NEWPORT BEACH, Calif.--(BUSINESS WIRE)--Identifying and using high performing physicians in medical networks treating workers’ compensation claimants can have a significant impact in reducing overall claims costs and duration.
Harbor Health Systems, a One Call Care Management company (“One Call”), presented these findings at the California Orthopaedic Association annual meeting in Carlsbad, Calif. earlier this month as part of a panel entitled, “How Workers' Compensation Medical Provider Network (MPN) Physicians are Rated/Selected.” Kent Spafford, who sits on One Call’s Board of Directors and serves as an advisor to Harbor Health Systems, co-presented with an executive from Coventry Health.
“Benchmarking and scoring are the first steps in identifying high performing physicians,” Spafford said. “When this intelligence is used in MPN management to assure regulatory compliance and direct patients to these physicians, payers are seeing outstanding results in lower costs and improved outcomes.”
Harbor manages or owns 154 medical provider networks nationwide with 1.7 million employees enrolled. The company has developed a proprietary software suite, MD 360, that examines 20 different variables within the MPNs treating workers’ compensation claimants. Harbor does not evaluate medical skills of individual physicians, but uses a scoring method based on a retrospective analysis of closed claims. Among the criteria examined are cost of treatment, duration of treatment, recidivism of the patient, and litigation involving the claim. Harbor’s proprietary software suite is then used to schedule patients to be cared for by the higher-scoring physicians, and to manage and measure the outcomes.
As a result, Harbor has been able to cut overall claims costs by nearly 20 percent and indemnity-related costs by nearly one-third, compared to some other workers’ compensation management firms. In one instance where a third-party administrator (TPA) used the Harbor Health’s platforms, closed claims increased by 50 percent and the average claim amount dropped by 9.1 percent within nine months.
To learn more about how an outcomes-based approach can reduce risk and produce cost savings for your organization, visit http://harborhealthsystems.com/.
About Harbor Health Systems
Harbor Health Systems, a One Call Care Management company based in Newport Beach, Calif., leads a revolution in medical networks that allows customers to build and manage a medical system based on quality performance of providers rather than the “lowest bidder medicine” that is typical of PPOs and HMOs. Harbor Health builds and manages outcomes-based medical networks, and supplies the tools, software and services to help their customers build, implement and optimize custom networks. With Harbor Health Systems, companies can identify physicians and other medical professionals who have exceptional skills in clinical, patient care and business management. By working with these healthcare professionals, payers and self-insured employers can greatly reduce the cost of care, complications, and time away from work. For more information, visit Harborhealthsystems.com.
About One Call Care Management
One Call Care Management (One Call) is the nation’s leading provider of specialized solutions to the workers’ compensation industry. One Call's solutions enable faster, more efficient and more cost-effective claims resolution. One Call provides reliable, consistent connections to care with expertise in high end diagnostics, physical therapy and transportation services, post-discharge home care and durable medical equipment, dental and doctor specialty services, complex care management, and the language services required for today’s multicultural workforce. With a focus on injured workers’ needs across the continuum of care, One Call enables maximum medical improvement and superior outcomes. For more information, visit www.onecallcm.com.