M EDICAL P ROVIDERS & E MPLOYERS Carrie Freeland, Manager Integrated Leave Department 1

T HE E MPLOYER ’ S R OLE IN W ORKING WITH M EDICAL P ROVIDERS 2 Employee TPA Employer Medical Provider

N ETWORK E VALUATION & M ANAGEMENT 3 Outcomes & Performance Measurements Usually completed by your TPA, Managed Care Organization or the Network itself Highly useful for Specialist Groups, Surgeons, Diagnostics, etc. Can be applicable to Point-of-Entry (POE) Clinics, but may not be useful for evaluation of specific providers Employers can have the most direct impact with POE clinics & providers

W HY POE P ROVIDERS A RE S O I MPORTANT 4 Set the tone & expectations for injured worker! Function & RTW Diagnostic Requirements Medication Management Employee’s Role in Recovery Starting point of all downstream referrals PT Diagnostics Specialists Usually very accessible and open to establishing relationships with employers Willingness to understand your specific business needs and return to work programs

G ETTING I NJURED E MPLOYEES TO THE R IGHT POE C LINICS & P ROVIDERS 5 Understand all available options in each jurisdiction Full control Partial control No direct control Full Control Include the Right Providers Hold employees accountable to see only approved providers Partial control What does this mean for the jurisdiction Take advantage of every opportunity Initial 30 days only State identified & controlled networks Notification to state agencies of your specific MCO No direct control Consider options for Soft Channeling Direction of Care

S OFT C HANNELING TO POE P ROVIDERS 6 Customized Provider Posters at each facility Ready-made “New Claim Packets” Letter to employee  Explains process, benefits, preferred providers and expectations Letter to medical provider  Explains contacts, forms, RTW commitments, preferred providers and expectations Includes all preferred and required forms Understanding of process by ALL management and supervisors

S OFT C HANNELING THRU T RIAGE P ROGRAMS 7 Incident Intervention Lines Ask a Nurse and / or Physician Consult The Right Care at the Right Time  self care or medical visit If medical visit is needed or wanted  schedules appointment for employee  faxes documents to provider  peer-to-peer discussion pre and post visit

I NCIDENT I NTERVENTION L INE 8 Costco’s Success in Hawaii o FY08 – FY10: Average loss rate of 3% o 2011 Implemented Corporate & Store Focus WorkCare Incident Intervention Line o FY11 – FY13: Average loss rate of 1.79% o Savings, after costs: Approximately $1.5M Costco’s Pending Results in LA Region o April 2013 o Implemented WorkCare Incident Intervention Line o Estimated 6 month savings, after costs, $100K o Stay tuned…

W HAT M AKES A G OOD POE P ARTNER ? 9 #1 - The Basics o Proximity and convenience do matter o Hours of operation o Drug testing options o Cleanliness of clinic o Timeliness of evaluations o Bedside manner of providers o Part of the non-occ health plan’s network

#2 - W ILLINGNESS TO B UILD R ELATIONSHIPS 10 Tours your facility / operations Follows your specific protocols Uses your job analyses, job descriptions and other specific forms Provides timely and appropriate communication to all parties Consistent provider seeing your employees Provides single “Problem Solver” to address issues for your location

#3 – P ROVIDES Q UALITY C ARE 11 Sets appropriate employee exceptions Focus on Function, Activities of Daily Living and RTW (not symptoms and disability) Practices Evidence Based Medicine Medication usage and management Timely and appropriate referrals for diagnostics or specialist

S ELECTING THE R IGHT POE P ROVIDER 12 POE clinics (and specific providers) that historically have seen the majority of your employees for your specific locations Average claim duration & cost per POE Clinic % of claims released with or without restrictions within state waiting period & within first 30 days of initial treatment % of cases with ultimate permanent RTW with and without accommodations Historical Patterns

P OINTS TO R EMEMBER 13 No single solution fits every employer Problem clinics & providers often need more attention than others  Consider suppression of low performers Requires continual communication & education Single point of contact at employer is best Accessibility to current information  Google docs accessible to anyone with link Always more ways to improve the process

Q UESTIONS ? 14 Carrie Freeland