When it comes to work-related injuries, no two are alike. Those injured may need an array of specialized supports to achieve the best outcome and potentially return to a productive life. Nearly half of workers’ comp claims result in medical expenses ranging from $10,000 – $500,000 with high-cost claims accounting for a larger share of spending. Specialty services needed for timely recovery, are reported by NASI to represent 20% of this spend including durable medical equipment (DME), diagnostics, home health, and transportation and translation, to name a few.
Effective management of specialty networks is one area where a significant impact can be made, including outsourcing to an expert in that field, ensuring appropriate utilization, facilitating greater speed and efficiency to meet injured employees’ needs and controlling cost. Apricus, the Specialty Network under the Enlyte family of brands, is well positioned to manage these services. Below are some key areas where Apricus can make a significant impact on patient recovery and your workers’ compensation program.
Durable Medical Equipment (DME) Requests Can Be Complicated
Durable medical equipment, which can include anything from medical equipment and supplies to modification services, rehabilitation equipment, and electrotherapy units, can be complex. There is a wide range of equipment, and within each category, there are significant numbers of products that vary in nuanced ways, with many offering slightly different functions. Treating physicians may be unaware of the wide variety of equipment available and may inadvertently write a prescription for a costly brand-name product when a cheaper generic version is available.
Adjusters can rely on knowledgeable specialty network coordinators at Apricus to review orders on their behalf and bring any concerns to their attention. We can also tailor service and delivery to help eliminate administrative hassles. Apricus DME coordinators offer a single point of contact for all equipment and services, handle all fulfillment and billing, and work exclusively with dedicated, cost-conscious vendors nationwide to meet the needs for virtually any type of case.
Home Modifications Make Injured Workers Feel More at Home After an Injury
Home modifications, which involve everything from installing railings, ramps, and high-seat toilets to widening doorways to accommodate wheelchairs, are just one aspect of the out of the box benefits a specialty network can deliver. When planning home modifications, it’s essential to really understand the individual’s needs.
Apricus is experienced in identifying reputable occupational therapists and other experts within a region who can recommend the necessary modifications. We have experienced partners that can help ensure home modifications are done correctly and in a timely manner to meet the ultimate goal of improving an injured worker’s day-to-day ability to function.
As Prosthetic Devices Improve, So Can Injured Worker Outcomes
Amputations are the costliest type of injury in workers’ compensation, both in terms of lost time and long-term expense. Apricus has experience being engaged early in the process to work with the care coordinators to begin communicating with key stakeholders including the adjuster, treatment team, discharge staff, or catastrophic case manager. Each injured worker must receive complete, comprehensive evaluations to assess their unique needs, and to support not just their return to work but also their hobbies and lifestyles. Prosthetics, while rare, can be one of the most complex, expensive and ongoing expenses coordinated by Apricus.
Access to Accurate Diagnostic Imaging Affects Not Only Quality of Care but Claim Costs
Diagnostic imaging and radiology play a significant role in workers’ comp claims. Diagnostic imaging such as an MRI, CT, or PET scan is often the first critical step to assess the severity of an injury and develop a treatment plan for prompt recovery and return to work. That’s why it’s imperative an imaging facility produces a quality image from the onset to ensure the best-possible outcomes for injured workers. Apricus offers expedited scheduling and access to a wide range of diagnostic facilities with up-to-date equipment, and procedures to assist physicians, nurses, and adjusters as they return injured workers to function and work.
Reliable Transportation Facilitates Better Injured Worker Outcomes in Unexpected Ways
The importance of transportation in health care outcomes—sometimes an overlooked factor—has been drawing more attention in recent years. One review found that 10 to 51 percent of group health patients cited lack of transportation as a barrier to care. With services like Uber and Lyft, finding a ride may seem easier than ever. But injured workers often require more complex transportation, such as a scheduled ambulance, wheelchair, stretcher, basic life support, or advanced life support transportation. On an average day, Apricus arranges hundreds of rides for injured workers, frequently to routine doctor visits.
Translation Services Are a Fundamental Element to Managing Language Barriers
Translation is one of the most commonly requested and used services for injured workers, which is why Apricus provides certified translators and interpreters to facilitate communication of over 200 languages including American Sign Language. This is usually accomplished thru rewritten documents or translating live calls or visits and even via video conference when sign-language is required. These requests require a fair amount of coordination, especially as more people are involved.
Despite Shortages Home Health Remains a Critical Element of Care for Many Injured Workers
When injured employees are struggling with a difficult transition home, they need compassionate health professionals, who are highly skilled and experienced in caring for those who have experienced a severe or life-altering injury. Today, there are significant challenges, including persistent staffing shortages, facing home health, which could affect the industry’s ability to meet the needs of injured employees. To proactively address such issues, Apricus offers a broad national network of home health and home care agencies and can assist in matching the injured employee’s medical needs to the appropriate skill level required. Across our many agency partnerships, you will have access to a deep bench of expert home health professionals and support with high priority needs.
Hospital Discharge Planning Is an Integral Part of the Transition to a Facility or Home
Often specialty services, such as home health, transportation, DME, and prescription coordination, are needed on complex injury claims when an injured worker is to be discharged from a hospital or other medical facility. Although you may try to work with these facilities to plan for a release, they often receive last-minute notices of an injured employee being discharged with urgent specialty product and service needs.
Apricus allows you to hand off care coordination immediately to arrange for needed products and services prior to leaving the hospital. Discharge planning coordinators can evaluate and manage the specific needs outlined by the physician, case manager, social worker, and/or hospital.
Summary
Understanding the complexities surrounding specialty services enables organizations and claims staff to operate with greater understanding of the intricacies involved. If you are looking to initiate improvements in your specialty service program it may make sense to assess the partnerships you currently have in place. Specifically:
- Are your needs being fulfilled in a timely manner?
- Is an initial plan being outlined, providing ongoing communication and cost transparency along the way?
- Is a clinical patient-centric process in place to deliver optimal outcomes, cost savings and superior service?
- Are digital strategies used to streamline the process, provide full visibility and ensure nothing falls through the cracks?
- If issues arise, are all team members and the injured individual kept in the know to avoid surprises?
If any of these services are keeping you up at night, contact Apricus and we can start supporting you and your injured workers specialty needs today!
Partner Post:
This is a sponsored post from WorkCompWire marketing partner Enlyte.