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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

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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