Company Experts Present Case Study at National Workers’ Comp Conference November 9-11
LAS VEGAS & SAN JOSE, Calif.–Wasting medical payments in workers’ compensation is avoidable, according to a panel of experts presenting at the National Workers’ Compensation and Disability Conference® & Expo November 9-11 in Las Vegas.
“Our panel will demonstrate how this connectivity can bring huge aggregate savings to the industry”
Using a real life example, risk managers from a Fortune 100 company, will join DataCare Corporation andEK Health Services, Inc. to show how their collaborative pilot program linked two critical components of workers’ compensation claims management, generating a 20 percent decrease in the company’s medical spending.
Leading the presentation, “Using Technology to Control Medical Cost Leakage,” are risk management representatives from the large self-insured employer and Eunhee Kim, Co-founder/CEO of DataCare and Founder/CEO of its sister company EK Health.
Kim will explain the role DataCare and EK Health played in helping the company find and close the gap between Utilization Review and Bill Review, reducing a major cost driver in workers’ compensation.
“Understanding the benefits of merging UR and BR in workers’ compensation claims management is a critical step to helping payers lower the overall cost of the claim,” said Kim.
The team was motivated by a 2008 study from Navigant showing workers’ compensation payers lose major dollars in wasted medical payments.
The Navigant study showed that in California alone more than $1 billion has been spent on treatments not in accordance with evidence-based medicine, prompting the employer to review its own records. With the help of Data Care and EK Health, they conducted their own study of 100 files, analyzing all medical payments associated with the cases.
The collaborative study confirmed that inappropriate payments were being made to medical providers when neither medical treatment authorization had been given nor original approval obtained to perform treatments.
Employing EK Health’s technologically-driven program linking UR and BR supported by DataCare, the team was able to generate substantial savings for the company.
By establishing UR/BR connectivity, if there is no match between the utilization review-authorized CPT code and the bill, the payment request is culled out and analyzed for appropriate adjustment. “Our panel will demonstrate how this connectivity can bring huge aggregate savings to the industry,” said Kim.
The panel’s findings will be presented at a morning session Friday, November 11 of the National Workers’ Compensation and Disability Conference® & Expo. Visit EK Health and DataCare at Exhibit Booth 125.
About DataCare
Headquartered in San Jose, CA, DataCare software supports evidence-based treatment decisions with defensible supporting documentation for workers’ compensation claims. DataCare technology supports the highly specialized workflows for workers’ compensation claims management, case management, utilization review, and bill review systems. Web-based DataCare solutions enable reviewers to be twice as productive as those using legacy paper-based workflows, and offer managers much better visibility into status, quality, and workload issues.
About EK Health
Headquartered in San Jose, CA, EK Health Services, a sister company of DataCare, is one of the nation’s leading medical and disability management services companies, providing workers’ compensation case management, utilization and peer review services to insurance companies, employers, for-profits and public entities across the country.