Value-based Care and Centers of Excellence – A Winning Combo for Injured Employee, Employer, Carrier/TPA and Medical Provider
If a provider mixes Value-based care and Centers of Excellence, the result may be what Workers Comp has been searching for in the last 40 years. WCRI hosts a webinar next week on Centers of Excellence.
Feel free to read my article on Centers of Excellence from earlier this week.
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Two of the up-and-coming areas of medical treatment in Workers Compensation fills a great need for:
The above list considers on a few points of what I think the newest and best trend in medical treatment for injured workers. The Centers of Excellence Model has sustained high-levels of very specific care for specific serious injuries (Burn Centers, Brain Injury Center, etc.).
One caveat – not all traumatic injury treatment providers are considered Centers of Excellence.
Centers of Excellence Concept
The one very expensive yet needed Centers of Excellence are closed head injury treatment centers. Those medical and rehab providers, while expensive,produce amazing results. I referred quite a few patients to them and have recommended them in my claims consulting practice often for the and upper spinal injuries. The work they do often reaches the miraculous level.
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One drawback remains the cost of out-of-state treatment in Workers' Comp claims. Fee schedules are gone when the treatment moves across state lines. Please do not mistake that as a critique.
One of the considerations is the cost. One of the main criticisms of the staff at any Centers of Excellence comes from the paperwork required by Workers Comp carriers/TPA's. The staff wants to spend every second of their time improving the injured workers' lives, not getting multiple authorizations every week. I find that hard to criticize in such serious cases.
The local Center of Excellence, which I referred seriously injured workers to is Duke University Medical Center. One cannot forget the University of North Carolina Medical Centers or WakeMed Centers of Excellence. All three help keep Raleigh as one of the top places for medical care in the nation.
Value Based Care Concept
The new medical treatment term that has gained traction in health coverage originates from outcomes and cost as the determining factors. For the mega-claims, the Centers of Excellence could be considered as value- based care.
PBMs (Pharmaceutical or Pharmaceutical Based Management) systems became a natural beginning for the value-based care model in Workers Comp. Last year, I attended a session at the NWCDC Conference on value-based care. I realized the significance of what the session covered after-the-fact.
I said at the time of the NWCDC session – this will not work in Workers' Comp. I now say that I was a little hasty in my decision. WCRI also presented a webinar on value-based care. Dr. John Lea presented earlier this year on value-based care and now will present a webinar on Centers of Excellence on October 12th.
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Combination of Both
A combination of both concepts would allow for:
Reduced paperwork for Centers of Excellence
Keep injured employees in-state for the fee schedules
Instill trust in injured employees <
Very specialized industrial medicine clinics in a certain area
Payment providers (carriers/TPAs) more readily make payments
Avoid injured workers having multiple Independent Medical Exams and external Second Opinions
The list could go on for a long time
Please do not consider this one of those recycled topics that appear in workers comp every few years. Value based medicine and especially Centers of Excellence wield a unique concept.
This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com
Disclaimer: WorkersCompensation.com publishes independently generated writings from a variety of workers' compensation industry stakeholders. The opinions expressed are solely those of the author and do not necessarily reflect those of WorkersCompensation.com.