National Council of Self-Insurers
2013 Annual Meeting
“Transforming Workers Compensation Programs and Outcomes”
Presented by: Don Duford, Chairman of the Board
One Call Care Management
May 22, 2013
What is One Call Care Management?
One Call Care Management (OCCM) is the nation’s leading partner in providing
specialized services that lead to faster, more efficient and more cost-effective
resolution of claims.
From high-end diagnostic procedures, to post-discharge and home care
management, to transportation and language services, to superior dental
programs and other medical specialties, OCCM provides reliable, consistent
connections to care and improved outcomes.
Three Stories, Three Outcomes –
One Health Care System
HealthCare for Workers’ Compensation:
Success Factors

The “Right” doctor: A good clinician who understands return to work

Urgency: Aggressive pursuit of root cause and solution

Teamwork: A team of appropriate specialties linked with information to move
the case forward
Can the More Successful Health Delivery Models
Apply to Workers Compensation?
McKinsey's Three Criteria Are
Present in the Integrated Care Model

Integrated care can be implemented in virtually any health system if these
conditions are present:

A focus on the patient segments most likely to have high health care spending

Core care delivery processes that enable multidisciplinary teams to function
effectively

Key support components including accountability, joint decision-making and
clinical leadership, information sharing and aligned incentives
"What It Takes to Make Integrated Care Work"
McKinsey & Company
Health International 2011 Number 11
Workers’ Compensation Transformation
Requirement 1: The Ability to Identify High Performing Primary Doctors
and Specialists

Predictive analytics can now identify the physicians who are the best
workers’ compensation doctors

Approaches include clinical pathways, adherence to guidelines, overall
performance

Achievable in the workers’ compensation setting; difficult for general health
care populations
Workers’ Compensation Transformation
Requirement 2: The Availability of “Virtual Teams” of Best-in-Class
Specialty Services

Networks of specialty providers are routinely available with accessibility to 95% of all
injured workers.

Includes specialties like diagnostic testing, prescription drug management, physical
therapy, home care, durable medical equipment, dental professionals, transportation
and translation experts

Networks provide focused credentialing, scheduling services, efficient information
flow between stakeholders

High performing physicians, working with these high performing specialties deliver
superior quality care from first report of injury to return-to-work
Workers’ Compensation Transformation
Requirement 3: Technology Can Link the “Best of the Best”

Today’s technology enables
these superior healthcare
providers and specialists to be
linked throughout the life of the
claim

Proactive and automated
communications reduce delays,
deliver reports, and speed
decisions that move the injured
worker’s care plan forward

Patient progress can be tracked,
and corrective action
implemented if they go “off the
tracks”
How Does Integrated Care Change the
Game In Workers’ Compensation?

Early intervention and planning
aligns the therapies, equipment,
and providers to eliminate delays
and administrative hassles

Each component of the treatment
plan is delivered by superior
providers who produce superior
outcomes

Pain is treated aggressively to
avoid long-term disability and
potential addiction

The ball is never dropped or
fumbled!
Integrated Workers’ Compensation
Care Creates a Win/Win/Win

Improved medical and total claim outcomes

Reduced overall costs

Streamlined efficiencies throughout the life of the claim
One Call Care Management
One Call Care Management
www.onecallcm.com