m edical p roviders & e mployers carrie freeland, manager integrated leave department 1
TRANSCRIPT
MEDICAL PROVIDERS &
EMPLOYERS
Carrie Freeland, Manager Integrated Leave Department
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THE EMPLOYER’S ROLE IN WORKING WITH MEDICAL
PROVIDERS
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NETWORK EVALUATION & MANAGEMENT
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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
WHY POE PROVIDERS ARE SO IMPORTANT
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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
GETTING INJURED EMPLOYEES TO THE RIGHT POE CLINICS & PROVIDERS
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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
SOFT CHANNELING TO POE PROVIDERS
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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
SOFT CHANNELING THRU TRIAGE PROGRAMS
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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
INCIDENT INTERVENTION LINE
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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…
WHAT MAKES A GOOD POE PARTNER?
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#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
#2 - WILLINGNESS TO BUILD RELATIONSHIPS
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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
#3 – PROVIDES QUALITY CARE
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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
SELECTING THE RIGHT POE PROVIDER
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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
POINTS TO REMEMBER
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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
