Macro measures look at actual loss experience overtime. Given the long tailed nature of workers compensation, we find that comparisons with 24 to 36 months of development provide an accurate measure of programmatic success
Micro measures can be thought of as specific sentinel measures of the incidence of medical procedures or use of prescriptions that are leading indicators of programmatic success. We work with our Enterprise Partners to identify the types of data they are easily able to pull to create these important yardsticks.
“Efficiency is doing things right, Effectiveness is doing the right things” Peter Drucker
It doesn’t take a rocket scientist to understand just how complex modern medicine has become. The good news is that contemporary medicine can accomplish incredible things. The tough news is that it is at best magical thinking to believe injured workers/patients have the knowledge and skill sets to navigate through the complexities of modern medicine, much less be able to tell the difference between good and inappropriate medical care.
Perhaps more importantly, the very rapid changes in the organization and financing of healthcare resulting from the Affordable Care Act has made dramatic changes in the financial incentives in workers compensation for both clinicians and injured workers. And these changes are creating many more demands on the time of the workers compensation claims professional. One does not need to look far to see these incentives play out. The egregious increases in pharmaceutical costs is an obvious example, but the increases in injury severity resulting from co-morbid conditions, an aging workforce and exciting and expensive new technologies are another.
Yes, as Drucker points out, we can try to reduce costs at the margin by striving for more efficiency in the way we do our work, or we can strive to dramatically improve outcomes by becoming more effective in the way we do our work.
The Best Doctors Occupational Health Institute(BDOHI) is designed to help the busy claim professional become much more effective in the way they do their work. Our rigorous focus on helping injured workers become better stewards of their own care, facilitating access to physicians recognized by their own peers as being expert in their specialty and committed to “return to work” as a necessary part of care help reduce the costs associated with frequent misdiagnosis and inappropriate medical care. And that is very good news for injured workers and very good news for the bottomline.
Just take a minute to calculate the amount of time and dollars spent on the transactions costs associated with the fee for service nature of traditional managed care models. Those dollars produce no additional value and force the busy claims professional to constantly make difficult cost benefit trade off decisions before applying any managed care tools.
BDOHI provides its Enterprise Partner with an annual budget. That budget includes all of our services except for required travel and any specialty services. Typically this cost is less than what had been previously spent for traditional nurse case management and IMEs and includes our onsite medical director resources, pharmaceutical management services and predictive index.
The benefit for our Enterprise Partners is twofold. First, because it is a fixed budget, the busy claims professional is actually incented to use the services before thing run off the rails, which helps keeping them on the rails. Second, an unpredictable variable cost, becomes a highly predictable fixed cost.
And yes, the benefit to BDOHI is that we are incented to work very closely with you to assure our tools are used appropriately to achieve our mutually agreed clinical goals and objectives.
BDOHI also has worked with each of its Partners to develop the methodology for allocation of the costs to the claim file.