It is no secret that healthcare systems can be difficult to navigate. When work-related injuries occur, complications can rise due to the challenges of the workers’ compensation system. Working with an experienced claims and managed care partner can improve the employee experience, facilitate recovery and return to work, control costs, and ensure full compliance with jurisdictional requirements. Here, we will show you how that is possible.
Benefits for Employers
When an employee is injured at work, their employer is responsible for making them whole again. Organizations should strive for the highest quality, most appropriate, and timeliest care for their employees to maximize recovery.
While that combination may sound too good to be true, it is possible when employers work with the right managed care provider. By using a partner with an established network of highly rated, licensed, and insured practitioners, employers can take advantage of rates well below fee schedule while providing employees with outstanding care. Premier managed care providers also conduct bill reviews to yield an additional 10-15% in savings — with no additional work required by their employer clients.
Another way we help employers reduce claim costs is by applying sound healthcare price management techniques for medical supplies and equipment. Managed care providers use formularies and product catalogs to identify generic equivalents — for everything from name-brand bandages to crutches — so employees receive equally effective care and supplies at significantly lower prices. But it is not just about saving money. When employees are referred for treatment through a managed provider network, clinical experts review claims to ensure medical necessity and appropriateness of care.
This approach brings tremendous value to any employer’s program — especially when it comes to high-cost products and services, such as custom prosthetic devices, diagnostic imaging, and in-home healthcare services.
Benefits for Injured Employees
Naturally, the employee is the one who gains most from well-managed care in workers’ compensation. The efficiencies and oversight of integrated programs helps employees to promptly secure appropriate and high-quality medical care to help them recover faster.
After an injury takes place, the employee may be going through one of the most uncertain and scariest moments of their life. With one call to our nurse triage line, their questions will be answered. During the call, they receive instructions on how to apply first aid or will be directed to a telephonic or in-person clinic. Starting their journey on the right track is a pivotal moment ensuring the employee knows they are in the right hands.
Depending on the complexities of the injury, they may be assigned to a telephonic or field case manager to oversee their recovery progress and keep them on the treatment path best suited for them. Including ancillary care in a workers’ compensation program offers a seamless experience to employees needing medical equipment, supplies, or special services. Careworks arranges for ordering, delivery, and setup, as well as any fittings or training that may be needed. Streamlining the process gives the employee the best possible experience and increases the likeliness they will use all available resources to achieve maximum recovery.
The Difference We Make
As your managed care partner, our goal is to help everyone – the employer, the employee, and those impacted by the injury. Until every case goes from “injured employee” to just “employee,” our job is not done, and we will be there every step of the way.
Our mission begins at the first referral and does not end until everyone is satisfied. We use the power of choice to help those who need it most, and though we are proud of the outcomes, we strive to improve each and every day.
- 41% fewer claims initially treated at the ER through nurse triage
- 27% faster return to work with telephonic case management
- 23% fewer opioid prescriptions through our field case management
- 99.7% of ancillary orders are placed within one day
- 45% average savings on injured employees’ care