Jacksonville, FL – One Call recently released a new white paper by National Clinical Leader Michelle Despres entitled Incorporating Predictive Analytics and a Biopsychosocial Approach to Identify and Treat At-Risk Injured Workers, noting that at-risk injured workers are slow to recover and expensive to treat.
When it comes to physical therapy and rehabilitation, in general, the same guidelines for claims hold true – a small percentage of claims account for a disproportionate percentage of costs. The top five percent of cases account for 25 percent of total PT costs. In fact, the average cost associated with the top five percent is more than five times the average PT cost per case.1
As these cases unnecessarily drag on or worse, convert into permanent disability, the injured worker may simply give up on returning to normalcy and work while unnecessary costs continue to mount and employers lose productivity.
To-date, the inherent problem has been the difficulty in accurately identifying these individuals early enough to develop and implement an intervention plan quickly and change the potential outcome of the injured worker’s treatment. Historically, these cases were identified as problematic and at-risk only after a treatment plan exceeded the initial guidelines, and by then, it was too late to reverse course.
Alternatively, payers recognized certain injuries as the culprit and invested in screening those types of injuries. This ‘injury approach’ could result in an inaccurate assessment or under-count potentially problematic cases since some problematic cases may not be associated with such injuries. In reality, only a small subset of all cases need attention. The question is…which ones? Screening each claim of a certain type could potentially identify some candidates, but may miss others, and could divert valuable resources that could be used toward treatment and outcomes. A more efficient solution is needed.
1One Call National Data, 2019
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