Trends That are Paving the Way for Successful Managed Care Programs in 2025
Turning Back the Claims Clock
2025 is set to harbor several workplace transformations, including mass retirement, persistent labor shortages, and the increased presence Gen Z. In response to these changes, employers are adopting more customized approaches to meet the needs of an evolving workforce.
One such strategy is the implementation of Early intervention measures, which involve the rapid involvement of case management resources to address worker injuries. This approach represents a powerful lever to extend personalization efforts into workers’ compensation.
By adhering to early intervention principles–such as timely triage and escalation, patient-centered care, individualized treatment, and continuous evaluation–employers can tailor claims management protocols to suit their workers’ circumstances and unique risks of injury. As organizations seek to adapt to a changing workforce, expect a renewed focus on early intervention as a critical component of their approach.
While early intervention measures help address the changing needs of a modern workforce, another crucial area of focus is the evolution of pharmacy management and its role in improving worker health outcomes.
Pharmacy Management’s Next Phase of Growth
Today’s pharmacy management landscape is nearly unrecognizable compared to its laissez-faire origins, which featured limited quality and cost controls. Key to this space’s evolution is the expertise and oversight offered by pharmacy benefit solutions.
As employers increasingly approach worker well-being from a holistic perspective, highly integrated pharmacy programs stand out as a valuable tool for improving worker health outcomes. Pharmacy benefit solutions drive these enhancements by facilitating strong relationships between pharmacists and injured workers, resulting in increased medication access and adherence.
In the coming year, as employers contend with rising costs of care and more frequent specialty claims, they will rely on pharmacy benefit solutions’ clinical expertise to identify the most cost-effective and medically appropriate therapies. This trend will also be reflected in increased demand for highly skilled personnel, such as Certified Pharmacy Technicians, who leverage automation and advanced analytics to enhance pharmacy program efficiency.
As pharmacy management continues to evolve, another key area for improvement in workers’ compensation is the accuracy and efficiency of medical bill review, which is critical to minimizing errors and costs.
Future-Proofing Medical Bill Review
Given the rising complexity of medical bills, including a surge in bills documenting both psychological and physical injuries, opportunities for error are also increasing. With over 40% of medical bills missing critical information, frequent billing errors can impede timely bill reimbursement, resulting in provider abrasion that can eventually lead to a delayed return to work and potentially no longer accepting workers’ compensation.
By embracing a holistic, integrated approach to medical bill review, employers can avoid costly missteps. At the center of these comprehensive programs are rigorous bill review processes, which include careful data validation, in-depth review of jurisdictional guidelines and coding edits, and when appropriate, clinical review for specialty services, such as surgical implant procedures.
Compliance in the bill review space is ever-changing and increasing in difficulty as technology advances. To maintain compliance, employers will benefit from consulting a strategic partner to navigate state-specific regulations, integrate provider networks, and optimize bill review workflows. With the increasing complexity of medical bills, it’s clear that adopting a strategic, forward-thinking approach to managed care programs is vital for optimizing worker recovery and overall cost savings.
Embracing Innovation in Managed Care for 2025
As the workers’ compensation landscape evolves, managed care programs stand as a cornerstone for achieving better worker outcomes and maximizing savings. By staying ahead of emerging trends, employers can create a seamless, adaptive framework to address the complexities of modern workplace health. Embracing innovation and strategic partnerships will be essential in 2025, enabling organizations to not only navigate industry changes but also redefine recovery and care for the workforce of tomorrow. &