The Future of Value-Based Care in Workers’ Compensation – Part 2

Paradigm − January 9, 2018 − filed under Medical Expertise

In his second Leaders Speak on WorkCompWire, Dr. Choo discusses value-based care in complex and catastrophic workplace injuries and how such a systematic approach can deliver better clinical outcomes at a lower lifetime cost.

Catastrophic injuries, medically complex cases and chronic pain remain difficult challenges for all stakeholders in the workers’ compensation industry. To achieve greater results, the injured workers in these situations require care from those proficient in specialized skillsets and capabilities that extend beyond what is acceptable for more common, straightforward injuries.

In Part 1, I discussed value-based care and how it can be applied in Workers’ Compensation. Now, I’d like to specifically address value-based care in complex and catastrophic workplace injuries and how such a systematic approach can deliver better clinical outcomes at a lower lifetime cost.

What Drives the Cost and Volatility in Complex Injuries?

Catastrophic and medically complex injuries are inherently very complicated with a high degree of medical instability during the acute or early phase of injury management. Additionally, there is a strong association with an expansive list of medical and surgical complications that occur in post-acute periods, which can significantly confound the recovery and medical costs associated with these injuries. Even more vexing is the harsh reality that many catastrophic injuries result in some level of permanent residual impairments, leading to unexpected and distressful adjustments to one’s body image and/or self-image.

Ultimately, the extent of medical problems, complications, and changes in psychosocial aspects that occur throughout the care continuum drive the high levels of volatility and costs associated with these injuries. Furthermore, and not surprisingly, due to the high level of medical volatility, the long-term financial exposure from medical costs is currently much higher than the indemnity cost, and continues to grow.

How Can an ACO Approach Manage Cost and Volatility?

A value-based care approach, essentially functioning as an Accountable Care Organization (ACO), requires a system of effective communication, collaboration, clinical expertise, and innovation that integrates evidence-based medicine, robust data analytics, and a culture of continuous quality improvement.

Read the entire article here.

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