By Karen Wolfe
Caution: This is called a White
Paper because it specifically recommends MedMetrics’ solution.
A poorly performing medical provider is costly, particularly when the
patient is an injured worker. For injured workers, certain unique administrative
processes must accompany medical treatments and procedures. Even doctors who
are highly regarded in their medical specialty may generate negative results in
the world of Workers’ Compensation.
Medical doctors might treat the injury with medical expertise while
causing complexity for claimants and their employers. For instance, not
supporting return to work initiatives drives costs and is known to contribute
to extended disability. Continued referral to specialists to find the ultimate answer
rather than declaring Maximum Medical Improvement (MMI) can result in claim stalemate
rather than resolution. Moreover, frustrated patients often seek legal assistance,
further compromising outcome. In other words, finding doctors with knowledge of
Workers’ Compensation is essential to cost control and improved outcomes.
Some say finding the good doctors is difficult. In fact, finding the
right doctors can be easy when MedMetrics does the work. The process is simple.
The data are
transferred to MedMetrics from organizations’ disparate sources of claims data,
bill review data, and pharmacy benefits management data (PBM). Claimant-identifiable
information is not included so confidentiality is not an issue. MedMetrics does
the heavy lifting by giving the organization's IT a list of data items to put into a file for transfer.
MedMetrics imports, integrates, and analyzes the data, then scores providers’
performance based on the facts found in the data. Results and rationale are easy to
search and available online any time. Moreover, it’s affordable.
License fees are sized to the organization. The organization or the payer benefits
immediately by being able to find the best-in-class doctors any time. Headaches
and significant dollars are saved.
Karen Wolfe, BSN, MA, MBA is the
founder and president of MedMetrics® LLC, an Internet-based Workers’
Compensation analytics company. MedMetrics focuses on analyzing the medical portion
of claims, including medical provider performance evaluation and scoring, with continued monitoring.
MedMetrics offers its clients online apps that link analytics to operations,
thereby making them actionable.
