By: Emil J. Bravo, Executive Vice President, Gallagher Bassett Services, Inc.
Nurse triage services have been existence for more than 30 years designed to help individuals decide whether or not they need medical attention, in other words: “Should I stay or should I go?” This same service is having a positive impact in the Workers’ Comp industry. Nurse triage ensures that when an employee has a work-related illness or injury they receive the right care, at the right time, in the right setting. National data has shown that employees would either under-utilize or over-utilize the health care system more than 50 per cent of the time without the assistance of a nurse triage service. That means one out of two employees would have not have cared for their illness/injury correctly, which can have a substantial impact on medical spend as well as return to work.
When an individual gets ill or injured, regardless of where or when, a natural response is to seek advice on what to do next, typically from family, friends or co-workers.. More often than not, in the case of a work related injury, the employee will be unsure of what to do and possibly be apprehensive about discussing the situation with their supervisor. Similarly, supervisors (when approached) have little to no expertise when it comes to medical treatment and are unprepared to address the situation with confidence. This creates the perfect opportunity for nurse triage to support the employee and employer in making the right decision whether it is first aide, a doctor’s visit or immediate attention at an urgent care center or emergency room. The resulting effect: appropriate care, at the right place at the right time, utilizing network providers and pharmacies when needed – ultimately decreasing overall claims and claim costs.
Underutilization of the Workers’ Compensation Network
Employers have difficulty getting employees to in-network first treatment providers even in states where employers can direct care. Additional complexity occurs when employers have a mobile work force or employees who work extended hours. Nurse triage services have proven effective in increasing network penetration. Triage nurses provide the employee with recommended time frames for receiving initial treatment and can assist in finding appropriate in network providers including those with extended hours. Provider information can be shared utilizing “Health Information Cards” that can be faxed or emailed to the employee to take with them to the provider visit. With the use of smart phones many employees prefer to get this information via text message whereby the information is easily accessed and then shared. Nationally employers using nurse triage have experienced an increase in network penetration ranging from 8 to 12 percent.
Making the First Fill an In-Network Fill
Workers’ Comp pharmacy programs offer insurers and employers a great opportunity to manage their pharmacy costs. The value of such programs can be substantially reduced when network pharmacies are not used from the very first prescription. This is where Nurse Triage comes into play. When recommending care the triage nurse provides the employee with information on network pharmacies in addition to medical care providers. This not only eliminates out of pocket expenses that can occur with non-network pharmacies but also increases employee satisfaction and results in increased savings for the payor as well as improved pharmacy utilization management if future fills occur. First fill penetration has been shown to increase between 20 and 30 percent when nurse triage is involved.
Making the Most of Nurse Triage
No one would argue that the primary goal of nurse triage is evaluating and advising injured workers on the most appropriate course of action. And, results have proven as many as 40% of the calls result in simple first aid, thereby never resulting in a filed claim. But why not make the most of this 24/7/365 resource? Take advantage of the opportunity to show care and concern for the injured worker when they need it the most and at the same time provide education on the most appropriate level of care needed, while providing information on in-network provider and pharmacy options. The end result – – cost savings and improved overall claim outcomes.
About Emil Bravo
Emil Bravo began his career at Gallagher Bassett Services, Inc. in 1977 in New York. Emil quickly moved up the corporate ladder using his positive attitude and business savvy. After moving from the East coast to Illinois, he started in his position as Executive Manager in charge of training and development. He then moved on one year later to Vice President of the Managed Care division where he developed managed care programs for Gallagher Bassett. He soon added to his responsibilities by also taking on the Account Coordination division (currently Account Management). From 1997 to 2000 he was Senior Vice President for Sales, Marketing and Managed Care. In 2003, Mr. Bravo was elected Corporate Vice President/Corporate Officer for Arthur J. Gallagher & Co. In addition to his duties as Corporate Officer, Mr. Bravo is also Executive Vice President of Gallagher Bassett, responsible for Sales, Marketing, and Managed Care. Emil Bravo attended State University of New York at Stony Brook and graduated in 1973 with a B.A. in Economics.
About Gallagher Bassett Services, Inc.
Gallagher Bassett Services, Inc. is one of the nations’ largest property casualty third-party claims administrators. They provide insights and services in the areas of claims management, information management, medical cost containment, and consultative services which includes risk control consulting and appraisal services. Gallagher Bassett has been providing comprehensive risk management services for nearly 50 years. They currently have over 100 service offices worldwide, including offices in Canada, Australia, New Zealand, and the United Kingdom. They employ 4,200 professionals to serve and deliver high-quality, cost-effective and innovative claims management services – from Workers’ Compensation, Automobile Liability, General Liability, Products Liability, Texas Non-Subscriber, to Property lines of business – with recorded revenues in excess of $462,000,000. For the third consecutive year (2008, 2009, 2010), they were the proud recipients of Business Insurance magazine’s Readers Choice award as the “Best Property/ Casualty Third-Party Claims Administrator.” Visit www.gallagherbassett.com to learn more about how Gallagher Bassett can help you to lower your cost of risk.