When we begin with healthcare, we usually think of care provided through group health insurance or through Medicare or Medicaid. However, there is another significant reimbursement system that pays for about $142.2 billion dollars of care every year: Workers' Compensation Programs.
In recent years, the industry has been focused on the reduction of healthcare costs in general. Many companies are turning to managed care to provide medical management of workers' compensation to further reduce costs. This approach has been referred to as Managed Workers' Compensation.
As a result, many managed care providers, including health plans and integrated delivery systems, are offering occupational health services through a variety of contractual arrangements. Care Station participates in many such plans through provider organizations. They have enlisted Care Station to treat the injured employees of their insured, simply because we have adopted the philosophy that true cost containment can only be realized through proper utilization of treatment.
Just as in group health, the care of workers' compensation injuries and illness should be guided through the use of clinical management tools. As in group health, these tools outline the preferred approach to care in order to reduce variation, manage resource utilization and provide a homogeneous group of patients upon which to measure outcomes.
Outcome management is underscored by Care Station 's practice philosophy. Immediate referral for physical therapy, specialist and diagnostic testing are not indicated for first line injury rehabilitation. To guarantee measurable results, first one must eliminate waste.
Process and outcome measures are a major consideration in performance measurement for managed workers' compensation. The process measures should focus on the efficiency of addressing injured workers' medical needs and returning them to work. The outcome measures should focus on the effectiveness of care, particularly functional outcomes.
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