by Karen
Wolfe
Workers’
Compensation is an industry where the high cost of medical care is a major
issue, yet tracking accurate medical cost and outcome information for specific
medical conditions is uncommon. It is all the more puzzling because evaluating
outcomes and costs for medical care can be done rather easily using data readily
available.
People have consistently dodged the issue of quality medical care, convinced that quality is more expensive. But more quality actually means less cost! Tracking claim outcomes and costs based on injured workers’ injury or condition leads to selecting the doctors that deliver better results and at lower cost.
Understanding costs
Measuring
and tracking results is a familiar principal in most industries, yet in
Workers’ Comp medical costs are measured in broad terms such as overall medical
spend. Medical costs are used to set reserves and calculate premiums. But
rarely are costs measured in context with medical outcomes or how patients improve.People have consistently dodged the issue of quality medical care, convinced that quality is more expensive. But more quality actually means less cost! Tracking claim outcomes and costs based on injured workers’ injury or condition leads to selecting the doctors that deliver better results and at lower cost.
Understanding costs
Michel Porter and Thomas Lee in their article, “The Strategy That Will Fix Health Care” published in the Harvard Business Review[1] list six methodologies necessary to change healthcare in the US. One of the six value strategies they list is to measure true outcomes and costs for every patient.
“When outcomes are
measured and reported publicly, providers are under pressure to improve and to
adopt best practices, with resulting improvements in outcomes.”
Defining quality medical care
Porter and Lee further state that we focus too much on what doctors do, rather than what is important to the patient (injured worker). What the injured worker wants is freedom from pain, return to pre-injury status, to health, and to work. We should be measuring what matters to the injured worker.
What the patient wants
is the true measure of
quality medical care.
It matters
very much to injured workers that they avoid any adverse effects of the medical
treatment they receive. Adverse effects include infection, re-admission to the
hospital for the same problem, returns to the Emergency Department, complications
such as embolism or thrombosis, and revision or re-do of a surgical procedure.
Length of treatment is important, as is length of stay in the hospital. What injured
workers want is quality care.
Adverse effects
Quality Medical Care
Traditional measures of quality focus on what providers do, the treatment they render. That can include laboratory tests and other diagnostic procedures, surgery, medications, referral to specialists, and, of course, cost. However, measuring the full set of outcomes that matter to patients with similar conditions is essential to understanding quality and meeting their needs and expectations.[2] It is the only real measure of quality care.
Minimize disability
In Workers’ Compensation we can easily measure functionality or return to normal physical activity by return to work or modified work data. Duration of disability and disability rating at claim closure are other important indicators of the injured workers’ functionality. These are the things important to injured workers because they portray health. Moreover, shorter disability means lower costs.
Other measures of quality include length of medical treatment and length of hospital stays. Measuring the full set of outcomes that matter is critical to meeting injured workers’ needs and is a powerful vehicle for reducing medical costs.
When outcome measures
improve, costs go down!
Quality measures reduce costs
Absent complications and other adverse effects, costs are naturally lower. It’s simple logic. Analyzing the data reveals the elements of care that are positive and, as a result, keep costs down.
Choose doctors with good results
Costs by themselves are not the driving force in medical management. The driving force is increasing the quality of care and the avoidance of adverse effects. The way to apply analysis of outcomes, including cost, is to identify the doctors who consistently get the best results for patients. Find the best providers associated with the best outcomes. Those with better outcomes will have lower costs.
Finding doctors who consistently get desired outcome measures is the first step. Then injured workers must be directed to them in states where that is appropriate. In other places, offering injured workers objective information regarding the doctors who get the best results in terms of outcomes can be very persuasive.
Monitor the course
Provider performance can fluctuate over time. Consequently, the data must be monitored continually to insure the best doctors continue to generate the best outcomes.
Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’
Compensation medical analytics and technology services company. MedMetrics
analyzes the data to score medical provider performance and offers other online
apps that link analytics to operations, thereby making them actionable. karenwolfe@medmetrics.org
No comments:
Post a Comment