Where’s the Value?
As we’ve come to expect, Joe Paduda has blogged about some issues that are near and dear to our hearts. He poses the question, “Where’s the value,” to the several different “customers” who factor into the work comp managed care buying decision.
Let’s focus on three specific “customers” and their needs according to Joe:
“For the adjuster, the definition isn’t quite so apparent. With a desk swamped under case files and a screen stuffed with flashing ‘red flags’ on critical diary entries, there’s less focus on finding the cheapest wheelchair and more interest in picking a vendor that can take work off the adjuster’s desk, do it competently and without claimant complaint, and provide documentation that, at a maximum, is readily cut-and-pasted into the claim file.”
We’ve found adjusters that are doing everything they can to stay above water—averaging 180 files on their desk at one time. When we talk about our services with them, their number one goal is to close the file with the best solution possible. In our world, the best solution is attained when we place our focus on closing cases as quickly as possible versus an emphasis on billable hours. That means dedicating the appropriate number of hours per individual case up front which typically results in faster, and safer resolution in cases and fewer files on the adjuster’s desk. But what does that mean for the employer?
Once again we turn to Joe:
“For the claim manager, it’s about closing files, minimizing litigation, and avoiding those calls from Home Office management about low network penetration and excessive use of non-authorized vendors, while struggling to keep overworked, underpaid, and unappreciated adjusters on the job and out of the clutches of headhunters.”
The formula for claim managers is much simpler. They want a resource that can help them close files—with the required processes and documentation to minimize litigation. At the same time, 180 cases on an adjuster’s desk can lead to burnout and good adjusters are hard and expensive to find.
Now, onto the employer. Joe, take it away:
“For the employer, value is fast, thorough medical care that gets the injured worker back on the job and keeps her/him there…unless the employer is dealing with declining revenues, in which case they don’t want John/Jane Doe back at work no matter what, as there isn’t any job for her/him and they sure don’t want to yet another unemployment claim.”
Let’s focus on the first part of his equation—getting the injured worker back on the job and keeping him/her there. The employer plays a major role here—larger than he thinks. When he takes action on a case within 24 to 48 hours and it gets in our hands, the average amount of lost work days is 29. Wait longer and the average skyrockets to 179 days.
When each “customer” realizes that we’re all in this together, the value of a managed care provider that consistently closes cases quickly and safely skyrockets. And in that “case” everybody is a winner.
