Podcast

Rigorous vs. Permissive UR — Going Beyond the ‘Comfort Level’

… part of it is connected to the case management process. In other words, case managers actually do some of this work in some models. We think it's important that this process be separate — an … and has higher clinical fidelity in terms of what the system does, versus what physicians do on the first and second levels. You're going to see higher escalations. You're going to see … categories that people ask for more than they need.  If you want to wring that out, you can do that in a process that virtually reduces the appeals. The providers know these procedures are …
Blog

Introducing Networks 2.0: Part Four

… injured workers. And, of course, specialty networks focus on narrow areas to let clinicians do more of what drives them and what they’re best at doing. These newer networks present … efficacy and efficiency. They allow the best providers, with the support of payers, to deploy top clinical skills to help injured workers return to work. This paper is based on articles …
Podcast

Closing Loopholes: Tackling Drug Price Inflation in Work Comp

… If you look at the statistics on drug pricing, if you look at when advertising became legal to do, the next years, it’s like a rocket going straight up in the air on the graph as to how fast … mail-order pharmacies, where they’re likely must be some sort of financial incentive to do that. We don’t really know what that is, but there’s this shift to the out-of-state mailer, … then the purveyors of this pharmacy supplies to doctors went to manufacturers and had them do boutique drugs just for them that had their own NDC. So, it was the manufacturer’s NDC, not …
Article

Examining Social Determinants of Health: The Whole Person Approach

… The conversation around whole-person approach generates many important questions. For one, how do we support the whole person by offering one comprehensive solution? And, what part do digital health programs play in meeting the needs of injured employees? Further, how do we deliver a personalized experience and meet injured employees where they are in their …
Article

What is Ticket to Work?

… : And who’s eligible for the program? And how do they benefit from it? … of Social Security Disability in order to get back to work. There are incentives for people to do this. And there’s assistance from state OVR, Office of Vocational Rehab, as well as employment … How do eligible candidates become part of the program? … will come up. They can then choose by going to the Genex link as to what the services  that we do provide. They can call us on an 800 number. They can send an email.  They can also apply via a …
Article

What is Ticket to Work?

… : And who’s eligible for the program? And how do they benefit from it? … of Social Security Disability in order to get back to work. There are incentives for people to do this. And there’s assistance from state OVR, Office of Vocational Rehab, as well as employment … How do eligible candidates become part of the program? … will come up. They can then choose by going to the Genex link as to what the services  that we do provide. They can call us on an 800 number. They can send an email.  They can also apply via a …
White Paper

Workers’ comp networks are constantly evolving

… injured workers. And, of course, specialty networks focus on narrow areas to let clinicians do more of what drives them and what they’re best at doing. These newer networks present …
News Release

Bebrick Collision Care Center—Three Generations of Quality OEM Repairs

… using a different shop management system. With the GM program and Mitchell platform, we can do the research at least four times faster," Dennis explained. Just because a car has four wheels … to purchasing new frame equipment and paint booths. "We'll stick to our core values, and we'll do the training that we're supposed to do, and have the equipment necessary to do the jobs properly," he said. Dennis credits much of …
Article

Delivering The Most-Favored Nation Prescription Drug Pricing to American Patients

… those drugs. Even at our negotiated rate, it's not a great deal. What President Trump wants to do is get the drug companies to sell to the U.S. at or below the pricing offered to these other … economically on par with the United States. It is another attempt to reduce drug costs, and we do pay a lot. $460 billion last year. It will be interesting to see how this shakes out. We are …
Podcast

The Other Drug Issue - When Addiction is a Pre-Work Injury Problem

… more likely to have injury‑related absences than workers who don't have alcohol issues. So, we do have and we do see a large population who have substance abuse issues before they got injured, and those … to live with it, and how to make other people believe that they don't have an issue. So, they do come up with a lot of stories. There are certain signs that our case managers look for when they work with the injured workers in case they do have a substance abuse issue, and those signs are similar to what any employer should look for …
Podcast

Providing a Lifeline to Flood Victims

… activities, such as wound dressing changes and glucose monitoring for people with diabetes. We do our best to help clients maintain independence while in the shelter. For those who are injured … Do you have a story you’d like to share of a particular individual you’ve helped? … and wanted to find a volunteer opportunity closer to home. I also wanted an opportunity to do more hands-on care. I contacted my local Red Cross chapter and, after speaking with them, …
Article

DevSecOps: An Interview with Peter Chestna at Mitchell DevCon 2018

… developers aren’t always producing secure outcomes and taking accountability for what they do. DevSecOps emphasizes the point that security is fundamental to software development. … second way is about amplifying feedback loops. As we put tooling in to measure security what do we do with that information? How do we go from reactive to proactive, taking that learning from it …
Article

Secrets to a Successful Stay At Work Program

… to work programs take too much effort. While employees sometimes think that employers have to do whatever it is the employee requests to change the job. So, it's almost like they're coming … — it's become so broad that falling under that umbrella for an accommodation is very easy to do. So, when someone presents themselves with saying they have a major life activity effected, … help us with that?" They have a vague notion of the required under the ADAAA, and they want to do return to work, and they value their employees, but aren’t sure where to start. So, there is …
Article

Secrets to a Successful Stay At Work Program

… to work programs take too much effort. While employees sometimes think that employers have to do whatever it is the employee requests to change the job. So, it's almost like they're coming … — it's become so broad that falling under that umbrella for an accommodation is very easy to do. So, when someone presents themselves with saying they have a major life activity effected, … help us with that?" They have a vague notion of the required under the ADAAA, and they want to do return to work, and they value their employees, but aren't sure where to start. So, there is a …
Article

Celebrating 70 Years of (m)Powering Better Outcomes in the P&C Claims Process

… success over the years, the first thing that comes to mind are our customers. Our clients do very important work and are absolutely passionate and committed about their purpose in the … and trusted relationships with them, because we recognize the importance of the work they do and the important role we play in fulfilling their mission. So for me, it’s really about our customers and what they do, and the people that we have, and the passion that we have for serving them well. "...it’s …
Podcast

Rigorous vs. Permissive Utilization Review: Beyond the ‘Rubber Stamp’

… One of the arguments against UR is that it slows the return‑to‑work process. What can payers do to ensure that their UR program actually helps? … takes less than one-and-a-half to two days. That's how fast it needs to be. Then. when you do get a clinically rigorous review, it's as important to not approve those from a return‑to‑work … part of it is connected to the case management process. In other words, case managers actually do some of this work in some models. We think it's important that this process be separate — an …
Blog

Morphine Equivalent Dose (MED) Continues to Decline

… have heard the term morphine equivalent dose or MED. But what exactly does that mean and why do we use it? MED is a calculated standardized value of the total opioid intake of a person over … has positive effects on controlling MED levels because in general, when people know more, they do better. An injured worker may be more likely to give physical therapy a try in lieu of asking … because they are more aware of the dangers. Jurisdictional Rules - states are continuing to do their part in controlling opioids by placing restrictions on how these medications can be …
Article

From Reactive to Proactive: How to Leverage Data to Capture Savings

…    Me too. Today, we're taking the conversation a step further and looking at how data can do more than just guide decisions. … intervention and getting those early warning signals, and for years we've had the ability to do that using predictive analytics, and such. But we're in a world now where we've got a lot more … we've been using structured, relational data. Now we can use unstructured sources. What do we mean by that? Narratives, medical records, claim notes, etc. We can use all of that. To …
Podcast

Managing the Labor Challenge: Provider Networks

… in the system. As far as provider networks, I would say when you think about how adjusters do what they do, their goal is really to manage the claims as best they can. They're looking for shorter … in certain markets, they find out which providers they like to work with or which ones do a lot of workers' comp cases. That just further allows them to streamline and get more and … and more proficient and use these providers, then they can start to figure out “which ones do I have a better relationship with? Which ones do I seem to be able to assign patients with, …
Podcast

Care Abroad: Assisting U.S. Employees Injured Overseas

… the case assigned to our international, telephonic case management team, and they immediately do outreach to all the involved parties to start gathering information. Because each referral is different, their activities may vary, but some of the key activities that they do are many of the same things we do when we’re doing normal, case management activities within the U.S. we provide that support to …
Podcast

Getting OnBoard With New York's Regulatory Changes

… And what do these changes mean to how utilization review claims will be handled in New York? … people involved in the work comp system are going to have to log into this OnBoard portal and do the work within the portal itself. So, we won't be getting forms and then faxing back to … And do you think the OnBoard system will offer significant improvements to the way claims are handled? … : Do you see OnBoard as something that will help Genex speed up claims processing in New York? …
Article

Enlyte Pharmacists Discuss a Changing Workers’ Comp Pharmacy Landscape

… the only thing consistent in workers' compensation pharmacy is that it changes. Right. So what do you think what's next? … The way that we drive product development, I think this is the way to do it, is to look very macro level. So what are the changes impacting? Let's say, for example … So how do those coverage options impact our care? So that's all very macro level. But what we try to do …
Podcast

It Starts With the Scan: How Specialty Networks Improve RTW

… review three or more scan types, whether it be MRI or other diagnostic testing, and 85 percent do two or more. So, it used to be that a general radiologist would review everything. Now … In terms of some of the other challenges you had mentioned, how do these problems affect return to work? … perspective. I very rarely hear that the quality of the scan wasn’t good. We don’t have to do a lot of rereads. We don’t hear feedback from the radiology readers that they couldn’t …
Podcast

Peter Rousmaniere Part 1: Comp’s Evolutions and Influencers

… you think of industry icons in workers’ comp, Peter Rousmaniere is among the select few at the top of the list. For more than 30 years, Peter has been a major influencer in workers’ comp, … what they're doing, and to the extent that I can help them understand the industry, I will do so. … 1990, and is still moving its way through the field. It has largely done what it needs to do in terms of major innovation. What we're looking at right now is continuous improvement of …
Article

Utilization Review: Addressing the Issues

… multimedia series in which subject matter experts discuss problems and offer solutions to top issues affecting our industry. I’m Tom Kerr, and today we’re discussing issues in Utilization … and experience, their years of training, their years of practice, but then overlaying on top of that, evidence‑based medicine, looking at the scientific literature, looking at … when utilization review steps in, we're focused more on that evidence‑based approach, where we do have physicians that have that experience, and we do have that academic background and the …
Article

Depression: Stop Negative Thoughts

… Thinking that you or other people "should" or "must" do something is a sign of this type of thinking. For example, "I should get these seven things … think: "I must get so many things done today." You can replace that thought with: "I could do one of these things today. Which one could I do quickly, so I can check it off my list? Or which one is the most important to do today?" Use a …
Blog

Network 2.0 - Constructive partnerships between providers and payers

… return-to-work programs to help their injured employees recover. The best programs do far more than safeguard the bottom line. They focus on truly addressing the needs of injured … complications resulting from potentially being forced into a more sedentary lifestyle. 17 Top companies understand that having a worker return to the job either under modified duty or, if … these employers offer fair reimbursements to providers and pay on time. That’s because top-tier employers recognize the irreplaceable value providers bring. Alongside employers and …
Article

How to Strategically Develop a Strong PBM Partnership

… Some questions to discuss with your PBM: What kind of unique or proprietary services do they provide? What kind of integration with other software and services to they offer? How in-depth are the programs over the lifecycle of the claim? What kind of clinical programs do they offer? How extensive is their network and how to they drive out-of-network capture? What … How safe and secure is their data and technology? What kind of implementation support do they provide? What kind of account management and partnership will you receive? What are their …