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Coordinated Care: The Payoff is Real

1 month ago

Coordinated Care: The Payoff is Real

Model demonstrates 30% or greater savings on claims when incorporating this approach

By Linda Colsen, Vice President of Customer Experience, One Call

Incorporating a coordinated care approach has long been the answer to providing the most comprehensive, efficient, patient-centric and successful healthcare possible – and the workers’ compensation segment is no different. COVID-19 has presented an ideal setting in which to demonstrate the effectiveness of the coordinated-care model.

As we continue to work hard to prevent COVID-19 infections, too many of the nearly 11 million COVID-19 survivors are still battling life-altering symptoms long after a COVID-19 test reads negative. These ‘long-haulers’ — as they have come to be known—often face severe issues from complications like acute respiratory distress syndrome (ARDS), central and peripheral nerve impairment, altered mental status, acute kidney injury (requiring dialysis), atrophy and muscle weakness, blood clots and vascular conditions, cardiac complications, and pressure ulcers. The cost of healthcare for these long-term cases is just the beginning – for some, lingering health conditions may cost them the ability to return to work.

A recently developed health economics model, examined the economic impact of coordinated care vs. unmanaged care for a variety of COVID-19 complications and lingering symptoms. Many of these are also common to traditional catastrophic injuries.  

Coordinated Care: The Payoff is Real  

 

The health economics model developed by One Call and PRECISIONheor shows that incorporating a coordinated care approach in the treatment of COVID-19 complications and lingering symptoms significantly improves health outcomes and cuts medical costs for workers’ compensation payers and employers. Using data from Medicare, the Centers for Disease Control and Prevention (CDC), and One Call’s proprietary database of historic claims, the simple, user-friendly model simulates scenarios based on different patient archetypes, ranging from cardiac to musculoskeletal to organ damage. Highlights include: 

  • Payers and employers can potentially save between 31 - 53% when applying a coordinated approach to care with network pricing. The increase in savings is associated with a lower level of hospital readmission volumes in the coordinated home health population versus the unmanaged population.*  
  • Using the Centers for Disease Control and Prevention (CDC) reporting of illness severity, and basing the model on one thousand patients, the care for those with COVID-19, if unmanaged, could potentially cost $21 million using state fee schedules and U&C rates for services. With a coordinated care approach, this number could decrease by more than $6 million.*
  • Coordinated care of home health services revealed hospital readmission rates at one-half of 1%.* Medicare (unmanaged) population readmission rates were about 2%. 
  • Coordinated care reduces the length of skilled nursing facility stays through proactive engagement and planning for discharge, reducing the average length of stay by 9.5 days – an additional cost-avoidance savings of around $10,000 per patient.*
  • Active, clinical oversight of physical therapy returned patients to health with 35% fewer visits than an unmanaged program, reducing overall cost and duration.*

In the recently released Workers’ Compensation Benchmarking Study, the idea of injured worker advocacy was a hot topic. Data showed that both claims leadership and professionals believe in a patient-centric approach that delivers the best possible outcomes for injured workers.

Barring the debate about presumption and subsequent compensability of COVID-19 claims for essential workers and beyond, it is vital that as an industry, we do what is best for injured workers. A coordinated care approach puts injured workers’ needs at the center of the process, resulting in better outcomes for all.   

*Based on One Call national data

This article, not including the infographic, was featured on WorkCompWire.

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