In the world of healthcare today, quality can and must be quantified, measured, and demonstrated. But defining quality can be difficult – quality according to whom, to what standards and most importantly, to what end? While the industry continues to focus on solutions to further expand provider networks, Sedgwick recognized early on that the most effective workers’ compensation programs begin with medical providers who are committed to outstanding results while managing costs and meeting the needs of injured workers and their employers. We were one of the first to measure quality of care provided to injured employees and to use that knowledge to build superior networks.
Sedgwick has access to more than 25 provider networks and collaborates with clients for the best network solutions. When injured employees visit top-performing providers identified through our benchmarking program at the onset of injury, there is a 40% shorter claim duration, 68% less incurred cost, 73% faster return to work, and 46% lower litigation rates.
Employers face multiple pressures in complex state workers’ compensation systems. Our claims examiners and nurses utilizing provider benchmarking and search tools have access to the highest quality medical networks when assisting injured employees to find a network provider and take advantage of all available resources embedded in state systems. We operate state based networks under the CA MPN, Texas HCN, Illinois PPP, CT MCO, and KY MCO.
Controlling workers' compensation premiums is vital for business owners and elected officials. Since our inception in 1997, CompManagement Health Systems, a Sedgwick company, has always exceeded the benchmark for Optimal Return-To-Work measurement compiled by the Ohio Bureau of Workers´ Compensation. We manage some of the toughest risks in the state of Ohio from our service centers in Columbus, Cincinnati, Cleveland and Toledo and we make it our business to understand the business needs of approximately 30,000 active clients in Ohio. We work with the injured worker, their physicians and our employers to facilitate the safest, quickest and most successful return to work. And we forge strong and lasting relationships with our partners in the workers´ compensation industry to provide our clients with the best of the best. Visit CompManagement Health Systems at www.chsmco.com
to learn more.
Pharmacy benefit management
Sedgwick’s pharmacy benefit management (PBM) solution ensures injured employees promptly receive approved medication, without paying out of pocket, and to offer the lowest possible charges to our customers. Sedgwick PBM solutions address the challenges of high prescription drug spending and its causes. Our PMB solution provides added safety for injured employees and improves return to work outcomes. Learn more about how our PBM solution can improve your bottom line by clicking the link on the right.
Sedgwick provides access to best in class networks for radiology, diagnostics, durable medical equipment, home healthcare, translation, and transportation services. Sedgwick leverages our vast national book of clients to negotiate the favored nation pricing for these services. Our investment in technology automates referrals and provides fast and accurate information to speed the delivery of necessary care. It means peace of mind, top quality care and continuity of care for injured employees, which supports timely return to work, and cost savings for our clients. Take time to learn more how Sedgwick’s specialty networks can provide the full range of services you need.
Independent medical examination
Independent medical examination (IME) protects both the injured employee and the client by ensuring consistent and high quality via a fully credentialed national network. IMEs are used when we believe the physician is not providing us with a clear or accurate assessment of the injured worker’s functional abilities, or when the injured worker has not progressed in treatment and the provider has not altered the treatment plan. Continuous quality review controls are in place to ensure random selection of non-biased providers, timeliness of communication to involved parties, and security of protected health information.
One of the best ways to mitigate escalating costs is to ensure the injured employee receives evidence based medical care as soon as possible. When a medical expert is engaged at the onset to provide additional oversight, employees are more likely to return to healthy, productive living. Sedgwick’s physician advisor network facilitates proactive and aggressive medical management which helps employers control claims costs. Our team of in-house physician advisors and partner network ensures official disability guidelines are followed to ensure protection and safety for injured employees. Learn more about how our URAC accredited advisor network can deliver results for you.