Have you ever heard the term “doctor’s doctor?” They are considered the best of the best — those that physicians trust and go to based on word of mouth from other doctors. Though physicians have the inside scoop, it can still be a challenge for them to find the right specialists for their unique needs. And if finding the right specialist is difficult for a doctor, typical patients are feeling it tenfold.
To help address this issue, workers’ compensation (WC) PPOs need to create streamlined referral pathways to the best orthopedists, pain management specialists, physical therapists (PT) and other providers who specialize in work-related injuries — especially in states that allow patient steerage for life of claim. WC PPOs should not just be about medical savings — they need to enable people to receive the right care at the right cost to achieve the right outcomes.
Referral to Top Doc Is Key
Of those WC medical expenses, over 60 percent are related to surgeries. That means getting the first orthopedic referral right is extremely important. A referral to an unsuitable orthopedist can delay recovery, prolong lost work time and increase overall claim costs. Horizon Casualty Services addresses this issue by cultivating a strong, reliable network of the most qualified New Jersey musculoskeletal-focused providers.
According to Jacqueline Alonso, newly appointed President, Horizon Casualty Services, Inc.:
“Our goal is to streamline the selection process for case managers and claims adjusters by connecting them to the top orthopedists and specialists with ease and efficiency and assisting claims departments with scheduling services.”
Identifying Top Doc and Effective Care Direction to Achieve Critical Objectives
Horizon Casualty Services operates based on a unique health care value strategy known as the Outcomes Focused Network (OFN). The Appointment Scheduling Services team assists WC insurers by scheduling appointments for their claimants requiring orthopedic care or early intervention pain management with top doctors in the Horizon Casualty Services WC PPO network.
The OFN selection criteria is as follows:
- Demonstrated use of evidence-based medicine
- Conservative approach to surgery and opioid prescribing
- A care approach that results in an appropriate length of disability and lost work time within Official Disability Guidelines (ODG) parameters
- Consistent use of in-network resources to reduce costs
- Administrative efficiency, including timely initial appointments and medical reports following office visits
Easy Appointment Scheduling for Claim Adjusters
Horizon Casualty Services makes appointment scheduling easy for claim adjusters at no additional cost and includes:
- A dedicated scheduling team for orthopedic, early intervention pain management, PT and radiology appointments
- One business day turnaround from receipt of claim adjuster referral to appointment scheduling
- Appointments scheduled with OFN providers as first preference
- Claimant and claim adjuster notification when appointments are scheduled
Streamlined and Precise Provider Search
The Horizon Casualty Services provider search tool features value-based sorting with OFN providers at the top of search results for adjuster convenience. This search tool creates a streamlined and precise pathway to top providers:
- Providers are graded on in-network utilization metrics
- Orthopedic active practicing subspecialties are included in search results (e.g., shoulder, knee, spine, etc.)
Our Results Speak for Themselves
- We strive to ensure that medical care delivered through the OFN network program is at or close to 100 percent in network, including ASCs, assistant surgeons, anesthesia, post-operative care and PT
- Exceptional PT performance benchmarked by ODG and use of comparative provider analysis
- Our quality assurance approach includes a multi-dimensional assessment of provider performance and provider education to ensure positive medical outcomes for patients and helps to effectively control costs for payers
By leveraging the Horizon Casualty Services OFN WC health care value strategy, WC insurers, those who are self-insured and TPAs can achieve best-in-class results. This strategy achieves optimal medical and return-to-work outcomes at the lowest cost.
“Our innovative health care strategy and clinical quality initiatives allow claimants to receive superior care while our clients benefit from the highest medical cost savings in New Jersey.” — Jacqueline Alonso
For More Information
For more information, email Jed Hoban, HCS Business Development Executive, at
Jed_Hoban@HorizonBlue.com or visit HorizonBlue.com/HorizonCasualty/service-offerings/workers-compensation.
About Horizon Casualty Services, Inc.
Horizon Casualty Services, Inc., a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, in business since 1994, is the #1 New Jersey workers’ compensation (WC) and personal injury protection (PIP) PPO. The company’s 100 percent direct-contracted provider network includes 99 percent of New Jersey acute care hospitals, overall WC savings 62 percent below UCR, and with its deep focus on precision, an extremely low WC appeals rate of 0.2 percent. Its PPO results combined with its WC health care value and OFN strategy enables insurers to be the best at delivering quality medical care to claimants at the right cost — clearly a win-win for all stakeholders involved in WC claims.