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Medical Factors
The effects of a specialist healthcare provider network for workplace injuries on costs and lost time

At a glance:
This study described a healthcare network, established by an insurance company in conjunction with a hospital. Employees who had a workers' compensation claim accepted were encouraged to use this network. Those who did had lower medical costs and missed less time from work. This represented a significant saving for the insurance company.

Savings were made largely by reducing the amount of time that patients were off work. Case management provided by the health care network may be important for reducing costs by ensuring early treatment and getting people back to work sooner.
Perspectives:
Employee
Managing a work injury is more complex than managing many other medical problems. Treating practitioners find this area of work challenging. Some doctors avoid treating people with a work injury. Treating practitioners report that delays and “red tape” in the system can interfere with their treatment, and they often find their advice is not followed by people involved in the workers' compensation system. Patients who are injured at work have poorer health outcomes.

This study showed that when patients used a specialised health care network (for the treatment of workplace injuries) they had better outcomes. Whilst the study looked at whether using the system reduced costs, a lower cost result reflects better patient outcomes. When people do better they are back at work earlier, and their claim is less expensive. People generally suffer less when they get back to work earlier.

People can be frustrated with the treatment they receive for a work injury. You have a choice of treating practitioners. If you do not feel you are making satisfactory progress and you are concerned about treatment, talk to your treating practitioner. It is important to be satisfied with your medical treatment.

The other feature of this study was that a manager from the clinic was involved in each case. The case manager's role was to coordinate care and prevent any delays in treatment. Delays in getting treatment for a workplace injury are common and make recovery more difficult. Patients sometimes think they need to wait until they receive advice. You can be proactive in your own management. It is always important to be polite, but you can reduce delays in treatment by asking about expected timeframes and by being persistent.
Employer
Patients in this study received medical treatment from doctors who specialize in the management of work injuries. The results for people who received this specialized treatment were significantly better.

There were a few differences between patients who attended this system and those who saw their usual doctors:

1. Patients chose to use this system (which may have influenced the outcomes).
2. They received treatment from practitioners who were experienced in managing work injuries.
3. They had case managers to coordinate care and avoid delays.

Employers can help patients to avoid delays. A good relationship with the claims manager can help. Having a work injury can be a difficult time for many people; they are not only dealing with their medical condition, but a system they are not used to. Most patients don't know how to use the system to reduce delays and get the best care. Supporting employees and helping them avoid delays can substantially improve their recovery.

Helping employees get good medical care can also make a difference. Not all doctors know how to manage work injuries and get the best out of the workers compensation system. Your employees should be free to get a second opinion if they wish. Treatment does not always help, and there is little value in continuing treatment that isn't going to improve health. Help your employees to understand what is best for their condition and be proactive in getting the best care for their problem.
Treater
Managing work injuries is complex. In this study patients had better outcomes when they attended a clinic specializing in work injury management.

One of the major differences in the specialized system was the use of a case manager to coordinate care and minimise delays. Dealing with a workers' compensation system can be challenging and frustrating, particularly when there are delays. Following up treatment and minimising delays also improves outcomes for patients. It may be worth having an administrative person at the practice able to follow up requests, to improve medical care and outcomes.
Insurer
This study describes using a network of treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 with experience managing work injuries to treat patients with a workers' compensation claim. Medical and wage replacement costs were reduced using this system of specialized care. This cost reduction may be related to factors other than treatment that weren't controlled in the study. Patients were free to attend this provider network, or to attend their usual practitioner. Patients who wanted to use the system may have been more focused on returning to their normal job. The other major difference was use of case managers who worked to minimise delays in receiving appropriate treatment. As there were a few differences between the care at the specialised clinic and normal care, it is not possible to tell which features made a difference. However other studies have also indicated that avoiding delays improves patient outcomes.

Making claims management decisions can be challenging. There are a range of factors that need to be taken into account. Nevertheless avoiding delays is important and can make a substantial difference to long-term case outcomes. This is an area where WorkCover agents or insurers can help improve return to work results.

The study also implies that using treaters who understand management of work injuries can improve treatment outcomes. Patients have the choice of treaters and should be satisfied with their medical care. Patients should feel free to seek a second opinion if they have any questions or are concerned they are not making progress.

Patients in this study attended the same doctor over the course of their condition, rather than attending different doctors at different times. Patients attending public hospitals will often see different doctors at each outpatient appointment, and this can delay medical management decisions and treatment. In selecting their treater, patients may consider attending a private practitioner rather than an outpatient department at a public hospital.
Original Article, Authors & Publication Details:
E. J. Bernacki1, X. Tao1 and L. Yuspeh2 (2006).

An Investigation of the Effects of a Healthcare Provider Network on Costs and Lost Time in Workers' Compensation. Journal of Occupational & Environmental Medicine 48(9): 873-882.

1Division of Occupational and Environmental Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Research and Development, Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana.
Background, Study Objectives, How It Was Done:
In this study, a large insurance company in the United States (the Louisiana Workers' Compensation Corporation) set up a healthcare provider network (“Omnet Gold”) in conjunction with a large hospital. Injured employees seeking compensation were referred to this organization by their insurer, but were also free to choose another healthcare provider. The cost of the compensation claims and length of time on sick leave for patients treated by the healthcare network were compared to the outcome for patients treated elsewhere.

The healthcare network set up by the insurance company had several important characteristics.

Each patient had a “managing doctor,” who was almost always an occupational physician specifically trained in work-related medicine and experienced in compensation cases.

This doctor remained with the patient over the full course of their medical treatment. On top of their usual fees, this doctor was paid $US250 by the insurance company to cover administrative costs, referrals etc.

The managing doctor had access to a formal network of healthcare professionals, including orthopaedic surgeons, neurosurgeons, physical medicine and rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 specialists, physiotherapists and others.

All doctors, nurses and other professionals in the network were also given 2 days specialty training.

A staff member at the doctor's office was assigned to follow each case and make sure there were no unnecessary delays in treatment. This case-manager followed the patient's case as it progressed and acted as a bridge between all the professionals involved in the patient's care. Patients also had a second case-manager within the insurance company, who managed the processing of their claim and their return to work.

Weekly meetings of 1 hour and 30 minutes were held between the case managers and representatives of the insurance company to discuss the progress of the cases.

Within the insurance company, all patients (whether they were treated by the healthcare network or not) were followed up by claims representatives, healthcare services officers and vocational
vocational
Related to work or career. Vocational rehabilitation focuses on the process of returning to the workforce.
 consultants. These people were responsible for processing of the patient's compensation claim, managing their return to work and keeping track of their healthcare.

The insurance company encouraged all employers to suggest their employees use the healthcare network. However, the networks were set up close to businesses with large insurance policies (businesses with many employees who were involved in hazardous work), and most of the clients therefore came from this background.
Study Findings:
Between August 1, 2003 and July 31, 2004, there were 176 clients with successful compensation claims who chose to use the healthcare network. 1464 clients with successful claims chose to receive their healthcare elsewhere. By the end of the study, over 90% of all claims were closed.

Clients who were treated by the healthcare network had significantly less time off work. Their medical expenses and indemnity costs
indemnity costs
Compensation costs for a person's injury, such as replacing their wages, a lump sum etc.
 (compensation for lost time from work) were considerably lower. All costs below are given in US dollars.

Closed claims that were treated by the healthcare network had an average of 53 days lost from work, compared to an average of 99 days for claims treated elsewhere. People whose cases were managed by the healthcare network were somewhat more likely to have a condition that required time off work, but they returned to work more quickly than other clients.

For closed claims that had required time off work, the average cost of medical treatment was 40% less for claims managed by the healthcare network ($3,995 compared to $9,850.)

The average indemnity costs were 38% lower for closed claims managed by the healthcare network ($3,017 compared to $7,081)

The average total cost of each claim managed by the healthcare network was $12,554 compared to an average of $20,400 for other claims (38% lower for the network).

For open claims, the time lost from work, medical expenses and total expenses were also considerably less for the clients that used the healthcare network.

The researchers estimated that claims that were treated by the healthcare network saved the insurance company a total of approximately $1,883,750

56% of network-treated claims were closed before the client had missed 30 days of work, compared to 37% of other claims.
Conclusions:
This study described a healthcare network, established by an insurance company in conjunction with a large hospital.

The key features of the healthcare network were:

Patients were treated by an occupational physician, who had access to a formal network of other medical specialists.
Each client had a case-manager who ensured there were no unnecessary delays and acted as a bridge between the different healthcare and insurance professionals.
Doctors in the healthcare network were not reviewed by the insurance company or required to minimize their costs, but were left to conduct treatment as they saw fit.

Patients claiming compensation were encouraged to use the network, but were not obliged to. Patients who did use the network had significantly lower medical and indemnity costs, and missed less time from work. Reduction in claims costs represented a significant saving for the insurance company.

Claims were closed more quickly for clients treated by the healthcare network, indicating that patients were returning to work more quickly. The researchers concluded that this was the main reason for the financial savings of the insurer. They also believed that early treatment helps people to return to work more quickly. They suggested that the expertise of occupational physicians and the case-management approach of the healthcare network were important factors in its success.

There are, however, many factors that could have influenced return to work and compensation costs in this study. Since patients were able to choose their doctor, the group of patients who selected treatment from the healthcare network may have been considerably different to those patients who were treated elsewhere.

For example, this healthcare network initially targeted businesses with large insurance policies – these were large companies, and companies involved in hazardous work. These companies are more likely to have the resources to manage injuries and return-to-work more economically and effectively. There is likely to be alternative duties available within the company for injured workers who are unable to return to their previous jobs. This decreases time off work and compensation costs.

The researchers concluded that the way a claim is handled early on in the process is the most important factor in reducing disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 and medical and indemnity costs. It appeared to be more difficult to influence the outcomes of a case as more time passed. Using case-management is an effective way of ensuring early diagnosis,
diagnosis
The process of identifying a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of various diagnostic procedures.
 treatment and return to work.
References:
PubMed Abstract
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