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Medical Providers & Employers

Medical Providers & Employers. Carrie Freeland, Manager Integrated Leave Department. The Employer’s Role in Working with Medical Providers. Outcomes & Performance Measurements Usually completed by your TPA, Managed Care Organization or the Network itself

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Medical Providers & Employers

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  1. Medical Providers & Employers Carrie Freeland, Manager Integrated Leave Department

  2. The Employer’s Role in Working with Medical Providers

  3. Outcomes & Performance Measurements • Usually completed by your TPA, Managed Care Organization or the Network itself • Highly useful for Specialist Groups, Surgeons, Diagnostics, etc. • Can be applicable to Point-of-Entry (POE) Clinics, but may not be useful for evaluation of specific providers Employers can have the most direct impact with POE clinics & providers Network Evaluation & Management

  4. Set the tone & expectations for injured worker! • Function & RTW • Diagnostic Requirements • Medication Management • Employee’s Role in Recovery • Starting point of all downstream referrals • PT • Diagnostics • Specialists • Usually very accessible and open to establishing relationships with employers • Willingness to understand your specific business needs and return to work programs Why POE Providers Are So Important

  5. Direction of Care Understand all available options in each jurisdiction • Full control • Partial control • No direct control • Full Control • Include the Right Providers • Hold employees accountable to see only approved providers • Partial control • What does this mean for the jurisdiction • Take advantage of every opportunity • Initial 30 days only • State identified & controlled networks • Notification to state agencies of your specific MCO • No direct control • Consider options for Soft Channeling Getting Injured Employees to theRight POE Clinics & Providers

  6. Customized Provider Posters at each facility • Ready-made “New Claim Packets” • Letter to employee • Explains process, benefits, preferred providers and expectations • Letter to medical provider • Explains contacts, forms, RTW commitments, preferred providers and expectations • Includes all preferred and required forms • Understanding of process by ALL management and supervisors Soft Channeling to POE Providers

  7. Incident Intervention Lines • Ask a Nurse and / or Physician Consult • The Right Care at the Right Time • self care or medical visit • If medical visit is needed or wanted • schedules appointment for employee • faxes documents to provider • peer-to-peer discussion pre and post visit Soft Channeling thru Triage Programs

  8. Costco’s Success in Hawaii Costco’s Pending Results in LA Region • FY08 – FY10: • Average loss rate of 3% • 2011 Implemented • Corporate & Store Focus • WorkCare Incident Intervention Line • FY11 – FY13: • Average loss rate of 1.79% • Savings, after costs: • Approximately $1.5M • April 2013 • Implemented WorkCare Incident Intervention Line • Estimated 6 month savings, after costs, • $100K • Stay tuned… Incident Intervention Line

  9. #1 - The Basics • Proximity and convenience do matter • Hours of operation • Drug testing options • Cleanliness of clinic • Timeliness of evaluations • Bedside manner of providers • Part of the non-occ health plan’s network What Makes a Good POE Partner?

  10. Tours your facility / operations • Follows your specific protocols • Uses your job analyses, job descriptions and other specific forms • Provides timely and appropriate communication to all parties • Consistent provider seeing your employees • Provides single “Problem Solver” to address issues for your location #2 - Willingness to Build Relationships

  11. Sets appropriate employee exceptions • Focus on Function, Activities of Daily Living and RTW (not symptoms and disability) • Practices Evidence Based Medicine • Medication usage and management • Timely and appropriate referrals for diagnostics or specialist #3 – Provides Quality Care

  12. Historical Patterns • POE clinics (and specific providers) that historically have seen the majority of your employees for your specific locations • Average claim duration & cost per POE Clinic • % of claims released with or without restrictions within state waiting period & within first 30 days of initial treatment • % of cases with ultimate permanent RTW with and without accommodations Selecting the Right POE Provider

  13. No single solution fits every employer • Problem clinics & providers often need more attention than others • Consider suppression of low performers • Requires continual communication & education • Single point of contact at employer is best • Accessibility to current information • Google docs accessible to anyone with link • Always more ways to improve the process Points to Remember

  14. Carrie Freeland • cfreeland@costco.com • 425-427-3940 Questions?

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