CCP 05-23-1994 - Laserfiche WebLink

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. . LMCIT Member Cities . Page 2 June 3, 1994 Experienced Health Provider Network Managed care channels injured workers into a system of experienced workers compensation health care providers. The mal/aged care organization is better able to assure necessary and appropriate plans of treatment by working with health care providers who are experienced in treating workers' compensation injuries. They can also keep network health care providers up to date on changes and trends applicable to workers compensation treatment. Medical Utilization Management Through use of a trained care manager, every injured employee's claim is managed to encourage the appropriate use of medical services and facilities. This will improve quality of care and maintain cost effectiveness on a case-by-case basis. The objectives of managed care and medical utilization management are four fold: * To provide the knowledge and tools required to appropriately manage the employees medical care at the point the employee . first comes into the workers compensation system * To evaluate each episode of medical care and address the procedural necessity and eliminate settings that seem questionable * Manage standard of care and present the most efficient and effective plan of treatment * Channel injured employees into the most appropriate network Active Case Management . Certainly from both the employer's and employee's perspective, the ultimate goal of treating any workers compensation injury is to bring the injured worker back into the work force if at all possible. To that end, care managers work with the injured worker, their family, and their treatment provider to: * Arrange for alternative treatment when necessary * Support and encourage return to work efforts with the employee and employer . ,