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Networking pays off

Posted On: Nov. 8, 2015 12:00 AM CST

Partnering with occupational physicians who are open to learning about an employer's operations can improve the outcomes of workers compensation claims and reduce medical costs.

“It's pretty important to have physicians who at least understand workers comp because it's not just, "Come in, treat a diagnosis and release the patient,'” said Robin Bush, Grand Rapids, Michigan-based vice president of networks at Sedgwick Claims Management Services Inc.

Physicians who aren't familiar with the system and the importance of returning employees to work as soon as possible might focus on workers' restrictions rather than their capabilities, she said.

Working with physicians who understand an employer's business or a job's essential functions can further improve claim outcomes, experts said.

“The goal is to get an injured worker to a physician that's both knowledgeable” about the type of injury he or she has, “aware of the workers comp process and knows enough about the injured worker's job and the employer to facilitate ... a path to recovery that includes getting back to work or modified duty,” said Ron Skrocki, Wayne, Pennsylvania-based vice president of product management and development at managed care services provider Genex Services L.L.C.

But experts say this is more feasible for employers with a large concentration of workers in one location or those who don't compete with other companies for nearby physicians' attention.

With more than 1,500 employees in Orange County, California, Al Gorski, chief risk officer of the Orange County Transportation Authority, said he works closely with the physicians who treat his workers injured on the job.

This includes discussing physician evaluations that injured workers fill out and quarterly meetings attended by all the “workers comp players,” he said.

Previously when coach operators for the Orange, California-based mass transit system were injured, they would tell physicians they had problems driving certain bus models. Without understanding this was an issue of preference, doctors returned operators to the job with written orders limiting them to driving only certain models, which “restricted us severely,” Mr. Gorski said.

The solution was to line buses up in the clinic parking lot so providers could see the “minimal” differences firsthand, Mr. Gorski said. Now when drivers ask for such restrictions, physicians say, “What in particular is bothering you about these (models), because I'm very familiar with the bus(es)?”

However, “if you have 25 locations, you're in major metropolitan areas,” Mr. Skrocki said, it may be challenging to arrange meetings with treating physicians.

In that case, nurse case managers can facilitate connections between employers and physicians, experts said. As a bridge between the two parties, nurse case managers will take an injured worker's capabilities, according to his or her physician, and work with the employer to accommodate that person.

Another best practice is utilizing a physician network “that contemplates your geography and identifies” physicians that produce quality outcomes.

Genex and Sedgwick are among managed care services providers and payers using data to assemble networks of highly rated health care providers.

“Historically, it was almost a guarantee that network-managed claims would deliver better outcomes than non-network-managed claims,” said Alex Swedlow, president of the Oakland, California-based California Workers' Compensation Institute. “Higher concordance with evidence-based treatment guidelines, faster return to work, less litigation — those are the hallmarks of well-managed claims.”

However, the institute released a study in June that found overall medical cost savings associated with network-managed claims in California have diminished over time.

“There's a wide range of diligence and attention paid to network performance in California,” Mr. Swedlow said, noting that higher-performing networks with good claim outcomes have invested in talent, data and analytics, allowing them to better manage day-to-day issues.

Ms. Bush said Sedgwick has started meeting with health care providers in California and Florida to discuss how to better treat injured workers. The meetings allow the TPA to get “closer to those key providers that work with our employers and injured workers,” she said.

These conversations are important because, with workers comp, “you've got someone who is going about their day, not expecting anything different from yesterday, and they get injured on the job,” Ms. Bush said.

“If a provider can, besides giving (employees) quality medical care,” work with them and their employer to make sure they get back to work and productivity, “that makes all the difference in the world,” she said.