The workers’ compensation industry has fallen behind the rest of the general healthcare industry nationwide. While other specialties adopt modern innovation and reforms to streamline healthcare delivery, workers’ compensation has struggled to provide the most efficient care for injured employees with work-related injuries. In recent years, however, the workers’ compensation sector in California is catching up to the rest of herd. The California industry has managed to save billions of dollars by adopting new policies and strategies, simplifying the care delivery process for workers, healthcare professionals, and insurance providers.
Telemedicine is Replacing Traditional Clinic Visits
When it comes to getting initial treatment for a workers’ compensation claim, using the telemedicine system can help to quickly and effectively sort through the severity of the injury and help determine if the patient requires more intensive physical treatment at an emergency room or a doctor’s office.
With telemedicine visits, the patient initially consults with a trained nurse or physician who can determine the potential cause of the injury and how to proceed with treatment. If he or she feels the injury requires hands-on treatment, he or she can refer the patient to a nearby medical facility. If the injury can be assessed and managed adequately via teleconference, they can prescribe medications and devise a treatment plan to help get the worker back on the road to recovery, while also documenting all of the necessary information to process the claim without having to cover doctor visit costs and emergency room fees.
S.B. 863 Signed into Law
S.B. 863 made changes to the workers’ comp delivery system by requiring physicians to use evidence-based medicine to guide treatment decisions and created medical provider networks. The WCIRB has estimated a $2.3 billion annual savings due to S.B. 863
EMOD Report Program
The delivery of healthcare through workers’ compensation requires the coordination of multiple players: the injured worker, the healthcare professional, and the insurance provider. While telemedicine and AI bring frontline care delivery up-to-date, programs such as the EMOD Report Program (https://www.emodreport.com/) harness the power of technology to further enhance the delivery of workers’ compensation.
When a company runs into workers’ compensation claims, its experience modification rate will increase along with its work comp premium. Over 70% of companies have an inflated experience modification rate due to miscalculations and mismanagement of workers’ compensation claims. To address this issue, the EMOD Report Program utilizes ground-breaking practices and the latest technology to help a company improve its experience modification rate and reduce workers’ compensation costs. Also, any company that joins the program will gain access to exclusive work comp rates and recover any overcharges from a workers’ compensation insurance carrier. In order to accomplish this, the service analyzes data used to calculate the experience modification rate, lowers reserves, identifies subrogated claims and, provides tailored services to protect from fraudulent claims and increase claim management efficiency. The service is leading the industry when it comes to lowering the EMOD, claims processing, including investigation, evaluation, and settlement. Due to the protections implemented in the program, they can provide the lowest work comp rates. It is an efficient method to save money and improve accuracy, while giving plenty of extra benefits and time-saving options.
Using AI to Diagnose Injuries
An exciting twist to telemedicine is the use of Artificial Intelligence, or AI, to quickly and accurately diagnose workers’ compensation-related injuries. This new use of technology is helping the industry save money on manpower, in addition to streamlining the process of documentation and treatment. Currently, this technology is being used in conjunction with human expertise to help provide a more rounded assessment and treatment. This type of hybrid technology is rapidly spreading through the California workers’ compensation sector and helping to save on expenditures on a large scale.
These new advances in workers’ compensation have saved the industry billions of dollars in a short period of time. The push to embrace change within the sector and harness the most recent methods of diagnosis and handling claims have proven to streamline the process for all parties and has spurred efforts to keep the system more modernized and user-friendly.