It is well understood that a very small percentage of claims drive an overwhelming amount of claims costs. These claims include catastrophic injuries and what we refer to as “Creeping Catastrophic injuries,” typically fairly minor or moderate injuries that run off the rails due to pre-existing risk factors or misdiagnosis.
What is common to both is that they are “long tailed” risks that often include year after year ever growing reserves for both medical and indemnity costs. By engaging this patient population at time of injury we are literally able to improve medical outcomes, reducing the costs associated with misdiagnosis and in effect, “clip” the tails. This process not only reduces overall costs, it improves reserving practices and creates a unique opportunity to negotiate more favorable terms with the reinsurance marketplace. Not surprisingly it is reinsurers who best understand the value of what we do.
The second factor we address is what we refer to as the “inefficiencies” of medical practice. The medical community organizes itself around the 98% of its dollars that come from group health, Medicare and Medicaid. It is not designed around the needs of helping injured workers return to productive lives as quickly as possible. Through our affiliate medical specialists, occupational health centers and well respected patient advocate programs, we are able to help injured workers access skilled care quickly with a focus on “return to work” as an integral part of the recovery process. That effort effectively reduces both indemnity and medical expenses associated with prolonged waits for appointments and delayed returned to work.
In addition, the co-location of our Patient Advocates and Medical Directors with your claims professionals provides your organization with a level of internal clinical expertise simply unavailable with traditional IME’s and case management programs
Studies done by Best Doctors and others show very high levels of misdiagnosis and inappropriate care for the medical specialties most commonly used in work-related injuries. Complicating this situation is that most injured workers simply do not have the skill or background to assess quality of care.
One only has to look at their own experience with failed back surgeries or the excessive use of opiates for chronic pain to see this unfortunate phenomenon. We, at Best Doctors are recognized internationally for our ability to bring the very best minds in medicine to all parts of the globe. That means we can bring that very same level of medical expertise to your workers compensation program. At the operational level, that means our regional Medical Directors can be literally on campus working closely with our Patient Advocate teams the very same way physicians and nurses work together in the hospital based ICU or specialty floor environment. That process dramatically improves decision-making for the busy claims professional and substantially reduces dependency on traditional IME’s and nurse case management.