How Technology Is Shaping The Workers’ Compensation Industry

The technology now used within today’s workers’ comp industry is remarkable compared to what was available just a few decades prior. A dominant component of advocacy, claims, and treatment, technology is helping employers and insurers work the bugs out of the process, producing amazing results and the promise of even more unbelievable advancements on the horizon…

How is Technology Reshaping the Workers Compensation Industry?

• Paper Falls by the Wayside
  • NOW: Endless forms and lost paperwork are no longer, replaced by automated forms, electronic signatures and correspondence that is both faster and easily trackable.
  • LATER: Lengthy, written legalese explanations will be replaced by clearer video demonstrations. Avatars, virtual assistants, and chat will become more commonplace.
• “Smart” Tech Takes Over
  • NOW: Smartphones and mobile devices empower injured workers, offering personal claims reporting, teledoctor consultations and referrals, status and payment checks, virtual correspondence examiners/case managers, and easy access to information via chat/messaging. This faster reporting and assessment speeds treatment, lowering pain severity and costs, and boosting network penetration.
  • LATER: Wearable Tech will become increasingly common in the workplace, from high-tech safety vests and helmets to watches that identify fatigue, repetitive motions, and even alert employees of dangerous situations. For the injured, mobile self-service tools will encourage a more active role in recovery and return-to-work, and the introduction of digital wallets will offer more convenient access to prescriptions.
• Automation Moves Things Along
  • NOW: Triggered by specific claims events, automated correspondence speeds the process with real-time text/email notifications, boosting productivity and claimant satisfaction.
  • LATER: Tech driven by “empathetic” artificial intelligence will aid claimants, further reducing workloads.
• Video Trumps Phone Communication
  • NOW: Employers, claims professionals, nurses, and attorneys can more easily communicate remotely and interactively.
  • LATER: The transition to a more personal video telepresence will boost efficiency and improve interactions, making them more personable.
• Analytics Provide Greater Insight
  • NOW: Predictive analysis through text mining is granting ever-faster access to previously unknown variables, identifying cost triggers (opioid use, comorbidities), and unearthing previously unidentified information.
  • LATER: Prescriptive analytics will come into play, implementing new tech that prescribes successful and actionable intervention techniques.

Exciting Times, Amazing Opportunities

The industry and employers are capitalizing on this wave of technological change. When was the last time you initiated change in your workers’ compensation medical cost containment strategy? ANS Solutions’ streamlined Pharmacotherapy Review program has a proven track record for improving efficiency, reducing costs by over 25% with a success ratio of 94%, yielding a guaranteed return-on-investment of 20-to-1 through our Guarantee Program. Centered around maximizing treatment outcomes for injured workers, our unique, multi-faceted approach delivers cost-effective, proven treatment solutions that make a lasting, positive impact on the overall employee workers’ comp experience. Blaze a new trail in this innovative era. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/how-technology-is-shaping-the-workers-compensation-industry/

The Impact of Workers Compensation Compounding

As custom-made compound prescriptions concoctions continue to rack-up higher workers’ compensation costs, insurers are scrambling to find alternatives and employers are looking for relief from equally inflated premiums. With little to no evidence as to the efficacy of such creations, many states have implemented treatment guidelines directing doctors to more evidentiary-based, easily reimbursable options. Despite guidelines and formularies however, loopholes in coverage continue to allow providers to sell millions of dollars of compounds, with many companies submitting inflated reimbursement bills in their attempts to get paid.

A Growing Issue in Workers Compensation

This June, the U.S. Attorney’s Office brought criminal charges against such providers across the country, accusing them of defrauding the Medicare, Medicaid, and Tricare health insurance programs that serve the military and their families. Additionally, the Inspector General of the U.S. Postal Service identified compound drugs as attributable for 34% of the postal service’s prescriptions, and 53% of prescription drug costs in 2015, a rise from 22% and 27% in 2014, respectively. State and federal prosecutors also continue to finger some pharmacies for offering doctor kickbacks in exchange for prescriptions.

Money or medicine?

Industry guidelines point to the use of such compounds as a last resort, accepted in instances where a person is allergic to an ingredient in a drug, or when a liquid version of a commercially available drug is necessary for one who cannot swallow capsules. Some doctors prescribe initially despite these guidelines. The unnecessary prescription of compounds is costing the workers’ comp industry billions annually.

Deep impact

2015 calculations indicate…

• Re-packaged drugs dispensed by physicians cost employers 60% to 300% more than those dispensed at retail pharmacies.
• The average paid per compound drug increased by more than two-thirds from $460.00 to $774.00, though non-compound drugs fell slightly from $113.00 to $108.00.
• The U.S. Postal Service alone spent a whopping $390,000.00 a day for compound drugs in 2015.

Tired of paying more for ineffective treatments?
Proven, more affordable, clinically tested and approved options to compounds do exist. It’s time to find a better way. Discover how to achieve better claims outcomes with ANS Solutions Pharmacotherapy Review. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/the-impact-of-workers-compensation-compounding/

What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

• A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
  • Higher average costs per indemnity for workers over 30.
  • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
• Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
  • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
  • 2003-2004: Drop in claim severity (reform laws enacted during this time).
  • 2003-2008: Indemnity claim frequency declines dramatically.
• Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
• Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
• Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

• Consolidation and coordination of drug therapies between multiple prescribers.
• Consideration of alternate therapies.
• Specification of weaning programs for over-prescribed narcotics.
• Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/whats-trending-with-california-workers-compensation/

The Human Side of Medical Cost Management

When we talk about the costly nature of large loss Workers’ Comp claims, it is sometimes hard to think beyond the financial impact.  Further to this point, when medical cost containment strategies are discussed they are often geared toward addressing the clinical and pharmaceutical treatment programs for injured workers from a financial perspective. What about the less tangible side of medical cost containment-the human costs which are equally as significant and damaging?

Addressing Human Costs in Medical Cost Containment

When we talk about the human cost of large loss claims, we are really talking about the effect a case has on the quality of life for an injured worker and their family. While all medical cost containment strategies focus on financial cost drivers, not all strategies address human costs. There are many drivers that can contribute to compromising an injured worker’s quality of life. These human cost drivers include, but are not limited to:

·         Pain treatment through highly addictive opioids, coupled with a lack of patient education on the risks and dangers of these drugs, subjects injured workers to a path of drug addiction which may hinder or prevent their recovery.

·         Lack of appropriate physician monitoring and/or patient compliance to a prescribed medical treatment regimen can contribute to a longer recovery period.

·         Lack of monitoring patient’s treatment program and progress results in missing the warning signs of drug abuse and addiction, missed opportunities to modify a treatment program based on patient’s recovery, lost opportunities to modify treatment based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.

·         Lack of coordination between multiple treating physicians can attribute to greater increase for drug abuse or unnecessary or inappropriate pharmaceutical and medical treatments.

ANS Cost Containment Strategies

The ANS PharmacotherpyReview Program is the most advanced and results-oriented cost containment strategy in the industry. At the first of three stages, we assess the existing treatment program using evidence based reviews to assess medical necessity. We also identify duplicate therapies, excessive dosages and alternate medication regimens. Our experts then make actionable treatment modification recommendations that ensure optimal outcomes for the patient. This includes consolidating and coordinating drug therapies between multiple prescribers.  In the second stage, our nurse experts work with treating physicians to obtain commitment on a modified future course of treatment. For a positive therapeutic outcome, we move to stage three where an ANS Clinical Liaison Officer proactively manages each case to ensure physician and patient compliance with the revised course of treatment.

ANS Solutions

Our approach to cost containment was uniquely developed to simultaneously ensure a medically appropriate and cost effective treatment program and enhanced quality of life and care for the injured worker. For more information on our industry leading cost containment strategies visit us at www.ans-solutions.com. 

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

 

What is a Medical Cost Projection?

Medical Cost Projection (MCP) is a medical cost containment analysis often used to set reserves in complex cases where multiple factors drive exposure, and complex medical and legal information needs to be considered. Most people look at it as “what this case is worth,” but that’s not really accurate.  MCP is a comprehensive and expert analysis which generates reliable, evidence-based recommendations to positively manage the medical portion of a claim.

Key Attributes of a Medical Cost Projection

To fully understand what a Medical Cost Projection (MCP) is, we need to boil a MCP down to its most basic form.  Below are the five key attributes that define Medical Cost Projection: 

1. It’s an educated speculation made by highly credentialed medical experts. Our expert Legal RNs harness a wealth of knowledge giving ANS the advantage of being able to make specific detailed recommendations that that achieve improved quality of life and identify financial savings for payers.   
2.  MCPs should include state specific jurisdictional expertise, married to intimate medical knowledge, and specific experience with catastrophic injuries. At ANS, the complexities of each case are matched to the relevant expert knowledge and experience of a highly credentialed RN from our national network.  
3. The cost figures in MCPs are based on the use of today’s dollars.   The cost remains static unless it is a known fact that something will increase in cost at a given point in the future. ANS evaluates potential areas of exposure and savings for the most comprehensive medical action plan possible. Anyone can take what someone is currently paying, multiply it by their life expectancy, and get a number. But a truly useful MCP is far more detailed than that. 
4. At ANS, it involves breaking down a case to each specific service and requirement.  This includes an injured worker’s past complications, current needs, co-morbidities, etc.  We also take into account future needs, based on a reasonable degree of certainty, using costs specific to each jurisdiction.  
5. MCPs projects costs within a specific period of time. Everyone has a life expectancy and every insurance company has their own way of calculating said life expectancy, be it rated ages, discounts, etc.  Our reports are fully customizable to fit any carrier’s policies in this area.  We can base our reports on any time frame requested.
 

ANS Medical Cost Projection Services

When it comes to complex claims, an accurate evaluation to identify the value of a claim can only be reached with the kind of comprehensive research and analysis that comes from ANS Solutions’ Medical Cost Projection services. The recommendations from our highly credentialed nurse experts, along with their local jurisdictional prowess, create an analysis that allows Payers to accurately set reserves for the life of the claim.

If you would like to learn more about our Medical Cost Projection programs and other medical cost containment services contact ANS Solutions today. 

About ANS Solutions

The ANSwer to Medical Cost Containment

ANS Solutions is one of the fastest growing health care cost management companies in the USA. Over the course of a decade, we have designed and honed a series of medical cost containment strategies that are truly unique in the industry.Our expertise includes the entire suite of Workers’ Compensation Medical Cost Containment Services designed to help our customers lower claim costs, improve loss rations, reduce risk and exposure, and dramatically improve the quality of care for injured employees. Our clients include some of the nation’s leading insurance carriers, Fortune 1000 self-insured companies, and the largest third party administrators in the United States. ANS is also one of the few Medical Cost Containment providers able to successfully perform pharma reviews and interventions with clients operating in ex-parte states.

A Better Drug Utilization Review 

ANS is an innovator in the field of Drug Utilization Review and implements a 360 degree approach to pharma review and intervention that we call our Pharmacotherapy Review. Because we have highly credentialed and experienced professionals on the ground in all 50 states, the analysis and intervention we do with doctors, lawyers and other claim stakeholders is highly effective.  Our face to face approach has set a new standard in our industry, a standard so high that we are able to offer our 1 Million Dollar Pilot Program Guarantee on case savings.  

The Road To Settlement  

ANS Pharma Cost Containment, Medical Cost Projection, and Legal Nursing Services programs enable ANS to achieve optimal outcomes for both workers and insurer’s alike.  To learn more about how ANS can help you navigate complex Workers Compensation Medical Cost Containment visit our website today.