Restoring Health
and Productivity
Problem
Higher than expected cost trends
A large global manufacturer experienced higher than expected workers compensation,
disability and medical cost trends. The services were all separately managed by
different carriers and new acquisitions focused management on operating in a “LEAN
MANUFACTURING” environment. Senior management wanted a simple and measured
approach to managing disability and care management.
Approach
Analysis of data and review of plans
- Analyzed and benchmarked available absence data and health claims, time-off patterns,
disease prevalence, provider selection and total cost of care cost-driver data.
- Reviewed health, disability, FMLA, and workers’ compensation plans for “management
triggers” and “policy conflicts”.
Action
Conduent Care and Quality Solutions implemented its integrated services
- Electronic Notification & Single Record
- Established one patient care management electronic record for all health, disability
and workers compensation patients and an e-mail referral system.
- Established an electronic notification system for the customer’s supervisors
to directly contact the nurse disability coordinator if there was a change in service
or health risk status.
- Management based on Measurement
- Developed a patient call list based on Conduent Care and Quality Solutions’
Predictive Health Risk scoring system, utilizing medical services, prescription
drug claims and disability types. This was extremely valuable in identifying members
with chronic health care conditions as well as employees with potential repetitive
absences.
- Assessment/Triage Point
- Coordinated Care for catastrophic, chronic, and disabled patients
utilizing Presley Reed and Milliman Care Guidelines as benchmarks. Implemented
Absence Management program - after 5 days of unscheduled absence, or
sooner if certain conditions were present, a nurse would call and assess a patient
determining when they could return to work. At this point the nurse would establish
a care and return to work plan which integrated medical and functional evaluations
and group health Case and Condition (Disease) Management, if needed.
- Outcome data were reported through Conduent Care and Quality Solutions’
HP Tools© applications and Integrated Care Management System©
applications.
- Instituted supervisor training program
Result
Dramatic direct cost reduction and high return on plan savings
- Absence Management ROI – 4:1 return on direct disability
indemnity plan savings.
- Coordinated Care Savings – Generated over $1.5 M due to clinical
involvement in such areas as reducing hospital stays, coordinating transfers to
more appropriate care settings, reviewing medical necessity, and identification
of administrative errors.
- Productivity – Reduced total lost days by 60%.
- Customer reports high satisfaction.