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Moore: Value-Based Care, Centers of Excellence Are Matched Pair for Work Comp

By James Moore

Thursday, October 10, 2019 | 0

If a provider mixes value-based care and centers of excellence, the result may be what workers' comp has been searching for in the last 40 years.

James Moore

James Moore

Feel free to read my article on centers of excellence.  

Two of the up-and-coming areas of medical treatment in workers' compensation fills a great need for:

  • Better communications.
  • Specific treatment to a certain population.
  • Better cost projections < enhanced outcomes.
  • Instilling trust of work comp and medical treatment systems; check out the Workers Compensation Research Institute's injured employee results surveys. Wow! It won the vaunted Comp Laude award this year for those studies.
  • Controled cost.
  • More industrial-based medicine. 

The list considers a few points of what I think are the newest and best trends in medical treatment for injured workers. The centers of excellence model has sustained high-levels of very specific care for specific serious injuries (burn centers, brain injury center, etc.).  

One caveat: Not all traumatic injury treatment providers are considered centers of excellence. 

Centers of excellence concept

The one very expensive, yet needed centers of excellence are closed head injury treatment centers. Those medical and rehab providers, while expensive, produce amazing results. I referred quite a few patients to them and have recommended them in my claims consulting practice often for the very serious cranial and upper spinal injuries. The work they do often reaches the miraculous level.  

One drawback remains the cost of out-of-state treatment in workers’ comp claims. Fee schedules are gone when the treatment moves across state lines. Please do not mistake that as a critique.   

One of the considerations is the cost. One of the main criticisms of the staff at any center of excellence comes from the paperwork required by workers' comp carriers/third-party administrators. The staff wants to spend every second of its time improving the injured workers’ lives, not getting multiple authorizations every week. I  find that hard to criticize in such serious cases. 

The local center of excellence I referred seriously injured workers to is Duke University Medical Center.  One cannot forget the University of North Carolina Medical Centers or WakeMed Centers of Excellence. All three help keep Raleigh, North Carolina, as one of the top places for medical care in the nation. 

Value-based care concept

The new medical treatment term that has gained traction in health coverage originates from outcomes and cost as the determining factors. For the mega-claims, the centers of excellence could be considered value- based care.  

Pharmacy benefit management systems became a natural beginning for the value-based care model in workers' comp. Last year, I attended a conference on value-based care. I realized the significance of what the session covered after-the-fact.  

I said at the time that this will not work in workers’ comp. I now say that I was a little hasty in my decision. 

WCRI also presented a webinar on value-based care. Dr. John Lea presented earlier this year on value-based care and now will present a webinar on centers of excellence on Saturday. 

Combination of both

A combination of both concepts would allow for:

  • Reduced paperwork for centers of excellence.
  • Keeping injured employees in-state for the fee schedules.
  • Instilling trust in injured employees < very specialized industrial medicine clinics in a certain area.
  • Payment providers (carriers/TPAs) more readily making payments.
  • Avoiding injured workers having multiple independent medical exams and  external second opinions.

The list could go on for a long time.

Please do not consider this one of those recycled topics that appear in workers' comp every few years. Value-based medicine, and especially centers of excellence, wield a unique concept.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.


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