Provider network advisory group
1 / 11

Provider Network Advisory Group - PowerPoint PPT Presentation

  • Uploaded on

Provider Network Advisory Group. COHE Expansion July 25, 2013. Provider/Employer Contact . Topics for Discussion. History of Best Practice Lit Review, Provider Focus Groups Use of Best Practice COHE Top Tier Implementation Challenges Measurement Challenges

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' Provider Network Advisory Group' - senona

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Provider network advisory group

Provider Network Advisory Group

COHE Expansion

July 25, 2013

Provider employer contact
Provider/Employer Contact

Topics for Discussion

  • History of Best Practice

    • Lit Review, Provider Focus Groups

  • Use of Best Practice

    • COHE

    • Top Tier

  • Implementation Challenges

  • Measurement Challenges

  • Modification of Best Practice

    • Process

    • Results

Provider employer contact1
Provider/Employer Contact

COHE Best Practices

  • Learning and Using Best Practices

    • Report of accident (ROA) in 2 days

      • Quick start to claim initiation/adjudication and employer notification

    • Activity prescription form

      • Communication between injured worker, provider, and employer

    • Provider call to employer

      • Discussion about restrictions and modified work

    • Barriers to recovery

      • Injured worker assessment typically at 2 to 4 weeks of time loss

    • Health Services Coordination

      • Assistance with return to work

Provider employer contact2
Provider/Employer Contact

Top Tier Criteria

  • Experienced Attending Providers

    • Average of ≥ 12 claims annually

    • In good standing

    • Higher certification

    • Committed to quality improvement

    • Include patients with complex claims in practice

  • Demonstrated best practices

    • Exceeding benchmarks in best practices: ROA, APF, Provider/Employer contact

    • Care coordination

    • Knowledge and expertise in core competencies:

    • Collaboration & communication

    • Pain management

    • Workers’ Compensation knowledge

Provider employer contact3
Provider/Employer Contact

Definition of this best practice:two-way communication about return to work between provider and employer

Provider employer contact4
Provider/Employer Contact

Implementation Challenges

  • Identifying appropriate claims

  • Finding the correct employer contact

  • Playing “phone tag” with employer

  • Knowing what information to share

  • Responding to employer questions about claim adjudication

Provider employer contact5
Provider/Employer Contact

Measurement Challenges

  • Using billing data

    • Time lag

    • Providers’ billing staff remembering to bill and use modifier

    • Providers using methods for contact other than telephone call

  • Developing a benchmark

    • Knowing when a claim needs this best practice

    • Recognizing that some providers do not bill for service or do not use modifier

Provider employer contact6
Provider/Employer Contact

Modification Process

  • Review original intent of best practice from focus groups

  • Review alternatives/options with COHE Medical Directors and L&I staff

  • Agree on alternatives that meet original intent

  • Identify opportunities to explore in future

    • OHMS risk factors and identification of claims

    • OHMS documentation of appropriate employer contacts

Provider employer contact7
Provider/Employer Contact

Results-How can best practice be met?

  • Attending provider telephone call to employer of injury

    • Billing code with modifier, or

    • OHMS documentation (in future)

  • Care Coordinator Initial Evaluation and Coordination (IEC)

    • IEC billing code, or

    • IEC notes in OHMS

  • Job description signed by provider

    • Billing code

  • Stay at Work benefit paid to employer within 1st 12 weeks

    • Signed job description required

Provider employer contact8
Provider/Employer Contact

Provider Adoption of COHE Practices:

Provider employer contact9
Provider/Employer Contact

COHE and Top Tier Goals

  • Increase provider use of best practices.

    • Add methods to facilitate provider/employer contact

    • Test benchmark for provider/employer contact

  • Increase number of high and medium adopters of best practices

  • Identify opportunities for Occupational Health Management System (OHMS) to improve use and measurement of best practices