Medical Management Track Addresses Costs, Reforms, and Outcomes
The 23rd annual National Workers’ Compensation and Disability Conference® & Expo takes place Nov. 19-21 at the Mandalay Bay Resort and Casino in Las Vegas. The conference is produced by LRP Publications, which also publishes Risk & Insurance®.
With medical overtaking indemnity as the main cost of workers’ comp claims in most jurisdictions, managing the medical component has become vitally important to the workers’ comp system. The Medical Management track addresses a variety of relevant issues. Sessions will include:
Improving Claim Outcomes Using Outcomes Based Networks
- David Deitz, M.D., vice president, national medical director, CI claims, Liberty Mutual Insurance
- Stephanie Perilli, senior director, medical health management, The Home Depot
Many workers’ comp practitioners are starting to believe that certain medical providers can make a difference in achieving the best outcomes. Effective partnerships among employers and payors can help engage providers who deliver the best care for injured workers.
Provider measurement strategies to assemble physician panels in multiple jurisdictions is another influencing factor, according to the speakers. They will share how to develop top quality medical networks and will explain how reviewing provider performance metrics has led to reduced workers’ comp and disability costs at The Home Depot. They will also demonstrate how employer engagement in the selection of provider panels may result in better outcomes and analyze various techniques and tools to measure physician quality.
Managing the Costs of Medical Containment and Cost Control Services
- Charles F. Martin, managing director, casualty operations consulting leader, Marsh USA Inc.
- Joe Picone, claim consulting practice leader, risk control and claim advocacy practice, Willis
Services to manage ever-increasing medical expenses are essential to help eliminate unnecessary care and inflated billing. But the very cost-control measures and services themselves can become part of the problem and generate unwarranted expenses, if not effectively overseen.
Martin and Picone will discuss analytics and options they believe can help improve return on investment from medical management services. They will demonstrate where unwarranted costs can creep into a workers’ comp program, how to apply strategies for eliminating such expenses, and evaluate medical management spend for optimal outcomes.
Medical Case Management: How to Position Your Program for Best Outcomes
- Kim Weaver, regional manager, MHayes
- Anita Weir, director, medical and disability management, corporate risk department, Safeway Inc.
Effective case management does not happen in a vacuum, say Weaver and Weir. Companywide planning that focuses on all aspects of the claim cycle is the best way to ensure the best outcomes.
The speakers, highly successful industry veterans, will share case management program strategies they say will help drive clinical quality, improve return to work, and reduce claim costs.
They will explain the elements included in a successful case management program, identify strategies to prevent or limit costly tail claims, and critique what they say are best practices in case management.
Modeling Managed Care for Program Impact
- Barry Bloom, principal, The bdb Group
- John Riggs, manager, workers’ compensation, Disneyland Resort
- John Smolk, principal manager, workers’ compensation, Southern California Edison
Many practitioners find the wide range of managed care services expensive, complex, and difficult to measure. The speakers believe it is important to understand what to look for to determine which ones will deliver the best outcomes for the injured worker and greatest cost savings for a company. The speakers, representing two large self-insured employers and a national workers’ comp consultant, specifically will define the available managed care services; distinguish the most appropriate services, depending on program needs; illustrate how to get better clinical results for injured workers; and assess ways to construct managed care services that are most appropriate for a particular organization.
Health Care Reform: Strategies You Can Apply Now
- Denise Zoe Gillen-Algire, director, managed care and disability corporate risk, Safeway Inc.
- William Wilt, president, Assured Research
The speakers say the workers’ comp industry needs to stop theorizing on the potential impact of the Affordable Care Act and start acting in order to be prepared. Wilt, an industry leading actuary, and Gillen-Algire, an occupational health executive, will share data reflecting some of the ACA’s current impact on the industry as well as strategies to help organizations be better positioned for the future.
The two will define the ACA and discuss how it is impacting the workers’ comp system, interpret data showing the direct effects of health care reform, appraise a variety of future changes to the system resulting from the ACA, and discuss design strategies to prepare for health care changes.
How to Reduce Costs With a Wellness Program
- Karen Curran, director, health risk management, Pinnacol Assurance
Wellness programs can do much more than many employers and payers think, says Curran. She says overwhelming evidence shows that a well-orchestrated program targeting employee health risks can have a significant impact on workers’ comp claims and costs. Curran, an expert on the subject, will outline the undocumented findings of an ongoing study and discuss ways companies can help improve employees’ health and reduce claims frequency, leading to better health and financial outcomes.
She will discuss the preliminary results of a groundbreaking program; show how workers’ comp fits into the overall spectrum of health promotion relative to the more traditional players such as health plans and wellness vendors; analyze documented data showing how health behavior and risk factors impact claims; and compare engagement strategies for small versus larger companies.