NEW ORLEANS--(EON: Enhanced Online News)--A Harbor Health Systems study analyzing more than 7,000 workers’ compensation claims involving claimants possessing one or more comorbid conditions found increased claims duration, higher medical costs, higher temporary total disability (TTD) days and higher rates of litigation. Harbor Health Systems, a One Call Care Management company, presented these findings at the National Workers’ Compensation & Disability Conference (NWCDC), in New Orleans, Louisiana earlier today.
“Because of the higher costs and increased duration associated with claims involving comorbidities, it is essential to proactively manage claims and guide these more complex cases to the physicians with the best track record and highest performance scores”
“Because of the higher costs and increased duration associated with claims involving comorbidities, it is essential to proactively manage claims and guide these more complex cases to the physicians with the best track record and highest performance scores,” noted Linda Lane, President of Harbor Health Systems. “By accurately scoring physicians who frequently see claims with comorbidities, we’re able to ensure the injured worker gets the best quality care throughout the recovery process, helping him or her return to work faster, reducing overall claims costs.”
The Harbor Health Systems research evaluated seven comorbidities – addiction, diabetes, hypertension, mental health, obesity, tobacco use, and multiple comorbidities – and how these factors impacted the following metrics:
- Total claims costs incurred
- Total medical costs incurred
- Claim duration
- TTD days
- Litigation rate
- Surgery rate
The analysis found that the presence of comorbid conditions impacted claims in the following ways:
- Claim duration is significantly longer for the claims involving comorbidities with the exception of tobacco claims. Claim duration increased by 76 percent for claims involving multiple comorbidities; 67 percent for claims involving addiction and 55 percent for obesity-related claims.
- With multiple comorbidities, incurred total costs increased 341 percent.
- Claims in all the comorbidity groups had significantly higher TTD days compared to the control group. TTD days increased by 285 percent for multiple comorbidities claims; TTD days in addiction-related claims increased by 274 percent.
- Litigation rates increased exponentially when claims involved multiple comorbidities, mental health or addiction. Litigation rates for claims with multiple comorbidities increased approximately 147 percent; for addiction-related claims they increased 224 percent and for mental health related claims they increased by 258 percent.
- Surgery rates increased dramatically as well when comorbidities were involved. Surgery rates increased 123 percent for claims involving multiple comorbidities, 140 percent for claims involving obesity.
Lane concluded with the recommendations to record more complete patient data at the beginning of a claim and incorporate comorbidities into utilization review, as well as factor them into treatment procedures so that claims managers can dramatically improve care and recovery of injured workers at a lower overall cost.
Learn more about the Harbor NWCDC session here: Comorbidity Impact on Claims and Doctor Performance: What the Research Shows.
To learn more about how an outcomes-based approach can reduce risk and produce cost savings for your organization, visit http://harborhealthsystems.com/.
About Harbor Health Systems
Harbor Health Systems, a One Call Care Management company based in Newport Beach, Calif., leads a revolution in medical networks that allows customers to build and manage a medical system based on quality performance of providers rather than the “lowest bidder medicine” that is typical of PPOs and HMOs. Harbor Health builds and manages outcomes-based medical networks, and supplies the tools, software and services to help their customers build, implement and optimize custom networks. With Harbor Health Systems, companies can identify physicians and other medical professionals who have exceptional skills in clinical, patient care and business management. By working with these healthcare professionals, payers and self-insured employers can greatly reduce the cost of care, complications, and time away from work. For more information, visit Harborhealthsystems.com.
About One Call Care Management
One Call Care Management (One Call) is the nation’s leading provider of specialized solutions to the workers’ compensation industry. One Call's solutions enable faster, more efficient and more cost-effective claims resolution. One Call provides reliable, consistent connections to care with expertise in high end diagnostics, physical therapy and transportation services, post-discharge home care and durable medical equipment, dental and doctor specialty services, complex care management, and the language services required for today’s multicultural workforce. With a focus on injured workers’ needs across the continuum of care, One Call enables maximum medical improvement and superior outcomes. For more information, visit www.onecallcm.com.