As a result of healthcare reform initiatives organizations are emphasizing outcomes-based programs to reduce costs and litigation while increasing access to quality care for injured workers within the workers’ compensation system. Although organizations spend substantial amounts of money on workers’ compensation insurance, there are other fundamentals they can consider to drive down workers’ compensation costs while improving employee health and safety.
Consider these Aspects to Reduce Costs:
- Claim Duration. Too many claims and claims that last too long. Focus on strategies that will deliver value-based care, superior patient outcomes at a lower cost. The need among workers’ compensation professionals to shift their focus toward getting injured workers to the best treatment available, as opposed to focused on discounts and network penetration.
- Return to Work and Transitional Duties. The goal is to return disabled employees to work as quickly as possible. If an employee is unable to work full-time, they may be able to work part-time, or in a limited capacity performing a light duty job or modified work. Successfully modified work programs can reduce workers’ compensation costs by eliminating time lost from work. It is also important to understand barriers impacting return to work or function, integrate tools and measures, manage return-to-work expectations and objectives, and summarize treatment alternatives.
- Manage Your Recidivism or Reopening Rate. Create programs to monitor workers’ transition back to work, whether they are coming back in a part-time or full-time capacity. Make sure resources are in place for employees to ensure recovery is optimized and re-injury is avoided.
- Eliminate Health and Safety Problems. Identify and eliminate health and safety issues that have caused illness or injury. Don’t expose other employees to the same risk.
- Educate and Train Your Workers. Train them on the safe and ergonomic use of equipment, safe working behavior and safety procedures. Encourage safe working habits.
- Follow the Official Disability Guidelines (ODG). ODG is a comprehensive and up-to-date treatment and return to work guideline, providing evidence-based decision support to improve; as well as, benchmark outcomes in workers’ comp, non-occupational disability, and general health insurance.
- Understand Your Litigation Rate. What is your litigation rate and how does it compare within your industry? Some of the most common reasons workers seek attorneys were: satisfactory care was not provided or was not adequate to relieve the injury; workers felt threatened and believed they would be fired as a result of the injury; employees perceived that the supervisor did not think the injury was legitimate; or employees perceived that their claim had been denied, even if it was paid later.
- Medical and Indemnity Payment. Create a process to rein in those undesirable litigation costs and boost claims resolutions. Progress is made by prioritizing claims, developing closure strategies, and monitoring case advancements through the legal pipeline.
- Claims Team Surveys. Gather feedback from workers’ on providers, treatment, results, and satisfaction and implement improvements.
- Billing, Pre and Post Bill Review. Evaluating billing offers insights into fraud, waste, abuse and new trends.
- Provider Ranking. The business model for an outcomes-based network moves away from the traditional model that looks at a discount below the fee schedule and proximity to the employer. Instead, it focuses on those providers that deliver the best outcomes for injured workers. Evaluating the data allows an organization to offer value-based reimbursements, which incentivizes physicians to engage in the outcomes program and improves overall performance. Gregory Moore’s article, Insurance Thought Leadership, revealed, “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.”
- Peer Review Comparison. Physician peer review is a method used to determine if the patient is receiving care that is not appropriate or medically necessary and whether it is not related to the work-related injury. Physician peer review reduces the cost of workers’ compensation claims by inhibiting inappropriate treatment and encouraging the treating provider to modify care or discharge the patient, when appropriate.
- Wellness Programs. Employers increasingly understand that mental health factors like stress, anxiety, and depression contribute to disabilities, productivity losses, and absences. There is also greater awareness that physical and mental healthcare interconnected — both necessary for recovery from injuries and illness. Employees often choose to work with pain instead of leaving for time-consuming clinic visits. In the U.S., most large and 75% of small companies are implementing some version of a wellness program supporting a culture of health.
- Complementary Pain Management Programs. In addition to standard healthcare, alternative options are available, cost effective, and useful. Many alternative treatments can help when traditional medication is ineffective, and they may better treat the underlying cause of pain. Musculoskeletal pain accounts for one-third of the healthcare claims in the U.S., and this category is one of the fastest growing. Studies show musculoskeletal pain produces workplace absenteeism, medication usage, low productivity, and low morale. Hands-on deep tissue treatment therapy is proven to reduce and eliminate muscular pain and injury in workers. Chiropractic care may be an alternative where another treatment has failed. Acupuncture is another alternative treatment that has proven effective for many people. Last, yoga can improve flexibility, strength, balance and can help with some kinds of pain.
There are many components to consider when your goal is to reduce workers’ compensation costs. More employers find 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. By addressing these workers’ compensation components, you can improve outcomes for employees while simultaneously lowering overall costs.