January 31st, 2017

Best Practices of Workers’ Comp Managed Care – The 4 Rs

Uncategorized, Workers Comp 0

For many employers, workers’ compensation is one of the largest cost-centers in their budget.

While much attention is often given to the indemnity side of the equation (the benefits paid out to injured employees for lost time and wages), the cost of medical care is another key component that impacts employers’ premium rates and eligibility for alternative rating programs such as group rating.  This is where the value of your workers’ compensation managed care organization (MCO) becomes important.  The MCO plays a key role in employers’ overall workers’ compensation cost control strategy.

This article will outline four key best practices for effective medical management.  We will refer to them as the “4 Rs” – Reporting, Referring, Remaining in Contact and Returning to Work.


Reporting

It is critical that you report a workplace injury to your managed care organization (MCO) as soon as possible after the incident.  Early reporting allows your MCO to become involved with the claim quickly to collect all necessary information and evaluate the injury and overall situation.  This early intervention facilitates effective medical management with an eye toward a quicker return-to-work, which helps to minimize medical costs incurred in the claim.

To make this process work as easily as possible, it is helpful to have a plan in place BEFORE an accident happens.  For example, personnel policies can establish parameters for claim reporting – when, to whom, etc.  Employers can also provide Injury Reporting Packets to their employees that provide instructions for the employees, supervisor and medical providers, reducing the chances for reporting errors and unnecessary delays.

After the claim is reported, it is key to investigate the details behind the accident.  Talk to the injured employee to obtain a statement, as well as other witnesses who may have seen the incident or have other helpful information.  As you collect these statements and collect facts, it is important to document this information and keep on file.<hr)

Referring

The choice of doctors is a critical piece that determines the quality of treatment your employee receives, as well as the cost for that care.  Just as with non-occupational medicine, emergency room visits are going to cost more than a family practice doctor.  While employees have a choice in medical providers, employers can establish relationships with local doctors who specialize in occupational medicine and are experienced in treating patients with an outcome-based approach of returning the patient to full duty with their employer.  Your MCO can help to identify these providers in your area and facilitate a meeting with them and their staff, either at your office or theirs.  At times, physicians are willing to attend a meeting in an employer facility to become familiar with your operations and the various job functions.  The key is to establish a line of communication with these physicians and set expectations.


Remain in Contact

As the treatment plan progresses, it is vital to maintain an open line of communication with the injured employee, as well as with your MCO.  Your MCO and TPA should keep you updated on any developments with the claim, but the employer should also communicate any new information to the MCO, as well.  There is no such thing as too much communication!


Return-to-Work

Of course, the ultimate goal in medical management is for the employee to return to work as quickly and safely as possible.  In many cases, that can happen fairly quickly.  However, with more significant injuries, this process may take longer.  In those cases, your MCO can work with you to identify temporary “modified duty” or transitional work for the employee to do while they are recovering. There are many benefits to this – keeping the employee engaged and connected to the workforce and minimizing costs charged to your workers’ compensation policy just to name two.


If you would like to learn more about how to implement these managed care best practices into your business operations, feel free to contact Shawn Combs with the CareWorks Family of Companies at (614) 760-3555 or via email at shawn.combs@careworks.com.



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