June 16, 2015
BWC exploring provider care initiatives to achieve better outcomes
Healthcare is changing rapidly throughout the United States. Among the changes, Accountable Care Organizations have evolved from doctors coordinating care for an assigned group of patients to large health plans collaborating with hospitals, health systems and physicians. These providers take a higher level of responsibility for patient recovery as opposed to the treatment of medical conditions, and they are a focal point for making the transition from volume to value in the healthcare arena. Understanding the general application of this model, the Ohio Bureau of Workers’ Compensation (BWC) and its stakeholders began discussing ways to enhance the delivery of care, review administrative workflows among contributors and encourage greater collaboration between providers. Primary components for achieving superior results and reducing barriers to recovery include the participation of high quality providers engaging with various participants, awareness of comorbidities that may affect anticipated results and a team approach. Accomplishing these objectives requires a multi-faceted process that is designed to enhance outcomes for employers and their injured employees.
A few managed care organizations (MCOs), including CompManagement Health Systems (CHS), have been acutely involved in developing proposals for an enhanced medical care model. CHS provided multiple recommendations regarding improved interactions between employer, provider and MCO roles and responsibilities. BWC identified that 15 to 20% of injured employees in Ohio experience poor outcomes and prolonged disability despite the fact that the injuries were primarily assessed as sprains or strains. BWC also referenced WRCI predictors of employee outcomes data that revealed comorbidities such as diabetes, hypertension and heart problems were factors that increased lost time. Furthermore, national data revealed that 50% of the U.S. population has chronic health issues and these statistics should certainly support holistic case management with appropriate delegation of the responsible payer. BWC made it clear that a comorbid condition would not be a covered workers’ compensation condition.
Collaboration between providers is critical based on research from Property Casualty 360 citing a threefold increase in risk when an injured employee has unrelated chronic health conditions, which may generate up to 85% of the costs (7 key performance indicators to improve workers’ compensation outcomes). Finally, medical conditions with co-existing or subsequent mental health conditions cost 42% more (WCRI – Accountable Care Organizations (ACOs) – Live). Evidence-based literature such as the Official Disability Guidelines confirms the potential increase in length of disability when psychological conditions are present.
Colleagues at CHS are taking an active role in promoting communication and care coordi-nation through injured employee surveys, and outreach programs between employers and providers. These critical steps confirm our team’s commitment to providing quality, cost-effective care to our clients and their employees.
David D. Kessler, D.C., MHA, CHCQM
SVP and Medical Director, CompManagement Health Systems
If you have questions, please contact your CHS Account Executive or call our customer service team at 888-247-7799.