The biggest hurdle in workers’ compensation medical cost containment is that the injured worker is not getting better. Even though WC claims have steadily declined over the last decade, medical costs keep rising as do the sub-par outcomes for the patient and the payer. What we are seeing is that the inter-connectivity of many factors is hindering the end goal of optimized outcomes. A multidimensional approach is crucial not only for combatting pharma costs, but also for ensuring optimal outcomes for injured workers.

At the end of the day medical care cost containment is more than finding savings, it’s also about examining the big picture to help identify potential areas of exposure while enhancing the quality of care and life for the injured worker.

How is this achieved?  Each case has to be approached individually to develop a custom tailored strategy. It has to start with well-established face-to-face communication with the physician. Once the line of communication is open, actionable treatment recommendations backed by evidence based clinical data can be implemented.

The industry also needs to focus on protocols that will ensure better outcomes and appropriate treatment for injured workers. Compliance protocols will result in improved outcomes for all stakeholders.

While medical expenses are the most obvious cost driver, the full picture involves much more than the number of medical services and associated expenses. Quality medical care directly impacts the speed and likeliness of the injured worker’s return to work. ANS Solutions understands the true cost of these practices and has taken an innovative approach to medical cost containment strategies.

Offering an innovative plan to assist payers, ANS Solutions’ proprietary Pharmacotherapy Review offers the integral assistance needed to optimize claim outcomes:

  • Expert review of cases by legal nurse experts, noting duplicate treatments and unnecessary/ineffective procedures.
  • Actionable, evidence-based treatment recommendations discussed via face-to-face meetings with physicians.
  • Ongoing compliance management with the help of clinical liason officers.

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