Medical Cost Containment Does Not Mean Compromised Care

The existing way that the workers’ compensation industry handles large loss claims has been contributing to diminished quality in care for injured workers, increased costs associated with treatments, and poorly coordinated care. Care delivery within workers’ compensation programs is arguably even more inefficient than in general healthcare but it does NOT have to be this way. Payers can have the best of both worlds with medical cost containment strategies that provide quantifiable outcomes that positively impact the patient’s health while also driving down associated treatment costs.

How does Medical Cost Containment Improve the Quality of Care for Injured Workers?

Interventions with prescribers can be instrumental in improving the quality of life and treatment for patients. ANS PharmaIntervention is designed to help treating physicians detect and correct underlying problems, promote functional improvement and reduce narcotic usage. Our legal nurse experts conduct comprehensive reviews of a patient’s medical history often uncovering risk factors and other considerations that can be overlooked by treating physicians. They are then able to collaborate with treating physicians to improve the current treatment plan based on actionable, evidence based recommendations. The benefits to the injured worker include but are not limited to:

• Reduced risk for prescription opioid painkiller addiction.
• A modified treatment program based on recovery.
• A modified treatment program based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.

All of which contributes to measurable improvements in quality of care and life for the injured worker- even increasing the likelihood of returning to work sooner.

How Does Medical Cost Containment Positively Impact Your Bottom Line?

Ensuring injured workers receive the right care at the right time from treating physicians, minimizes the financial impact of catastrophic injuries. The goal of ANS PharmIntervention is to improve quality of care by applying expert clinical knowledge and experience to recommend, where appropriate, alternative treatments and therapies. The financial benefits of the ANS PharmIntervention strategy stem from its ability to aid treating physicians in:

• Improving opioid painkiller practices.
• Avoiding unnecessary or inappropriate pharmaceutical and medical treatments.
• Avoiding duplicate therapies in the event of multiple treating physicians.

When done correctly, medical cost containment ensures that patients receive the highest quality of care balanced with the necessary cost controls.

Care without Compromise

ANS Legal Nurse Consultants provide comprehensive reviews of large loss claims while delivering optimized financial results and quality of care for injured workers. To learn more about our medical cost containment strategies visit our website at www.ans-solutions.com.
This content was originally published at: http://ans-solutions.com/medical-cost-containment-does-not-mean-compromised-care/#sthash.iSdyqFjt.dpuf

When is a Medical Cost Projection Recommended?

Medical Cost Projections are recommended to establish accurate reserves for the future medical costs of complex, large loss claims, often associated with catastrophic injuries. Catastrophic claims can extend over decades, racking up millions of dollars in medical costs. For this reason, setting an accurate reserve is absolutely critical to the financial well-being and security of the carrier and/or the employer.

Medical Cost Projections and the Complex Large Loss Claims

Oftentimes, large loss claims are highly complicated with multiple factors driving exposure and complex information needing to be weighed. The complex nature of large loss claims can stem from several elements:

• Multiple co-morbidities such as diabetes, multiple infections, respiratory ailments, heart disease.
• Injuries may include fractures that do not heal or develop infections, traumatic brain injuries, spinal cord injuries, amputations, and multiple surgeries.
• Treatment is ongoing resulting frequent reserve increases.
  • Reserves may become exhausted prematurely as a prior review did not include new or increasing exposures.
• Pain management treatment, including high medication utilization with escalating medication costs.
  • May also include the use of pain pumps and/or spinal cord stimulators.
• Ongoing frequent physician visits with multiple providers, possibly creating polypharmacy.
• It is often helpful to develop a Medical Cost Projection when settling a claim with an undocumented worker.
  • Cost Projections can be useful in detailing anticipated future care should the worker intend to permanently relocate outside of the United States.

The volatile nature of catastrophic claims makes accurately setting a reserve no small task. It requires the highly credentialed expertise and comprehensive analysis that a Medical Cost Projection program can provide. At ANS, our national network of highly credentialed nurse experts have extensive catastrophic injury experience and are able to apply jurisdictional specific knowledge to the cases they are strategically assigned.

ANS Approach to Medical Cost Projection

The ANS approach to Medical Cost Projections combines an evaluation of potential areas of exposure with potential areas of savings to provide a complete plan of action. Our findings are independently examined using expert medical and cost data sources. The resulting evidence-based recommendations achieve the best possible outcome from a cost and quality of care perspective. For more information on ANS Solutions’ industry leading approach to Medical Cost Projections, contact us today at www.ans-solutions.com.

This content was originally posted at www.ans-solutions.com.