More Care Early On Equals Better Outcomes for Workers’ Comp Claims

Early, proactive care from high-performing physicians produces superior outcomes at lower costs, according to information presented at the 2014 California Association of Joint Powers Authorities Conference held last month in Lake Tahoe, Calif.

Speakers Gregory Moore, M.P.H., president and CEO of Harbor Health Systems, a One Call Care Management company, and Douglas Benner, M.D., chief medical officer of EK Health, presented both data and best practices to the audience of insurance-based risk sharing pool executives.

“The purpose of our study was to determine whether claims outcomes were impacted by delays in care, and whether accelerating care created unintended consequences,” said Moore. “The message here is that claims operations leaders need to look at practices or inefficiencies that are delaying care delivery and consider the financial impact of those delays. We feel strongly this opens further conversation around the evidence that identifying high-performing doctors and letting them practice assertive medicine produces the best outcomes, lowers costs and shortens claims duration.”

The findings demonstrated that the more aggressive approach to care by high-performing physicians had significant reductions in claim duration, indemnity costs and a lower incidence in litigation:

• Reductions in claim duration from 13 – 20 percent;
• Reductions in indemnity costs from 19 – 61 percent;
• Reductions in litigation from 7.2 – 16 percent.

The following best practices should be followed to realize those benefits from proactive, early care:

• When you can, identify providers that have a trusted track record and treat claims aggressively in order to decrease claim duration and total claim costs. Data shows that the longer the delay in care, the longer the claim duration and cost.
• Integrate best-in-class physicians with the use of evidence-based guidelines in outcomes-based networks. Remember, guidelines are not absolute barriers on whether to approve care earlier – the key is to understand the patient and not delay care that is already identified as needed.
• Break down the barriers involved in care coordination for efficiency, better results and faster return-to-work.

The presentation included data from a Harbor Health Systems study on the impact of aggressive care. The study reviewed information for more than 700,000 claims for four procedures: ACL (anterior cruciate ligament) repair, knee menesectomy, shoulder rotator cuff repair, and carpal tunnel injuries.

A free white paper highlighting the impact of aggressive medical care in workers’ compensation is now available: http://bit.ly/1rUV9AV.

Source: Harbor Health Systems