WorkersCompensation.com : Managing Managed Care: Three Steps for Employers to Implement Cost-Effective Healthcare Solutions

Ron Wojciechowski, Vice President of Managed Care Strategy, CorVel

Proactive and personalized care is a cornerstone of a healthier, more productive workforce. For insurance carriers, the challenge lies in crafting strategies that not only meet regulatory requirements but also drive efficiency and satisfaction for both employers and their employees.

What constitutes effective managed care? It's a program that places the injured worker at the center of the workers' compensation process. To achieve this, insurance carriers must embrace continuous innovation and adapt to the evolving needs of the market. For carriers aiming to navigate this landscape and deliver comprehensive, cost-effective healthcare solutions, the focus should be on understanding unique needs, leveraging technology, and identifying strategic cost-saving opportunities. Here are three key strategies for insurance carriers to enhance managed care programs.

Recognizing and Responding to Unique Needs

Every business and injured worker have distinct healthcare needs. Therefore, it's essential to seek out managed care services that offer tailored solutions designed to address unique or specific challenges. Customizable solutions also offer more flexibility which, in turn, empowers organizations to select and adapt their solutions to fit their needs over time. This flexibility not only enhances efficiency but also boosts overall satisfaction between the carrier and the employers they serve.

To address the unique needs of injured workers, carriers should develop robust provider networks that offer diverse options. This variety enables quicker access to care, minimizing delays in treatment. Additionally, integrating comprehensive ancillary services-such as physical therapy, chiropractic care, and occupational therapy-into managed care strategies is vital. These services promote prompt and effective treatment, accelerate recovery, and control overall costs. Providing evidence-based treatment plans tailored to individual needs enhances recovery times and the overall experience for injured workers. To optimize well-being and cost savings, carriers should also invest in advanced technology solutions that streamline service management and enhance program efficiency.

Leveraging Advanced Technology

Recovery looks different for every injured worker, which is why personalized care plays such a significant role in an effective managed care program. However, true personalization cannot happen without the use of advanced technology and sophisticated analytics. Insurance carriers should prioritize managed care services that utilize dynamic treatment plans rather than static scoring algorithms. This tech-driven approach optimizes both cost savings and outcomes.

Further, the adoption of modern tools and integrations - such as data hub services and automated document reviewers powered by generative AI - allows for meticulous oversight and proactive management. This technology grants claims managers the ability to navigate systems, documents, and claims with speed and accuracy, further contributing to improved outcomes and greater efficiency. The future of managed care lies in customizable solutions tailored to the specific needs of each carrier. Customized dashboards, data hubs, predictive analytics, and generative AI are the future of managed care and are transforming the ways and efficiencies for managed care partners as we know it.

With advanced technology and consideration for employees' unique needs accounted for, the final piece of the puzzle is identifying - and acting on - the most strategic cost-saving methods available.

Saving Every Step of the Way

Managed care solutions offer significant cost-saving opportunities for insurance carriers while supporting faster recoveries for injured workers. The difference between a successful, effective managed care program and one that falls short is in the way the program is … managed. With a strategic, thoughtful approach to implementation, carriers are able to identify which solutions meet their specific needs and how they can contribute to efficient and effective resource utilization. Some of the most innovative and cost-effective solutions include extensive provider networks, utilization management (UM) programs, pharmacy solutions, comprehensive ancillary services, bill review programs, comprehensive clinical solutions, and a focus on patient journeys.

• Access to an extensive provider network ensures diverse and quality care tailored to employees' needs. Local engagement combined with national compliance offers comprehensive and customizable care, ensuring timely and appropriate care delivery.

• Utilization management programs ensure healthcare services are used appropriately and efficiently, resulting in the administration of high-quality care in a cost-effective manner. Over time, this leads to significant cost savings. Further, by optimizing the use of healthcare services and avoiding unnecessary treatments or procedures, employees can receive timely and appropriate care, leading to faster recoveries and reduced expenses.

• Managed care pharmacy solutions, such as drug utilization review and opioid management, should seamlessly integrate within claims platforms. This type of integration provides full visibility into data and pharmacy risk scores, ensuring that the most appropriate prescriptions are verified while considering cost-effective options. This added transparency generates substantial savings through minimizing untracked bills and mitigating pharmacy risks.

• A robust managed care network should offer a wide array of comprehensive ancillary services with personalized, evidence-based recovery plans to accommodate the varying needs of each injured worker. Because ancillary services make up an average of 30% of the total medical spend in the industry, it's critical to have seamless management of all ancillary care processes, including referrals, coordination, billing, and reimbursements.

• A tailored bill review program blends advanced technology with clinical expertise to provide unrivaled clarity in medical billing and savings. Enhanced by AI, proprietary platforms can offer customizable flexibility and meticulously check each line of every bill for reliable savings. While technology handles intricacies, clinical experts review bills holistically. At CorVel, we call this our high-tech, high-touch approach. Adopting a tailored bill review program allows employers to confidently navigate medical billing with advantages in accuracy, compliance, and exceptional cost savings tailored to their needs.

• Our case managers provide nursing interventions and advocacy throughout the claims process, focusing on functional restoration and reducing disability duration through comprehensive clinical solutions. This proactive approach identifies potential risk factors early, facilitating timely care and ultimately improving overall outcomes for injured workers.

• Finally, effective managed care programs must prioritize patient journeys with seamless return-to-work support, which can decrease litigated claims, streamline recoveries, and reduce costs. Carriers should ensure case managers collaborate closely with adjusters and medical teams to provide personalized support and overcome obstacles.

Turning these ideas into action, MSIG USA¹, a leader in quality direct commercial insurance across all 50 states, saw the pressures taking over the healthcare industry over the past few years and wanted to make a change to its managed care services while witnessing heightened price pressures. With CorVel's customized bill review services, pharmacy solutions, and ancillary care solutions to tackle challenges preventing employees from coming back to work, MSIG USA achieved a generic efficiency rate averaging 99.6% and heavily leaned into a drug diversion program that enhanced opioid safety and promoted appropriate usage. By providing comprehensive visibility into all transactions and closely monitoring initial opioid fills, the program successfully led to a remarkable 67% decrease in long-term opioid usage, a result that MSIG has continued to maintain.

By proactively recognizing and addressing the unique needs of injured workers, leveraging innovative technology for personalized care, and consistently identifying cost-saving opportunities, insurance carriers can significantly enhance their managed care programs. This strategic focus will not only improve outcomes for injured workers but also foster healthier and more productive workplaces, benefiting all stakeholders involved.

Public link

Please use the above public link if you want to share this noodl on another website.