Workers’ Compensation Utilization Management is an effective tool to assure that an injured worker receives the most appropriate treatment in order to return to health and function.
CompAlliance believes there is a difference between a proactive Utilization Management approach and a reactive Utilization Review approach when facilitating appropriate care. CompAlliance’s Utilization Management program has shown outstanding results and great satisfaction for our clients. Our philosophy of collaborating with providers reduces the overall claims cost by expediting the most appropriate treatment in order to speed recovery and Return to Work. Conversely, when a Utilization Review program is focused on denials, they often ADD to the cost of a claim by delaying recovery and adding friction to the claim.
When one examines Utilization Review at its basic level, it is actually a very simple process: “Does the treatment request match evidence-based medical guidelines?” The CompAlliance Utilization Management program views treatment as a continuum and examines whether the treatment plan is the most effective and appropriate to achieve resolution of the injured worker’s condition. CompAlliance is focused on achieving approvals versus denials.
- CompAlliance Nurses and Physicians collaborate and negotiate with the treating physician to develop a treatment plan most appropriate for the injured worker, rather than evaluating a treatment request in a vacuum.
- When the CompAlliance nurse receives a treatment request for an injury that would indicate future treatment would be required, rather than evaluate only the initial treatment request, the nurse reaches out to the provider to discuss the treatment plan as a continuum. Thus, when future treatment requests are submitted from the provider this additional treatment will have already been reviewed with our Nurse or Physician and agreed upon as appropriate, and a timely approval can be provided; thereby expediting treatment.
- CompAlliance does not believe we need to deny care in order to show savings. We look at all of the details related to the case and understand timely treatment will yield better outcomes for the injured worker and employer in the long run.
- CompAlliance researches current regulation to ensure clients adhere to current regulatory requirements, changing trends, and manage costs .
In summary, the CompAlliance approach not only reduces the cost of medical management services, it prevents unnecessary treatment by expediting appropriate care without putting an emphasis on denials. Our collaborative approach with the provider community fosters excellent relationships, expedites injured worker recovery and reduces overall costs.