‘Top Docs’ are Critical to Quality Outcomes
Horizon’s Top Doc Health Care Value strategy boosts employee and insurer well-being.
Have you ever heard the term “doctor’s doctor?” They are considered the best of the best — those who physicians trust and go to based on word of mouth from other doctors. Though physicians have the inside scoop, it can still be a challenge for them to find the right specialists for their unique needs. And however it is difficult for a doctor to find the right specialist, typical patients are feeling it tenfold.
To help address this issue, workers’ compensation (WC) PPOs need to create streamlined referral pathways to the best orthopedists, pain management specialists, physical therapists (PTs) and other healthcare professionals who specialize in work-related injuries — especially in states that allow patient care direction for the life of a claim. WC PPOs should not just be about medical savings: They need to enable people to receive the right care (at the right cost) to achieve quality outcomes.
Of those WC medical expenses, over 60% are related to surgeries. That means it’s critical to get the first orthopedic referral right. A referral to an unsuitable orthopedist can delay recovery, prolong lost work time and increase overall claim costs. Horizon Casualty Services addresses this issue by cultivating a strong, reliable network of the most qualified New Jersey musculoskeletal-focused providers.
According to Jacqueline Alonso, president of Horizon Casualty Services Inc., “Our goal is to streamline the selection process for case managers and claims adjusters by connecting them to the top orthopedists and specialists with ease and efficiency, and to assist claims departments with scheduling services.”
Horizon Casualty Services operates based on a unique healthcare value strategy known as the Outcomes Focused Network (OFN). The appointment scheduling services team assists WC insurers by scheduling appointments for their claimants requiring orthopedic care or early intervention pain management with top doctors in the Horizon Casualty Services WC PPO network.
The OFN selection criteria are as follows:
Demonstrated use of evidence-based medicine
Conservative approach to surgery and opioid prescription
A care approach that results in an appropriate length of disability and lost work time within Official Disability Guidelines (ODG) parameters
Consistent use of in-network resources to reduce costs
Monitoring complaints and grievances to ensure quality care is provided to claimants
Administrative efficiency, including timely initial appointments and medical reports following office visits
Horizon Casualty Services makes appointment scheduling easy for claim adjusters, at no additional cost, and includes:
A dedicated scheduling team for orthopedic, early intervention pain management, PT and radiology appointments
One-business-day turnaround from receipt of claim adjuster referral to appointment scheduling
Appointments scheduled with OFN providers as first preference
Claimant and claim adjuster notification when appointments are scheduled
The Horizon Casualty Services provider search tool features value-based sorting with OFN providers at the top of search results for adjuster convenience. This search tool creates a streamlined and precise pathway to top providers:
Providers are evaluated on in-network utilization metrics
Orthopedic active practicing subspecialties are included in search results (i.e., shoulder, knee, spine, etc.)
We strive to ensure that medical care delivered through the OFN network program is at or close to 100% in-network, including ASCs, assistant surgeons, anesthesia, post-operative care and PT
Exceptional PT performance benchmarked by ODG and use of comparative provider analysis
Our quality assurance approach includes a multidimensional assessment of provider performance and education to ensure positive medical outcomes for patients and helps to effectively control costs for payers
WC insurers, self-insureds and TPAs can achieve best-in-class results by leveraging the Horizon Casualty Services OFN healthcare value strategy. “Our innovative healthcare strategy and clinical quality initiatives allow claimants to receive superior care. We offer a comprehensive quality network, and our commitment is to partner with each client to achieve optimal medical and return-to-work outcomes.” — Jacqueline Alonso.