Network Innovation Drives Quality and Performance
HCS continues to build its network to provide quality care for claimants, the lowest cost for employers and carriers, and smooth administration for providers. Coordinated, evidence-based care rendered by workers’ compensation-savvy providers is the key to meeting each stakeholder’s needs and requires effective partnership among all parties.
Outcomes-Focused-Network (OFN), Episodes of Care (EOC) and new provider excellence programs offer the best possible care pathways for claimants, ensuing administrative and clinical quality.
Providers enroll in our OFN specifically to treat injured claimants in the EOC programs. Providers treat claimants within the programs’ guidelines, work with in-network resources, such as ambulatory surgery centers and in-network anesthesiologists, and understand workers’ compensation guidelines, including prompt return of medical documentation.
Partnership with OFN providers benefits all stakeholders:
- Claimants consistently receive prompt evidence-based care.
- Providers understand case management expectations, which leads to simplified authorizations and fewer delays in care.
- Carriers and employers reduce their costs by maximizing the use of in-network resources.
Episodes of Care (EOC)
Newly injured claimants who have not responded to conservative initial treatment are enrolled in EOC programs:
- Pain Management Medical Home (PMMH) for back pain
- Surgical Episodes of Care (SEOC) for knee, back and shoulder injuries
Conservative, evidence-based care plans ensure claimants receive prompt care that avoids inappropriate early imaging, opioids, injections or surgery.
The EOC program has forged partnerships with providers based on clear mutual expectations. This improves care for claimants, increases administrative efficiency and maximizes network penetration. Importantly, all stakeholders have to take responsibility for achieving these results; selecting the “right” provider is not enough.
Provider Excellence Programs
HCS is developing provider excellence programs to strengthen the care continuum and improve outcomes and efficiency for all stakeholders. These programs will match a select group of providers to claimants with specific diagnoses, as they do for EOC. HCS is also expanding its analytics capabilities to ensure claimants are following optimal care pathways.
For instance, some providers stand out for their use of in-network resources for surgery and their prompt return of medical documentation. Surgeons affiliated with in-network ASCs and in-network anesthesiologists collaborate with in-network physical therapists. Surgeons using in-network treatment plans help avoid authorization delays that result from requests to use out-of-network services, and help reduce the cost of care.
Enhanced analytics allow HCS to identify high-performing providers for deeper partnerships and target clinical and administrative improvement efforts. Deeper partnerships drive superior claimant outcomes at lower cost for employers with less administrative overhead for providers. The combination of these efforts will enable HCS to continue delivering the best workers’ compensation network in New Jersey for claimants, providers, employers and carriers.