Effective Use of Nurse Case Management and Professional Provider Organizations Drives Down Workers’ Compensation Claim Costs

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York Risk Services Group, a premier provider of claims management, managed care and risk management services, and Energi Insurance Services, Inc., a leading provider of insurance and risk management services to the energy industry, today released the results of a study that quantifies the significant positive impact of nurse case management (NCM) and professional provider organizations (PPO) in reducing the overall costs and duration of workers’ compensation claims.

York Risk Services Group, a premier provider of claims management, managed care and risk management services, and Energi Insurance Services, Inc., a leading provider of insurance and risk management services to the energy industry, today released the results of a study that quantifies the significant positive impact of nurse case management (NCM) and professional provider organizations (PPO) in reducing the overall costs and duration of workers’ compensation claims. The results were released at Energi's Risk Management and Insurance Summit to the more than 750 attendees.

The study, which was conducted by Risk Navigation Group, LLC, compared two sets of closed claims. The first is from a workers’ compensation program underwritten by a national insurer with risks in the transportation and energy industries. The second set of claims came from the Energi program underwritten by HDI Gerling and/or Sparta, with claims and managed care services provided by York Risk Services Group and its managed care division, WellComp Managed Care Services. The two sets of claims shared identical ICD-9 Codes and risk classifications, and the nature and extent of injuries were comparable. Injury types in both sets of claims included torn labrum, full thickness tear of the rotator cuff, lumbar strains, thoracic strains, cervical strains and torn medial menisci.

The two most significant differences in the sets of claims point to the impact of nurse case management. In the first group, a nurse case manager was assigned to the claim only 38% of the time and workers were directed to a PPO only 17% of the time. In contrast, in the claims managed by York with nurse case management services provided by WellComp, a nurse case manager was assigned to 100% of the claims and injured workers were directed to a PPO 100% of the time. In the first set of claims, the disability period lasted, on average, 196.2 days longer than, or 262% of the Occupational Disability Guideline (ODG) projections. In the York/WellComp claims group, the disability period lasted 44.3 days less than, or 66% of the ODG projection. The shorter disability duration can significantly lower overall claims costs.

The analysis of the claims also showed the nature and extent of the nurse case managers’ involvement that helped drive the superior results. From early triage instruction, immediate engagement with injured workers and treating physicians, followed by on-going engagement with both treating and consulting physicians throughout the course of the claim, the nurse case managers were proactively working to ensure that appropriate, timely, and effective care was provided and that the injured workers had an advocate to guide them through the sometimes complex treatment process.

Noted Doug Markham, President of WellComp Managed Care Services, “That level of involvement from knowledgeable case managers is what is needed to guide claims to better outcomes in an expeditious manner. They are able to focus all the various providers and involved parties in delivering the best care and best results for the injured worker and the claim.”

“We are thrilled at the validation this study gives to our Energi Workers’ Compensation Program,” said Robert Woods, Energi’s SVP of Claims. “We have always believed in the power of our Nurse Case Management program, but this study we believe shows us the true financial benefit to our policyholders.”

About York Risk Services Group
York Risk Services Group Inc. is a premier provider of risk management, claims handling, specialized loss adjusting, managed care, pool administration, loss control and other insurance services nationwide. York provides risk management and managed care solutions to a variety of strategic partners, including insurance carriers, self insureds, brokers, wholesalers, MGAs, programs, risk pools and public entities. York delivers customized claims solutions for all lines of business, including property, liability, products liability, ocean and inland marine, environmental, transportation and logistics, construction and workers’ compensation. York is based in Parsippany, New Jersey and has 90 offices across the United States and a strong international presence. Visit us on the web at http://www.yorkrsg.com.

About WellComp Managed Care Services
Since 1985, WellComp has been a leading national provider of managed care services specializing in Workers’ Compensation cost containment, and delivering value to customers through innovation, exceptional service and outstanding results. WellComp’s services include Case Management, Medical Bill Review, Utilization Review, PPO Networks, Diagnostic Networks and Scheduling Services, and Medicare Reporting Compliance Services. WellComp is based in Nashville, TN. Visit us on the web at http://www.wellcomp.com.

About Energi
Energi is a Peabody, Massachusetts-based provider of specialized insurance and risk management products to targeted market segments of the North American energy industry. The core programs include fuel distribution, fuel transport, energy construction, agricultural cooperatives, renewable energy, energy efficiency, utilities and oil & gas exploration. Founded in 2005 by insurance professionals and energy industry leaders, Energi is licensed in all 50 states. For more information, visit http://www.energi.com.

For more information contact
Anne Ellis
AVP - Marketing and Communications
York Risk Services Group
973-404-1282
anne.ellis(at)yorkrsg(dot)com

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