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The power of integrated services


Risk managers have long debated the use and value of bundled versus unbundled programs. Historically, conventional wisdom has dictated that risk managers buy services such as claims administration, medical bill review, preferred provider networks and case management from separate and distinct specialty companies. The decision was often based on which company was perceived to offer the highest quality service at the lowest possible price. It was believed that this approach allowed for maximum program customization and savings.

Today, there appears to be a shift in thinking among risk professionals. With the growing interest in a bundled services approach, it’s not unusual for a single organization to provide claims management, clinical consultation, utilization review, pharmacy management, bill review, case management and a host of other services aimed at controlling costs and optimizing outcomes. Risk managers see value in purchasing a complete package of integrated services that begin at the time of the incident and run through claim closure. A key factor driving this change in purchasing behavior and strategy is technology.

Robust technology systems provide risk managers with comprehensive real time data like never before. The ability to leverage this data is significantly enhanced by bundling services. The end result is the ability for all professionals managing the injury to make better, more informed decisions and ultimately improve outcomes.

An integrated services program is attractive because its various players can operate using one system. Claims examiners can hear a recorded conversation or view notes that a clinical consultation nurse gathered during the initial contact with the injured worker at the point of injury. Pharmacy management programs are strengthened by alerts sent to the claims adjuster when a prescribed drug falls outside of the approved formulary. Such prescriptions can be blocked prior to the sale. Related medical bills are maintained in one place and can be viewed on one system for maximum savings. And, integrated services programs can still be customized and tailored to meet any employer’s specific needs.

Technology advancements also are also improving the injured employee’s experience. Today, employees can check the status of their claim 24/7, and they can receive updates via text or email based on individual preferences.

Business trends will continue to evolve and innovation drive more enhanced capabilities. However, today, bundled programs of integrated services are getting results that appear to trump those of unbundled design.

Chris Mandel, SVP, Strategic Solutions

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