In an effort to reduce the delays incurred during the treatment process for injured workers, the DWC has been continuing to update medical guidelines to align with the workers compensation drug formulary as required by Assembly Bill 1124. DIR Director Christine Baker mentioned that the drug formulary will serve as a guide for medical providers, since certain conditions require specific treatments. Furthermore, the use of proper drugs will also benefit employers by reducing costs. As California adapts to the update in the medical treatment guidelines, all market players in the Workers’ Compensation industry should take note of this change.

Executive Medical Director Dr. Raymond Meister of the DWC stated “Many treatment guidelines have been updated and we want to reflect the most recent evidence in the MTUS. The updates will facilitate the best evidence-based care, while the formulary will provide a clear list of preferred medications.” The MTUS guidelines have updated the following chapters:

  • Ankle and foot
  • Cervical and Thoracic Spine
  • Elbow Disorders
  • Eye
  • Hand, Wrist, and  Forearm
  • Hip and Groin
  • Knee Disorders
  • Low Back Disorders
  • Shoulder Disorders

Since DataCare has been integrating medical guidelines into their software database for many years, this update will benefit the end-users. Through this process, nurse case managers have a simpler workflow around managing the cost of claims while reducing the duration in the return-to-work process. This integration provides them with a greater understanding of the diagnoses and procedures, along with treatments and prognoses of injured workers because the updates to the guidelines are readily available.

DataCare has a direct integration of these guidelines into the Ahshay Case Management and Utilization Review portals, which allows direct access to the updated information for all users. Not only can they manage cases with increased efficiency, but also make more informed decisions. Whether the user is a nurse case manager, physician, or an adjuster, all individuals have the ability to access the latest treatment guidelines.