Seamless management of injured workers’ care benefits all stakeholders

December 19, 2023

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It’s no secret that healthcare systems can be difficult to navigate. When care is associated with an injury or illness incurred on the job, the complexities of the workers’ compensation system may further compound the challenges. Many employers opt to work with experienced claims and managed care partners to give employees a better experience, facilitate recovery and return to work, control costs, and ensure full compliance with jurisdictional requirements. However, navigating a patchwork of specialists and ancillary care providers, along with their disparate online systems, can be just as challenging. Here, we will highlight how the seamless management of care for injured workers is a major win for all parties involved in the workers’ compensation system.

Benefits for employers

When an employee gets injured or ill at work, their employer is responsible for making them whole again. It’s a legal obligation, the right thing to do, and in the employer’s best interest. Organizations want the highest quality, most appropriate and timeliest care for their employees to maximize medical efficacy and recovery. What’s more, they want all of that at the best possible price, as Sedgwick’s workers’ compensation book of business shows medical spending accounting for about 50% of claim costs. 

While that combination may sound too good to be true, it is possible when employers work with the right managed care provider. By using a partner with an established network of highly rated, licensed and insured practitioners in the right specialties for occupational medicine, as well as pre-negotiated treatment discounts, employers can take advantage of rates well below fee schedule while providing employees with outstanding care. Premier managed care providers can offer “wholesale” rates for care due to their buying power and careful oversight; many also conduct bill reviews to yield an additional 10-15% in savings — with no additional work required by their employer clients. 

Another way we help employers reduce claim costs is by applying sound healthcare price management techniques. Among Sedgwick’s workers’ compensation clients, 32% of medical spending is on ancillary care, which includes durable medical equipment (DME) like canes and wheelchairs, as well as prosthetics, orthotics and supplies (POS). Much like in the pharmacy sector, managed care providers use formularies and product catalogs to identify generic equivalents — for everything from name-brand bandages to crutches — so employees receive equally effective care and supplies at significantly lower prices.

Fully integrated managed care programs offer benefits beyond cost savings, too. When injured and ill employees are referred for treatment through a managed provider network, claims are reviewed by clinical experts to ensure medical necessity and appropriateness of care. The use of well-vetted and credentialed network providers means a more accurate assessment of the warranted treatment plans. This approach brings tremendous value to any employer’s program — especially when it comes to high-cost products and services, such as custom prosthetic devices, diagnostic imaging and in-home healthcare services. System integrations further simplify processes and create efficiencies, and vendors and providers get paid faster due to pre-negotiated pricing.

Benefits for claims handlers

Workers’ compensation claims examiners and case managers on programs with integrated managed care are at a distinct advantage. Thanks to seamless technology interfaces, they can refer workers for care and order necessary medical supplies from multiple sources directly from their established claims system — without having to log onto separate vendor portals. 

Claims professionals know that having screens dedicated to managed care within their system of record is a real differentiator. Streamlining the number of password-protected websites they must use in their daily jobs promotes efficiency, lowers the risk of human error or data breach, reduces frustration and busy work, and improves their overall work experience. Furthermore, the integration enables electronic billing information to be transmitted directly to the claim file — and medical bills can be processed without further human touch if reserves are in place on the claim! 

Integrating the management of medical care with the workers’ compensation claims process also helps examiners focus on their primary responsibility, which is supporting injured and ill workers in their time of need. When examiners feel confident they’re referring workers to quality practitioners and equipment providers in well-managed networks, they can devote their energies to communication, removing barriers, and managing the fiduciary responsibilities of their assigned claims. 

To further support workers’ compensation claims examiners, some leading managed care providers have added ancillary care coordinators to their teams. These professionals spend a lot of time getting to know the services, equipment and supplies they manage, so they can ask the right questions and work with examiners to enlist the right resources on their claims. Care coordinators’ in-depth knowledge helps them readily identify issues as they arise and escalate them to the appropriate medical experts for accurate and prompt resolution. 

Benefits for injured workers

The ultimate beneficiary of effective management of care in workers’ compensation is, of course, the employee. The efficiencies and oversight of integrated programs enable workers to promptly secure appropriate and high-quality medical care after an on-the-job injury or illness, which helps them get back to health and productivity faster. Employers that include ancillary care in their programs offer a seamless experience to employees needing medical equipment, supplies or special services. The assigned examiner and care coordinator collaborate to arrange for ordering, delivery and setup, as well as any fittings or training that may be needed. Streamlining the process gives the employee the best possible experience and increases the likeliness they’ll use all available resources to achieve maximum recovery. 

With the constant threat of an unfavorable experience going viral on social media, combined with a lingering tight labor market, it’s more pressing than ever to take good care of your employees. One easy way to do that is to partner with a managed care provider with integrated capabilities that can bring the highest level of care to your workers’ compensation program.

Tags: ancillary care, Care, caring, Claims, Employees, Healthcare, Helping people, injured employee, injured worker, Managed care, People, Productivity, recovery, workers' comp, Workers' compensation, workplace injuries, workplace injury