Managed Care Savings Are Possible During Times of Inflation

When quarterly projections start to veer off course, businesses research internal metrics and take corrective measures across all aspects of their operations. Budget projections increase, costs need to decrease and the balance between the two becomes ever slimmer.

As wallets tighten and responsibilities increase, protecting your most valuable asset – your people – becomes an even greater priority.

“Caring for the wellbeing of your employees, in particular those struggling through a work-related injury, promotes confidence and loyalty amid growing societal sentiments of institutional distrust. When employee care is entrusted to transparent partners who serve with integrity, passion within your organization builds and ultimately, production increases,” said Kerri Wilson, President and COO of EK Health.

EK Health takes a two-pronged approach in assisting our clients as they realize cost containment and savings during inflationary times without compromising care of the injured worker. First, it focuses on the humanization of case management and; second, it focuses on leveraging programs and processes to help clients achieve their savings goals without compromising employee culture.

Kerri Wilson, CPCU, President and Chief Operating Officer

The Human Element

Delivering specific, cost effective and medically necessary care to the recovering worker to promote quality of life and expand return-to-work possibilities, involves timely assessment, robust advocacy, consistent communication, and mindful intervention.

Early Intervention with Assessment

A quick response following the report of an injury creates goodwill and trust between the injured worker and their employer. Early intervention has incredible potential to minimize treatment delays and lessen the threat of escalating costs, as longer claims historically lead to additional care.

EK Health requests that client claims be sent simultaneously through its system and the third- party administrator up front, with the goal of squeezing the time gap between injury and claim evaluation.

Douglas Benner, MD MS, EK Health’s Chief Medical Officer noted, “Knowing that all employees are different, our team is trained to assess common risk factors and barriers to recovery.”

Communication and the Return-to-Work Plan

After the development of a comprehensive plan for medical intervention and treatment, the nurse case manager’s level of communication with the injured worker should leave no doubt about next steps in the recovery process.

Often the mental aspect of injury recovery is as difficult as the physical. Nurse case managers provide necessary support and tools to mitigate this additional stress to further promote long-term health and wellbeing. Introducing a formal mental health care component to the treatment plan helps relieve anxieties that come from the injury itself and resulting complexities that follow.

Mindful Intervention

Having a nurse case manager that develops and closely monitors a holistic plan consistent with national guidelines reduces cost and length of claim, promotes quality of life, and ultimately, aids the return of the employee to the workforce quicker.

Because prescription costs are well known to be a large part of out-of-control case costs, engaging a managed care company with a strong prescription intervention program that uses evidence-based guidelines and clinical best practices, paired with diligent nurse oversight of utilization, is another important cost-savings tool.

Effective Programs and Processes

Dr. Douglas Benner, MD MS, Chief Medical Officer and Medical Director

Seeking savings within managed care programs and processes has to be executed using a holistic approach, rather than haphazardly attempting efficiencies. This means establishing a mindset that savings are broader than purely reducing dollars spent on program costs.

EK Health develops effective programs and processes by creating curated provider networks, recruiting and maintaining quality staff, utilization of clinical resources, and innovative technology applications.

Provider Network Design

By creating and managing boutique-style provider networks using prescreened physicians at fee schedule rates, EK Health’s clients have seen their injured workers receive prompt, quality care which in turn reduces lost days at work. Having solid, reliable network providers offers payors certainty and better overall claim outcomes.

Recruit and Retain Qualified and Compassionate Nurses

The COVID pandemic has clearly wreaked havoc on the nursing profession, so engaging a managed care organization (MCO) that actively recruits nurses and is intentional about retaining them is key. EK Health utilizes incentives such as flexible work schedules, work from home options, positive company culture, and continuing education to recruit and retain nurse case managers.

Optimize Clinical Resource Intervention

Another method of effective cost savings is in the managed care company’s program design, which calls for a qualified, non-clinical person for the primary utilization review. This practice allows for clinical personnel intervention only when medically necessary.

Maximize Technology for Claim Handling

Applying technology to improve efficiencies in workers’ compensation managed care is not a new concept, but it has been the undercurrent of EK Health and it drives the organization to seek efficiency and savings for its clients.

The automation of the bill intake process using a sophisticated and customizable rules engine classifies and sorts bills quicker, which is another contributing factor to compressing the claim processing time.

“Going a step further by combining bill review services with utilization review, EK Health applies proprietary technology that increases client savings as much as 20% above and beyond industry average fee schedule deductions. This is where savings numbers become truly meaningful,” said Wilson.

Economic times may be uncertain and broad sweeping cost containment a top priority. A top-notch managed care company utilizing industry best practices, transparency, and efficiency helps companies realize all possible savings in workers’ compensation programs and services.

EK Health is committed to achieving cost containment and savings for clients without compromising the care of the injured worker. “Providing the right evidenced based medical care at the right time is best for patients, their employers, and payors,” said Benner.

Visit EK Health at Ekhealth.com to learn more.

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