Healthesystems’ Physical Medicine Program Raises the Bar for Outcomes Measurement

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A focus on clinically appropriate, quality-based care leads to reduced costs and utilization of physical medicine services in workers’ compensation

We need to change the conversation from how many visits are acceptable, and ask the question: what level of functional improvement is accomplished during those visits?

Healthesystems, a specialty provider of medical cost management solutions for workers’ compensation payers, has developed a new physical medicine program that will provide payers with unprecedented outcomes data to more effectively manage the quality and utilization of physical medicine services.

Ongoing Quality Assessment
Physical medicine represents an expansion of Healthesystems’ revolutionary ancillary benefits management (ABM) platform. This will provide full integration with existing services under the ABM umbrella, which have included home health, durable medical equipment, transportation, and translation. Healthesystems leverages its existing ABM platform to collect over 30% more data than traditional physical medicine programs, including measures of clinical outcomes, high-risk indicators, administrative efficiencies, vendor performance, and network data.

True outcomes evaluation can only be achieved when measuring objective, comprehensive data throughout the course of claim. Healthesystems’ program takes a clinically focused approach to address crucial components of managing patient care that are absent from traditional models. Access to outcomes-focused data at key time points – such as initial assessment, pre-authorization and re-authorization – enables payers to more accurately assess the quality of services, helping them to better manage patient care and provider networks.

Chief medical officer at Healthesystems, Robert Goldberg, MD, FACOEM, explains that this focus on quality care will wield positive clinical and financial outcomes, as evidence-based implementation of physical medicine services into an injured worker’s treatment plan has proven to reduce overall medical costs and utilization.

“It still boils down to delivering appropriate and timely care to the right patient,” said Dr. Goldberg. “We need to change the conversation from how many visits are acceptable, and instead ask the question, what level of functional improvement is accomplished during those visits? When better care decisions are made, outcomes improve for all stakeholders. The injured worker regains function, the employer benefits from their employee’s faster return to work, overall costs are lowered for the payer, and the care provider is rewarded for the value they are delivering.”

As the program matures, payers will also have unprecedented insight into patient-reported outcomes, an important component of measuring treatment success that is currently not included within traditional physical medicine management programs.

Comprehensive Clinical Decision Support
Traditionally, claims professionals have made physical medicine decisions based solely on utilization. In order to successfully shift to a model that is outcomes-focused, they need a platform that provides them with the tools and support they need to make clinically based decisions. The comprehensive clinical decision support provided by Healthesystems has markedly improved the way other ancillary services, such as home healthcare, have traditionally been managed. With physical medicine being the most clinically focused of all ancillary services, Healthesystems has high expectations for the potential impact of their new program.

Increased Data Visibility
The platform will also help claims professionals focus on the information that is most critical. Traditionally, much of the data needed to make informed decisions about patient care is not codified or structured in a way that is actionable to the claims professional. Crucial information is often buried in handwritten notes, where it can be overlooked in the clinical decision-making process. Healthesystems’ platform translates anecdotal information into electronic data. Logic is then applied to these data to proactively alert claims professionals so that it can be integrated more effectively into care decisions.

To learn more about how Healthesystems is redefining how physical medicine services are managed, visit

About Healthesystems
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while increasing the quality of care for injured workers. To learn more about Healthesystems, visit

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Jill Holdsworth
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