By Carlos Luna, Director of Government Affairs, MDGuidelines, Reed Group
With the total annual cost of lost productivity attributable to health-related conditions exceeding $225 billion in the United States, employers are looking for ways to get the best medical results at the best prices for injured workers. In fact, more than 40 percent of employers are considering implementing value-based plan designs or high-performing networks in the coming year. Worker’s compensation providers who don’t adopt a value-based care model may find themselves left out of narrow networks in the not too distant future.
This message has repeatedly emerged as a key discussion point in industry thought leadership circles and conferences, including last year’s National Workers’ Compensation & Disability Conference (NWCDC). Specifically, industry leaders stress that the nearly 10-year movement to replace unsustainable fee-for-service models is final making inroads and becoming a reality. The majority of today’s physicians are still primarily paid for each patient encounter—a model that contributes to lengthy utilization reviews for treatment, rising costs and patient dissatisfaction. And while the healthcare industry has largely resisted the shift to fee-for-value, recent trends suggest that the tides are turning: stakeholders are now feeling some urgency to invest in strategies that make these models successful.
In fact, value-based care—with its emphasis on coordinated and collaborative care—could help worker’s comp physicians lower costs and improve outcomes, as well as grow their networks by making providers more attractive to payers. Amid uncertainties about how President Trump’s administration will impact the future of the Affordable Care Act (ACA), some industry stakeholders may consider taking a “wait and see” approach. In truth, this response is ill-considered as the industry at large agrees that the momentum fueling the broader shift to value is here to stay, such as the current unfolding of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Plus, as this shift continues, worker’s comp leaders will continue to see that value-based care ties provider payments to patient and financial outcomes. Its key benefits are twofold:
- Reduces variations in care: One of the keys to controlling costs and improving outcomes is eliminating unnecessary variations in care, which can prolong health problems and delay an employee’s return to health. Value-based care relies on evidence-based treatment protocols to achieve cost and quality outcomes. While not all physicians have such tools, they can have a significant impact on performance when made available.
- Incentivizes better outcomes: Under the fee-for-service (FFS) model, physicians are paid on the volume of services they provide. More treatment equals more money — and is associated with more fragmentation, waste, redundancies and no assurance of quality. But when physicians are paid for performance, compensation is based on the value of services and the overall impact on patients’ health. Those treatments that lead to faster, safer and fuller recovery are rewarded.
Health plans and healthcare providers have successfully embraced value-based care. In fact, this year 55 percent of ACOs earned shared savings while nearly one-third received shared savings bonuses.
Workers’ comp shouldn’t be left behind in this transformation — and the good news is that there are more data and tools to support the shift than ever before. For example, evidence-based clinical decision support at the point-of-care can help support and document treatment decisions. To help providers better adhere to established, clinical guidelines, resources such as physiological duration tables and estimates can be integrated into the EHR to offer additional decision support. By using these predictive tools and protocols, care managers are equipped with the evidence-based information needed to ensure patients receive the most efficient and effective care.
About Carlos Luna
Carlos Luna is Director of Government Affairs, MDGuidelines at Reed Group.
ReedGroup, a wholly owned subsidiary of the Guardian Life Insurance Company of America, provides absence and healthcare management services to over half of the Fortune 100 companies. With more than 2000 employees, ReedGroup has operations across the United States, Canada, and India.
ReedGroup’s product, MDGuidelines, is the industry’s leading solution for total health management and workplace productivity. MDGuidelines features the world’s most trusted disability duration tables, predictive modeling, analytic services, and evidence-based Practice Guidelines from ACOEM.