor Health Systems program found that physicians with superior outcomes reduced medical costs by an average of 20%. Previous studies have shown that treatment by these physicians also shortens the duration of the claim and reduces indemnity costs.
Greg Moore and Linda Lane add that, “The real goal should be better outcomes—and when these better medical outcomes are achieved, the money spent on these cases will achieve a superior return on investment.” The medical cost savings and reductions in claim duration and indemnity costs indicate how important this can be for your company’s bottom line.
Finding high-performing and quality physicians must be a top priority. It will help ensure that your injured workers are getting the best care they can with the most effective results.
A Deeper Look: Alternative Treatment Options
What if traditional healthcare is not working for your employees? Or perhaps you want to provide more options for your workers to heal injuries and chronic pain? In addition to standard healthcare, you can also explore alternative options that can have positive effects on your employees. Many alternative treatments can help when traditional medication is ineffective, and they may better treat the underlying cause of pain.
There are time and cost incentives to look into alternative healthcare options. Workers’ Compensation Institute reports:
Injured workers who receive ongoing medication therapy treatment are more likely to experience delayed recovery and extended disability durations... Further, these claims can cost 50 to 75 percent more than claims that are resolved using traditional methods of treating pain.
But you may be asking: Are alternative treatments available to workers’ compensation patients? As the Klein Law Group explains:
Many alternative treatments are available to Workers' Compensation patients under the right circumstances. First, only healthcare professionals who have been authorized by the Chair of the Workers' Compensation Board may treat claimants. Many different kinds of treatment are allowed under the law, as long as they are provided by a practitioner recognized by the Chair. Second, authorization for treatment or tests costing over $500 must be requested of the insurance carrier, in writing. An insurance carrier denial must only be based on a physician's report. Disputes over such treatment are determined by a Law Judge, or, in the case of an appeal, by the Commissioners of the Board.
Here are just some of the many alternative healthcare and treatment options available:
Massage & Deep Tissue Treatment Therapy
Massage is a well-accepted and widely available alternative to treating pain. It helps loosen muscles that have become over tensed and stimulates increased blood flow to traumatized areas. Massage is ideal for both injuries and chronic pain, and there are many different kinds of massage that focus on diverse problems and outcomes.
In addition to standard massage, deep tissue therapy is also a valuable option. DORN provides onsite deep tissue treatment therapy that is proven to reduce and eliminate muscular pain and injury in workers. DORN also teaches employees injury prevention stretching techniques, meaning employees are less likely to experience a reoccurrence of the pain or injury.
Chiropractors, Acupuncture, & Yoga
When an employee has a more serious problem with their back – whether chronic or due to injury – chiropractic care may be an alternative where other treatment has failed. Chiropractors typically treat musculoskeletal and radicular pain, headaches, and injuries.
Though it may seem a bit intimidating at first, acupuncture is another alternative treatment that has proven effective for many people. In some cases it can ease or eliminate pain and result in a feeling of relaxation.
Yoga has grown in popularity over the years. There are numerous unique kinds of yoga that are use to improve flexibility, strength, and balance. Yoga can help with some kinds of pain, and is now being incorporated into functional-restorative programs.
ODG Treatment Guidelines
ODG (Official Disability Guidelines) offers guidelines on both return-to-work and treatment, as well as other valuable components. The treatment guidelines within ODG are “unique and effective because, within the Procedure Summary, each recommendation is electronically linked directly to abstracts of the medical evidence. ODG is designed for clinical practice as well as utilization review/management.” You can refer to their website for more information and guidelines. Whatever form of care your employees get, it should comply with the guidelines outlined by ODG.
How does your company rank? Are you exploring proven alternative treatments and therapies? Are you sending your injured workers to the best physicians available? Make sure the healthcare options your provide adhere to ODG’s treatment guidelines. Looking at your claim duration, return to work, and other components outlined above will help you understand how your company is performing and where it can improve. Though prevention is always the best medicine, ultimately, it is vital that you provide your workers with quality care and outcomes – both for their sake and the company’s.
