The Challenge

Work Comp is an extraordinarily challenging environment with high-volume interactions occurring between the injured employee, Healthcare Providers/Practices, Employers, and Payers. The significant volume results from referrals to secondary physicians, specialists, hospitals, and/or clinics for a myriad of tests, labs, and procedures.  Included in the mix are Case Managers, Third-Party Administrators, Medical Directors from large Self-Insureds, Claims Adjustors, and Lawyers.

Traditionally, the interactions between all these parties are labor and paper-intensive.  Medical practices are only just beginning to realize the benefits of automation and Internet connectivity.  Likewise, these transactions also require authorizations for referrals and two-way communications among multiple parties for both medical and administrative management of each case.  Compounding the challenges are the strong demands for better medical and administrative outcomes; outcomes that result in cost savings with a high level of service and medical care at a low reimbursement rate.  The inefficient business and record-keeping processes of multiple providers, practices and other stakeholders all combine to create an unnecessary level of friction and wasted resources.

The existing Work Comp system is further encumbered by a variety of factors:

  • Fragmented, inefficient communications and data exchange
  • Continually rising costs of Work Comp cases
  • No common standards for documentation and processes
  • Inherent problems with paper-based records
  • Out of sync billing and payment processes
  • Difficult to share patient data outside the enterprise
  • Proprietary software applications using disparate data formats
  • Unclear clinical protocols/transaction hierarchy
  • Lack of incentive to change the current processes/systems

All resulting in:

  • Sub-optimal Medical & Disability Outcomes
  • Lost productivity
  • Increased cost of care
  • Increased cost for replacement wages
  • Burdensome administration and documentation
  • Higher litigation risk
Health Connections Networks | Copyright 2012