The workers’ compensation market appears to be gaining strength heading into 2011. More claimants entered the system in 2010 following a decline in 2008 and 2009, and that trend is expected to continue, according to Don Duford, president of One Call Medical (OCM).
A national company with a specific niche, OCM specializes in diagnostic test scheduling for workers’ compensation payers, including MRI, CT scans, electromyography, and nerve conduction studies.
“Improved productivity and greater efficiency in workers’ compensation claims operations will be priorities for the coming year,” Mr. Duford predicts. “As claimant numbers increase, we are going to see claims administrators trying to manage a bigger load with fewer resources. We anticipate they are going to be more dependent on partners to help them get workers’ compensation patients to the best available providers as early as possible.”
In 2009, OCM conducted market research to identify industry challenges for 2010. In surveys of claims managers, examiners, and nurse case managers, three primary challenges were cited – and they still hold true, Mr. Duford said. They are:
Cost Control:
While claim frequency has declined, there has been a corresponding increase in medical costs, creating an ongoing need for effective cost-containment measures.
Accountability:
Workers’ compensation professionals report they are under pressure to demonstrate a high level of performance. Clients require audits and detailed status reports on claims, provider network utilization, and early return-to-work outcomes.
Education:
Claims administrators and nurse case managers must keep abreast of complex issues in the industry, including medical procedures and regulatory requirements.
“Management of major medical dollars is key,” he said. “We are seeing more employers and claims managers peeling back resources. Their challenge is figuring out how to get better claim results with fewer resources. Our goal is to offer claims professionals services and tools to help them offload and manage specialized functions so they can focus on tasks that directly impact client service, costs, and outcomes.”
For example, OCM offers a service called MD Direct, which streamlines interactions when obtaining diagnostic services in workers’ compensation cases by preloading physician preferences in a computerized system.
Looking forward, OCM is exploring additional ways to reduce redundancy and improve linkages between payers and medical providers through the use of electronic referral authorizations and other mechanisms to reduce delays inherent to fax, mail, and phone transactions, which are difficult to consistently document and track.
Patient transportation and language translation are two other services OCM added to its armamentarium in 2010 through the acquisition of a company called STOPS.
“Our experience shows that rapid and accurate diagnoses, together with a comprehensive treatment plan, are the critical elements to achieve the best claim outcomes for both injured workers and payers.”
“We found these services to be a real need, not just for improved access but to ensure the receipt of reliable, high-quality services,” Mr. Duford said. “We feel STOPS is the perfect fit for One Call Medical’s strategy of building a broader suite of value-added cost-containment services for workers’ compensation payers. Our experience shows that rapid and accurate diagnoses, together with a comprehensive treatment plan, are the critical elements to achieve the best claim outcomes for both injured workers and payers.”
STOPS reports a 99.5 percent success rate in completing the transportation of injured workers to their medical appointments. The firm also provides in-person and telephonic translation services, which are increasingly in demand given the cultural diversity in the U.S. workforce.
“We were a little surprised to discover how broad-based the need for culturally sensitive translation is,” Mr. Duford said. “It is so important to have someone who can translate well and accurately.”
