Quality healthcare is an important component to injury recovery and return to work. The right care from the right provider at the right time has been shown to produce positive outcomes for both the employer and the injured worker. This session at WCI’s Workers’ Compensation Educational Conference explored what quality healthcare truly means and offered suggestions on how to implement it within existing programs.
– Denise Algire, Director of Managed Care and Disability, The Albertsons Companies
– Linda Van Dillen, Chief Communications Officer, CompAlliance Managed Care
– Kylanne Green, CEO, URAC
Businesses today are actively seeking ways to ensure employees have access to proven medical providers and effective treatment programs. The journey begins with understanding the definition of quality healthcare.
“Quality” is hard to define because it truly is in the eye of the beholder. In our industry, however, we do have defined measures of quality. We evaluate adherence to evidence-based medicine, standards of care, administrative issues like timely submission of reports and patient satisfaction. Balancing these processes with the overall goal of advocating for the injured worker creates true quality.
URAC is an accreditor that strives to achieve continuous improvement in the quality and efficiency of healthcare management. The accreditation process is extremely thorough, taking approximately nine months. Accreditation matters because, in healthcare, we still have a free market. There’s a lot a variability among providers, so accreditation provides that extra quality measure for validation. For an employer, the accreditation provides a measurement standard. For a provider, it offers a way to communicate you are a best-practice organization.
There are several ways to provide quality healthcare. First, collaboration and coordination is essential and must be a focal point. This helps to provide a patient-centered approach. Another aspect is educating the patient to enable their decision-making abilities. From an employer standpoint, it means leveraging the resources available to you in addition to assessing and treating the entire individual – not just the workers’ compensation injury.
Case management also plays an important role in quality healthcare. The case manager serves as the advocate for the injured worker and his or her family throughout the process. The case manager also serves as the liaison between all the other various vendors and providers working on different aspects of the claim.