In today’s world — where medical cost inflation is outpacing overall inflation — ensuring injured workers receive the treatment they need and return to work in a timely fashion is critical to keep costs in-line.

A number of factors, including provider consolidation and changes in billing practices are contributing to these increased costs.

“The same set of practices or treatments that would have cost $100 five years ago now cost between $130 and $140, representing a 30-40% inflation in overall charges,” said Sandip Chatterjee, chief product officer, MedRisk.

Sandip Chatterjee, chief product officer, MedRisk

There are a number of ways workers’ comp stakeholders can manage costs, including some strategies targeted specifically toward musculoskeletal injuries, which make up the majority of workers’ comp claims. These injuries can often be treated effectively with early physical therapy interventions, but differing state regulations and physicians treating patients with a formulaic, rather than individualized approach can make it challenging to ensure workers are getting the care they need, when they need it.

Fortunately, workers’ comp stakeholders can collaborate effectively to get workers the care they need while managing costs. TPAs, like Davies, are leveraging partnerships with managed physical therapy networks like MedRisk and SPNet to access discounted networks, use data and analytics to identify industry trends and at-risk claims and support recovery while managing costs through utilization review.

“Our strategic partners like MedRisk and SPNet provide data analytics and tools that help us identify trends and areas for cost savings. Our partnership with SPNet goes beyond a discounted network; their utilization review improves outcomes and manages costs by providing injured workers with only the necessary treatment related to their industrial accident,” said Beverly Adkins, president of the Third-Party Administrator, Davies North America.

“The tight integration with MedRisk’s network reduces administrative costs. We closely monitor network penetration through reports because keeping clients within the network and using those providers is key to controlling costs.”

Ensuring Effective Claims Management

Beverly Adkins, president, Davies North America

Effective claims management needs three key ingredients: timely and accurate injury reporting, leveraging technology and data analytics to improve outcomes and clear communication and collaboration amongst workers’ comp stakeholders.

“The sooner we can initiate care, the sooner the injured worker can complete treatment and recover. That’s our primary goal in this ecosystem – to help injured workers return to their pre-injury health,” Adkins said.

Timely and accurate injury reporting plays a key role in avoiding delays in care. Treating injuries — especially those of the musculoskeletal variety — in a timely manner is key in helping an injured worker recover and get back to their pre-injury level of function.

“Evidence shows that patients who receive PT sooner for certain conditions, such as acute and subacute low back pain, shoulder strains, and neck conditions, achieve better outcomes faster,” said Brian Peers, vice president of clinical services and provider management, MedRisk.

Making sure patients are being treated quickly is important, but so is making sure they’re receiving appropriate care. Adjusters and nurse case managers should proactively review files and leverage data insights to make sure an injured worker is receiving the right treatment and identify any potential hurdles in the recovery process.

Brian Peers, vice president of clinical services and provider management, MedRisk

“Doctors often prescribe standard treatments, such as physical therapy three times a week for four weeks, which may not be necessary for the injured worker to return to their pre-injury status,” Adkins said.

“We train our staff to review these recommendations against guidelines and authorize only what is needed. We rely on our strategic partners to assist in this process. If additional treatment is required, we can increase it, but our focus is on the injured worker’s recovery while managing costs through effective utilization review.”

This approach also allows workers’ comp stakeholders to focus on keeping employees at work.

“We work to keep employees at work rather than just focusing on return-to-work,” Adkins said.

“We emphasize the importance of keeping employees engaged and at work whenever medically appropriate. We also provide training to our occupational medicine physicians to help them understand the unique aspects of workers’ compensation and support recovery-oriented care.”

Collaborating to Get Injured Workers Back on the Job

Effective communication, leveraging data and analytics and ensuring injured workers get the right treatments swiftly is key to managing costs and helping workers get back or as feasibly close to their pre-injury level of function.

“Our model is like a map – it starts with a preplan, identifying the fastest route. Then, as we receive real-time information during the journey, we coordinate between all stakeholders to make necessary adjustments that get us to the destination faster,” said Greg Nichols, president of SPNet.

Greg Nichols, PT, president of SPNet, a division of MedRisk

To leverage partnerships with companies like MedRisk and SPNet, TPAs need to get buy-in from insureds. This level of support is also key to driving better outcomes for injured workers. As Adkins explained, “Workplace support is crucial for successful return-to-work outcomes. Most of our clients are self-insured and highly engaged in the process, as it directly impacts their finances. We build trust with them.

“This trust allows us to bring in strategic partners that can help save them money. Our clients, in turn, support our initiatives and share pertinent information we provide to their employees. Effective communication and staying proactive are key to maintaining this support,” she continued.

Strategic partners can also help with cost containment and identify options for cost savings.

“For clients, about 40-50% of their bills are subject to either zero or low discounts. In this situation, we need to consider alternative solutions,” Chatterjee said. “We can explore financial audits, clinical audits, and negotiation. Our company is actively investigating a range of strategies to help our clients drive better savings on their bills in this evolving healthcare landscape.”

Leveraging Strategic Partnerships for Targeted Savings

Finding the right partners can be critical to identifying opportunities for cost savings and ensuring injured workers receive the appropriate treatment within workers’ comp. MedRisk prioritizes connecting injured workers with high-quality providers, who understand the workers’ comp system, and follow appropriate treatment guidelines. The company also uses data and analytics to track claims and ensure injured workers are on the path to a successful recovery. All of these tools can help get workers back to work sooner and reduce claims costs.

“We are working in partnership with MedRisk and SPNet to mitigate these costs and show them value in that partnership,” Adkins said.

Their tools can help even when there’s been a delay in care. “We have an integrated system that delivers scores and recommendations for physical therapy delays. Just because we have a delay in access to care or recovery doesn’t mean it will be a high-risk claim,” Nichols said.

Their team is committed to providing appropriate care for each injured worker. “Most referrals are in multiples of two or three visits, even though some cases may require five or seven,” Peers said. “Our team assesses the unique needs of each case, aiming to provide the exact care required for functional recovery and resumption of pre-injury duties – no more, no less.”

By focusing on care-first strategies and strengthening strategic partnerships, workers’ comp stakeholders can improve outcomes for injured workers while controlling costs. This collaborative, compassionate approach helps workers recover faster, supports long-term function, and creates sustainable savings in a system facing rising costs and complexity.

To learn more, visit: https://www.medrisknet.com/.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with MedRisk. The editorial staff of Risk & Insurance had no role in its preparation.