One of the drivers of the high cost of medical care in workers compensation is the in-ability to get the right care, from the right provider, at the right time. A network of medical providers and a strong pharmacy relationship may be in place that can deliver quality care at a reasonable, negotiated price. However, if injured workers are not utilizing these networks, the opportunity for cost savings is lost.
This is especially true with workers’ compensation as the employee is rarely prepared for what to do in the event of an injury at the workplace.
Network Information Often Difficult to Access
At the time of injury the supervisor is often left in the precarious position to have to make a medical determination on the treatment for the injured worker. He has limited information and limited resources to be able to give the proper direction for the highest quality care at the most cost effective price.
This lack of information is also a challenge for the medical providers, injury coordinators, and adjusters. It frequently results in delays in medical treatment and can lead to unnecessary duplication of medical services, delayed return to work, lack of first fill pharmacy capture, and other inefficiencies.
Provide Critical Medical Information To Expedite Proper Care
Information For Medical Provider
The health ticket is a web based communication tool providing all the necessary information on the medical treatment to the medical providers, employer, employee and the claims payer. The health ticket will inform each medical provider of:
- The employee’s name
- The employer’s name
- An identification customer number assigned to the employer
- The date of injury
- The workers’ compensation adjusting company’s name and address
- The adjuster’s claim number
- The nature of the injury
- The name of ancillary network vendors and contact information
- A telephone number to call with any general questions they have in regards to the injured employee’s medical care.
- The medical care is limited to medical care arising from the date of injury only and for the specific injured body part.
Information for Injured Employee
The health ticket is also provided to the injured employee. It gives the injured employee the same information given to the medical providers. In addition, the health ticket provides the employee with:
- A phone number to call to locate additional medical providers – Or – refers the employee to the posting of panel physicians at the place of employment
Information Regarding Pharmacy:
Drug costs are the fastest growing component of medical care and often one of the most neglected areas of workers compensation cost control. Providing the injured worker complete pharmacy information greatly increases the chances to capture the first prescription fill to take advantage of negotiated payment arrangements and utilization management services of the Pharmacy Benefits Management vendor. The pharmacy information included is:
- Participating pharmacies
- Network identification numbers
- Rx help desk
Information Regarding Utilization Review
As different workers’ compensation insurers usually have different limitations and different requirements on what medical care they can provide without the insurers approval and what medical care needs to be approved through Utilization Review, medical providers frequently have to delay care (adding extra return medical visits to the medical provider) while the medical provider determines whether or not Utilization Review is needed. The health ticket will provide the medical provider with a list of the more frequent medical procedures needing prior approval, including [partial list]:
- Non-emergency hospitalization, surgeries (both in-patient and outpatient)
- Physical therapy
- Pain management
- Imaging procedures
- Facet, trigger point or epidural steroid injections
- Bone growth stimulators
- Second surgical opinions
- Durable medical equipment
The health ticket will provide the medical provider with the telephone number to call to obtain the Utilization Review, which minimizes the delay while the additional medical treatment is reviewed.
Information on Additional Services
The medical providers can also obtain from the health ticket the information needed to schedule additional services like:
- Durable medical equipment
- Home health care
- Orthotics and prosthetic devices
- Diagnostic imaging
- Transportation and translation services
- Physical therapy
Information to Connect With Adjuster Regarding Return to Work
Most importantly (from the work comp adjuster’s point of view) is the instructions on the health ticket to contact the adjuster for information on coordinating the employee’s light duty return to work.
Easily Accessible For Seamless Medical Treatment
The health ticket can be transmitted via the medical case manager’s website, email or fax. The health ticket can be transmitted to the injured employee’s smart phone or other smart device. This allows the injured employee to always have all the medical information available. All users of the health ticket can access the health ticket through the website and print the medical care instructions.
Having this medical information not only makes for near seamless treatment of the injured employee, it also provides many benefits for the employer including:
- A reduction in claim costs through:
- Avoiding unnecessary medical treatments
- Improved quality of medical care through medical network
- It is customizable for the employer’s or insurer’s needs
- Reduces the friction with the employee over the medical care
- Increases the PPO network penetration
- Increases voluntary compliance with Utilization Review
For more information on health tickets and how to utilize a managed care company providing these services, please contact us.
Author Michael Stack, Principal of Amaxx Risk Solutions, Inc. He is an expert in employer communication systems and helps employers reduce their workers comp costs by 20% to 50%. He resides in the Boston area and works as a Qualified Loss Management Program provider working with high experience modification factor companies in the Massachusetts State Risk Pool. As the senior editor of Amaxx’s publishing division, Michael is on the cutting edge of innovation and thought leadership in workers compensation cost containment. http://reduceyourworkerscomp.com/about/. Contact: mstack@reduceyourworkerscomp.com.
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