TY - JOUR
T1 - An investigation of the effects of a healthcare provider network on costs and lost time in workers' compensation
AU - Bernacki, Edward J.
AU - Tao, Xuguang
AU - Yuspeh, Larry
PY - 2006/9
Y1 - 2006/9
N2 - OBJECTIVE: The objective of this study was to evaluate the number of lost time days and cost of workers' compensation claims at a median claim duration (maturity) of 25 months for individuals injured between August 1, 2003, and July 31, 2004, who chose a statewide (Louisiana) network (Omnet Gold) of healthcare providers not subject to utilization review. METHODS: We identified and contrasted 176 lost time claims (143 closed) managed by Omnet Gold (OG) healthcare providers and 1464 lost time claims managed by healthcare providers not participating in OG. RESULTS: The average frequency of lost workdays for a closed OG claim was 53 days versus 99 days for a closed non-OG claim and the average cost of a closed OG claim was $12,554, whereas the average cost of a closed non-OG claim was $20,400. Both days lost from work and costs were significantly lower among claims managed by OG healthcare providers. This outcome was consistent with the findings of a previous study performed on the same claims in which a significant difference was demonstrated analyzing primarily open (unresolved) claims with a median claim duration of 6 months. The ability of OG healthcare providers to return a higher proportion of injured workers to work early and shorten claims durations were the major factors influencing these outcomes. CONCLUSIONS: In a state where claimants are permitted choice of medical provider, a network of healthcare providers can achieve superior lost time and cost outcomes than out of network healthcare providers.
AB - OBJECTIVE: The objective of this study was to evaluate the number of lost time days and cost of workers' compensation claims at a median claim duration (maturity) of 25 months for individuals injured between August 1, 2003, and July 31, 2004, who chose a statewide (Louisiana) network (Omnet Gold) of healthcare providers not subject to utilization review. METHODS: We identified and contrasted 176 lost time claims (143 closed) managed by Omnet Gold (OG) healthcare providers and 1464 lost time claims managed by healthcare providers not participating in OG. RESULTS: The average frequency of lost workdays for a closed OG claim was 53 days versus 99 days for a closed non-OG claim and the average cost of a closed OG claim was $12,554, whereas the average cost of a closed non-OG claim was $20,400. Both days lost from work and costs were significantly lower among claims managed by OG healthcare providers. This outcome was consistent with the findings of a previous study performed on the same claims in which a significant difference was demonstrated analyzing primarily open (unresolved) claims with a median claim duration of 6 months. The ability of OG healthcare providers to return a higher proportion of injured workers to work early and shorten claims durations were the major factors influencing these outcomes. CONCLUSIONS: In a state where claimants are permitted choice of medical provider, a network of healthcare providers can achieve superior lost time and cost outcomes than out of network healthcare providers.
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U2 - 10.1097/01.jom.0000232765.94327.e7
DO - 10.1097/01.jom.0000232765.94327.e7
M3 - Article
C2 - 16966953
AN - SCOPUS:33748685255
SN - 1076-2752
VL - 48
SP - 873
EP - 882
JO - Journal of occupational and environmental medicine
JF - Journal of occupational and environmental medicine
IS - 9
ER -