Healthy ways Featured

8:04am EDT January 30, 2004
Of the many issues you face as employers, employee health care coverage continues to affect your company's success. Workers' compensation premiums have exploded as state legislators advance the levels of benefits, and employers are struggling with rising costs that ultimately affect their bottom line.

According to the National Academy of Social Insurance (July 2003), the benefits paid to workers and employers costs for workers' compensation claims rose faster than wages for the first time since 1992. Two-thirds of employers reported that premium rates rose more than 10 percent, a trend that is expected to continue through 2004.

Workers' compensation covers injuries incurred on the job. However, every benefit program includes provisions for illness and injury away from the workplace. As your resources are stretched, greater burden is placed on your company. So how can you make workers' compensation economical and efficient, yet worker friendly?

Reducing employers' costs

Managed care seeks to improve the benefit of health care to patients, as well as its cost -effectiveness as perceived by those financially responsible for the care. By improving administrative efficiencies for both providers and payers of health care, a good managed care organization can help address everyone's interest in extending the reach of health care benefits. You can use managed care services to provide an innovative continuum of patient management services by reducing your company's costs through early intervention, medical treatment plans, recovery and early return to work programs for the injured employee.

A comprehensive case management program should include:

* First notice of loss

* Early intervention

* Utilization management

* Legal support

* Vocational rehabilitation

Minimizing claim costs

The best way to control workers' compensation rate increases is to prevent injuries, but despite the best safety practices, injuries continue to occur. However, there are two key measures you can use to minimize the cost of claims.

First, educate the injured worker to report injuries immediately, because prompt care decreases recovery time, enables a faster return to work and, in the long run, decreases the employer's cost. Second, initiate a formal return to work program.

Case management can help you keep costs in check because case managers identify appropriate providers and facilities across the continuum of health care and human services while ensuring that the available resources are timely, cost-effective and efficient. If the case is handled by a nurse case manager, both you and your injured worker gain an advocate. Physicians and hospitals also benefit because cases are facilitated and payer's costs are reduced.

Additional costs may not seem like much, but nonmedical costs can greatly affect your bottom line. These can include lost productivity, wages and benefits, decreased morale, the cost of temporary help or overtime for existing employees and job knowledge lost.

The benefit of case management

Case managers work hand-in-hand with the intake staff to promote efficient processing of new claims so the initial contact with the injured worker is done in a timely manner. Case managers also work with bill processors to accurately evaluate bill payment to providers. Evaluating the bills for appropriateness and accuracy also helps reduce employer's costs.

Quality and cost effective health care does not just happen. Good medical management goes hand-in-hand with good business management. Quick response and proactive care reduces employer costs and shortens the return to work period.

A tool used by Ohio Bureau of Workers' Compensation is called the Degree of Disability Management. It measures for specific diagnostic codes and job categories to estimate a return to work. The BWC sets return to work benchmarks as a standard for managed care organizations to follow.

In today's health care environment, an effective case manager has to embrace the medical and business aspects of a claim to manage it appropriately and to save the employer money. Mary Frye, RN, BSN, MBA, CCM, is TCM manger of CorVel Corp. She is experienced in workers' compensation and general medicine with expertise in cardiothoracic medicine, case management and business management. Reach her at (800) 275-6463, randy_porco@corvel.com or at www.corvel.com.