White Paper

5 Advanced Ways Clinical Expertise Can Improve Workers’ Comp Outcomes

Caring for injured workers should involve more than just processing transactions. Applying a clinical approach from the onset of an injury ensures more appropriate care and better outcomes.

White Paper Summary

Determining the best course of treatment for a workers’ comp patient is so often constrained by regulation. State laws, formularies, utilization review and the need for layers of authorization can make it difficult for case managers to balance the needs of the injured worker against the requirements set forth by the system.

For that reason, managing workers’ comp claims can become robotic and transactional. Instead of putting health and recovery first, claims become a series of checklist items. PBMs in particular process a lot of transactions, ensuring that medications make their way to injured workers in a timely manner. But that doesn’t mean that a PBM has to be a transaction-based company.

“PBMS can leverage their clinical expertise from the very beginning of a claim to coordinate the best care and improve outcomes – both for the injured party and for the employer,” said Tron Emptage, Chief Clinical Officer, Optum Workers’ Compensation and Auto No-Fault.

Here are five ways that applying a clinical approach to pharmacy benefit management from the initial injury report can drive better outcomes in workers’ comp:

To learn more about Optum, please visit their website.

The Optum workers’ compensation and auto no-fault division works to collaborate with our clients to deliver value beyond transactional savings while helping ensure injured parties receive safe and effective clinical care throughout the life of their claim. Our innovative and comprehensive cost management programs include pharmacy care services, ancillary benefit management, medical services, and settlement solutions.

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