Centers of excellence: How top-rated medical centers are changing claims outcomes

The claims industry depends on risk managers and claims administrators to help improve outcomes for injured workers. And as the industry continues to evolve, claims professionals are discovering new ways to approach treatment and care.

Collaborating with a center of excellence allows us to look at each situation holistically — providing the highest quality treatment and care for an individual, no matter how complex the case. Gaining access to a center of excellence for workers’ compensation may present challenges. Often, the reporting requirements, paperwork, fee schedules and regulations associated with workers’ comp are considered prohibitive for providers associated with centers of excellence. However, implementing centers of excellence is proven to lead to increased success and improved claim outcomes long term – and there is a way to make the process work.

To set an organization up for success with centers of excellence, it’s important to follow best practices:

  • Define criteria for eligible injury types
  • Identify the centers of excellence with whom to partner
  • Negotiate access and rates with centers of excellence
  • Roundtable with primary stakeholders
  • Get buy-in from the injured worker
  • Address the psychosocial elements
  • Establish scope of treatment and a clear budget with timeline
  • Coordinate care and reporting

I recently spoke with Risk & Insurance to explore the advantages and challenges of centers of excellence in workers’ comp. The thoughts shared in this article also reflect the vision of my fellow panelists: Ann Perkins, Chief Operating Officer of R & Q Health and Kris Sallee, Workers’ Compensation Claims Manager for American Airlines. We are presenting on Centers of Excellence: How Top-Rated Medical Centers Are Changing Claims Outcomes at this week’s National Workers’ Compensation & Disability Conference and will explore this topic in more depth, including case studies and discussion about:

  • How centers of excellence are changing occupational injury treatment
  • The differences between center of excellence care and treatment provided by visiting several providers
  • The advantages of implementing a center of excellence for both employer and patient
  • Best practices for a successful implementation
  • How to identify claims that will benefit from a center of excellence referral
  • How to overcome challenges to gain access for workers’ compensation

The bottom line is that finding a way to implement centers of excellence for workers’ comp is a unique challenge, but it is worth the effort. We’re seeing notable results when a person is given a chance and an environment to really focus on improving the challenges of their injury or condition. If you’d like to learn more beyond the article or our discussion at NWCDC, leave me a note here or tweet us @Sedgwick with your thoughts.

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