If we look back just 20 years in our history, it is easy to see how far the field of managed physical medicine has come. In years past, carriers and TPAs had no way to effectively manage the utilization of physical therapy, occupational therapy or chiropractic services. Without managed care specialists or clinical treatment guidelines in place, claims professionals often lacked the clinical expertise or the administrative resources to effectively manage the process – especially when additional visits were requested. Consequently, quality of care suffered and return-to-work results were less than optimal.
Todays managed care organizations have made impressive strides in developing programs and processes to help busy claims professionals to control utilization rates and costs. This is no doubt an improvement from the haphazard systems in place two decades ago. But are there instances where the pendulum has swung too far in the other direction?
Discounted unit costs and visit limits may achieve episodic savings but at the same time lack the flexibility to anticipate long-term barriers to recovery, both clinical and nonclinical.
In our efforts to reduce costs and improve efficiencies in the short term, has the managed care industry gotten too formulaic?
Our primary goal shouldn’t be to simply reduce unit costs, but to develop a system that minimizes administrative burdens and manages medical expenses while also improving the quality of patient care and wellbeing.
Contemporary research shows that there are many factors – both physical and psychosocial – that can contribute to an injured worker’s return to work success.
The best patient outcome, in order to positively impact the total cost of a claim, requires strategies tailored to the needs of the injured worker. Rather than creating cost structures and utilization rules around the idea of an “average” patient, best practices that go beyond the physical diagnoses to make room for patients’ unique conditions and personal circumstances are turning out to be much more successful for long-term rehabilitation.
There are a number of substantiated, patient-centered approaches that go far beyond discounts and visit limits to qualitatively impact clinical outcomes, patient experience, and, in the end, total claim cost, including:
- Evidence-Based Treatment Guidelines that are detailed enough to account for severity, chronicity and comorbidities.
- Proactive, peer-to-peer clinical collaboration on treatment strategies.
- Patient advocacy and education in advance of treatment and during the episode of care.
- Patient-to-provider matching services that take injury type, outcomes and the patient’s unique needs and preferences into consideration.
While utilization and cost must be effectively managed, research indicates that a holistic, patient-centered approach can lead to positive outcomes for all stakeholders. Specialty managed care companies are uniquely positioned to take a leadership position in developing new solutions and strategies to strike this balance.
For more information and research that support patient-centered strategies that lead to better outcomes click here.
MedRisk specializes in managed physical medicine, delivering innovative medical management solutions to the workers’ compensation industry.
With over 20 years of experience and a national network of expert providers, the company uses proprietary, evidence based treatment guidelines specifically developed for physical medicine to promote unsurpassed return-to-work results. Supported by cutting edge technology and a 100% US-based service model MedRisk incorporates both customer and patient advocacy to facilitate communication. By matching the patients to the right provider and closely monitoring clinical progress the company is able to provide actionable recommendations for better treatment strategies through peer-to-peer provider coaching, physician-to-physician peer review, functional capacity evaluations, work hardening or conditioning, telerehabilitation, impairment rating recommendations and solutions for psychosocial barriers to recovery. For more information about MedRisk go to www.medrisknet.com.
This is a sponsored post from WorkCompWire marketing partner MedRisk.