During our time at RIMS 2017, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “RIMS Review” series, focused on what to look for this year, and key takeaways from the conference! Here’s what Tina Brletich, RN, BSN, MBA, is Vice President of Product Strategy and Analytics at One Call Care Management had to say:
What do you believe will be the most significant development in the Worker’s Comp industry for this year?
A key development is the focus on data to assure quality and outcomes. This trend of outcomes analytics is a paradigm shift that is leveraging data to improve value through better insights. Today, the healthcare “value equation” is ‘quality’ divided by ‘costs.’ Dr. X might be twice as expensive but he achieves four times better outcomes than provider B. As such, Dr. X offers an overall better value. We could not make this assessment if we weren’t defining and developing the key outcome measures that lead to healthier outcomes. All of this is part of the strategy to take a more holistic view of patient health, which is driving improved medical decisions and an efficient return to health.
What is the top challenge you and your organization are currently working on?
The top challenge is access to the data needed. To develop a comprehensive approach to care, One Call is working to gather full claims data. This is a challenge because data is not all in one place and it’s not clean data, but we need the complete picture—from injury to claims closure—in order to analyze information to improve patient outcomes. As such, we’re working with various partners, including payers and other service providers, to bring this information together. We’ll be able to understand how quality is being impacted, and these insights enhance our ability to impact outcomes into the future.
To quantify value, we also need to take into account the complications and costs that we’re able to prevent, in other words, cost avoidance. Let’s say we have a patient with a wound. A nurse certified in wound care could monitor the progress of healing and based on best practice benchmarks, if the wound is not healing properly, we could intervene and make recommendations that result in proactive care and faster recovery. In this case, complications were avoided, such as potential infection and hospitalization. However, we need a way to measure the value we’ve achieved through this cost avoidance. Right now, the only means to do this is to compare two similar claims that diverge in a specific aspect of treatment, such as wound monitoring.
What was one major takeaway for you from this particular RIMS Conference?
Even though I’ve been in healthcare and workers’ compensation for years, this was my first RIMS conference. I really enjoyed soaking up all the information and interactions at the show. I was able to meet a lot of people who dropped by the booth, and I met with a lot of customers, who were interested in talking about data and analytics—and being able to use tools to develop and drive a value-based strategy.
What is one thing you’d like to promote?
One Call is providing better insight into the clinical management of injuries to enable healthier outcomes. We currently have 200 U.S. based clinicians, and we’ve developed a clinical leadership team, comprised of accomplished experts in their field who offer their perspective and strategic advice on trending issues, policies and procedures.
With the combination of our analytics capabilities and clinical programs, we are able to deliver quality and healthier outcomes in a number of ways. For example, we provide 100 percent proactive oversight across all applicable claims. Our physical therapy network performs PT services efficiently and effectively, so services have a duration that’s 40 percent below ODG guidelines for top types of injuries. Our home health clinical reviews result in clinical cost savings on over 50 percent of the cases. And our dental reviews have recommended treatment plans that have resulted in appropriate care and cost savings of more than $10 million annually.
Tina Brletich, RN, BSN, MBA, is Vice President of Product Strategy and Analytics at One Call Care Management. In her current position, she and her team perform comprehensive strategic analytics to illustrate data-driven quantifiable results, improved outcomes, clinical savings and superior outcomes-focused strategies. Tina has 19 years of combined clinical nursing, healthcare strategy consulting and healthcare industry experience. As a nurse, she worked in both outpatient and inpatient settings at leading academic hospitals throughout the country. She also severed as an Engagement Manager for a top Management Consulting firm, where she managed detailed research, analysis and strategy development for a variety of healthcare companies. Tina received her Bachelor of Science in Nursing with Honors from The University of Pennsylvania and her MBA from Columbia University.