m edical p roviders & e mployers carrie freeland, manager integrated leave department 1

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MEDICAL PROVIDERS & EMPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

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Page 1: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

MEDICAL PROVIDERS &

EMPLOYERS

Carrie Freeland, Manager Integrated Leave Department

1

Page 2: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

THE EMPLOYER’S ROLE IN WORKING WITH MEDICAL

PROVIDERS

2

Page 3: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

NETWORK EVALUATION & MANAGEMENT

3

Outcomes & Performance Measurements

Usually completed by your TPA, Managed Care Organization or the Network itself

Highly useful for Specialist Groups, Surgeons, Diagnostics, etc.

Can be applicable to Point-of-Entry (POE) Clinics, but may not be useful for evaluation of specific providers

Employers can have the most direct impact with POE clinics & providers

Page 4: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

WHY POE PROVIDERS ARE SO IMPORTANT

4

Set the tone & expectations for injured worker! Function & RTW Diagnostic Requirements Medication Management Employee’s Role in Recovery

Starting point of all downstream referrals PT Diagnostics Specialists

Usually very accessible and open to establishing

relationships with employers

Willingness to understand your specific business needs and return to work programs

Page 5: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

GETTING INJURED EMPLOYEES TO THE RIGHT POE CLINICS & PROVIDERS

5

Understand all available options in each jurisdiction Full control Partial control No direct control

Full Control Include the Right Providers Hold employees accountable to see only approved

providers

Partial control What does this mean for the jurisdiction Take advantage of every opportunity

Initial 30 days only State identified & controlled networks Notification to state agencies of your specific MCO

No direct control Consider options for Soft Channeling

Direction of Care

Page 6: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

SOFT CHANNELING TO POE PROVIDERS

6

Customized Provider Posters at each facility

Ready-made “New Claim Packets”Letter to employee

Explains process, benefits, preferred providers and expectations

Letter to medical provider Explains contacts, forms, RTW

commitments, preferred providers and expectations

Includes all preferred and required formsUnderstanding of process by ALL

management and supervisors

Page 7: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

SOFT CHANNELING THRU TRIAGE PROGRAMS

7

Incident Intervention Lines

Ask a Nurse and / or Physician Consult

The Right Care at the Right Time self care or medical visit

If medical visit is needed or wanted schedules appointment for employee faxes documents to provider peer-to-peer discussion pre and post visit

Page 8: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

INCIDENT INTERVENTION LINE

8

Costco’s Success

in Hawaiio FY08 – FY10:

Average loss rate of 3%

o 2011 Implemented

• Corporate & Store Focus

• WorkCare Incident Intervention Line

o FY11 – FY13:

Average loss rate of 1.79%

o Savings, after costs:

Approximately $1.5M

Costco’s Pending

Results in LA Regiono April 2013

o Implemented WorkCare Incident Intervention Line

o Estimated 6 month savings, after costs,

$100K

o Stay tuned…

Page 9: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

WHAT MAKES A GOOD POE PARTNER?

9

#1 - The Basics

o Proximity and convenience do matter

o Hours of operation

o Drug testing options

o Cleanliness of clinic

o Timeliness of evaluations

o Bedside manner of providers

o Part of the non-occ health plan’s network

Page 10: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

#2 - WILLINGNESS TO BUILD RELATIONSHIPS

10

Tours your facility / operations

Follows your specific protocols

Uses your job analyses, job descriptions and other specific forms

Provides timely and appropriate communication to all parties

Consistent provider seeing your employees

Provides single “Problem Solver” to address issues for your location

Page 11: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

#3 – PROVIDES QUALITY CARE

11

Sets appropriate employee exceptions

Focus on Function, Activities of Daily Living and RTW

(not symptoms and disability)

Practices Evidence Based Medicine

Medication usage and management

Timely and appropriate referrals for diagnostics or specialist

Page 12: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

SELECTING THE RIGHT POE PROVIDER

12

POE clinics (and specific providers) that historically have seen the majority of your employees for your specific locations

Average claim duration & cost per POE Clinic

% of claims released with or without restrictions within state waiting period & within first 30 days of initial treatment

% of cases with ultimate permanent RTW with and without accommodations

Historical Patterns

Page 13: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

POINTS TO REMEMBER

13

No single solution fits every employer

Problem clinics & providers often need more attention than others Consider suppression of low performers

Requires continual communication & education

Single point of contact at employer is best

Accessibility to current information Google docs accessible to anyone with link

Always more ways to improve the process

Page 14: M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

QUESTIONS?

14

Carrie Freeland

[email protected]

425-427-3940