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A York Risk Services Company
SERVICESPRESENTATION
2016
A York Risk Services Company
www.careworksconsultants.com
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Introduction
The CareWorks Family of Companies
More than 900 Ohio-based associates deliveringcustomer-focused cost control services tomore than 180,000 business customers.
t e c h n o l o g i e sCareWorks VocWorks
A York Risk Services Company
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Unique Culture
Empowered associates delivering customer service that exceeds expectations.
2005 « 2006 « 2008 « 2009 « 2010 « 2012
Our vision is to be a world-class organization providing productsand services of exceptional quality
and value to our customers.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Designated Account Management Team
Account Executive
Nurse CaseManager
DedicatedClaims Examiner
HearingRepresentatives
Bill PaymentManager
Account/ClaimsTeam Manager
Vice President Self Insured
Medical Only Claims Examiner
Team Assistants
MedicalManagement
Risk Services
Self-Insured Services
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Goals of the QA Program¢ Implement and monitor CareWorks Consultants
Claims Management Best Practices.
¢ Measure compliance with industry standards.
¢ Measure and monitor special handling instructions ofthe customer.
¢ Monitor and improve customer satisfaction with theultimate goal of exceeding customer expectations.
¢ Monitor and resolve all complaints that may arise.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Quality Assurance Responsibilities¢ Audit at claim/department level.
¢ Keep abreast of industry “best practices.”
¢ Ensure BWC compliance.
¢ Written reports of findings to our President and theVice President of Self Insurance.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
¢ FROI reporting (fax, mail, web-based).
¢ Electronic image of FROIs to claims examiner andnurse case manager concurrently.
¢ Lost-time or disputed claims: Reviewed by claims examiner and team manager. 90-day review added to agenda.
¢ All actions documented in RMS and appropriatediaries established which can be viewed through ACE.
Claim Intake/Set-Up
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
New Claim Process¢ All claims set up within 24 hours of receipt.
¢ Notice to FMLA team within 24 hours of any claimwith lost work days.
¢ Three-point contact: Employer. Injured Worker. Provider.
¢ Claim indexing/ISO checks.
¢ Partner with customers to discuss compensability.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Integrated Medical Management¢ Medical triage.
¢ Telephonic case management by dedicated teamnurse. Return-to-work savings reports. Return-to-work focus using national guidelines.
¢ Utilization management by dedicate team nurse.
¢ Field case management by VocWorks.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Cost Control Tools¢ Early and accurate allowance of claims with timely
payments.
¢ Modified duty off-site program.
¢ Proactive permanent partial negotiation to eliminatehearing expense.
¢ Functional capacity evaluations.
¢ Independent medical exams.
¢ Transitional work.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Cost Control Tools (continued)
¢ Settlement Coordinator.
¢ Excess Coordinator.
¢ SCHIP Coordinator.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Self Insured Account Executive¢ Addresses issues at the program level.
¢ Provides reports including Stewardship Reporting.
¢ Primary function - ensure we are exceeding customer expectations.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Bill Review Services¢ Comprehensive, national PPO network strategy.
¢ Ohio Networks: Procura. Rockport. Three Rivers. Prime Health.
¢ Customized networks/protocol capabilities available.
¢ Average bill turnaround - 14 days.
¢ Certified coder on staff.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Pharmacy Management¢ Partner with Modern Medical at no additional cost to
our client.
¢ Total savings over last five years for CareWorksConsultants clients equals more than $2.4 million.
¢ Over past five years, reduction of 6.5% on averagedrug costs.
¢ Brand name reduction over the past two years of72.75%.
¢ Redirecting 81% of all prescriptions filled to generic.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Pharmacy Management (continued)
¢ Effective management of opioid abuse with a 16% reduction in last two years. Quantity reduced by 16%. Cost reduced by 18%.
¢ Use of “Opioid Defense Manager.”
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Additional Services¢ Durable Medical Equipment (DME) through Modern
Medical with warehouse cost reduction.
¢ Use of Litigation Solutions for special investigationunit (SIU) and onsite accident investigation.
¢ Auditable file housing.
¢ BWC-required reports.
¢ Posters/packets.
¢ OSHA recordable services.
¢ SCHIP quarterly reporting.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Hearing Representation Services¢ 18 hearing representatives.
¢ Geographically positioned throughout Ohio.
¢ Average years of experience - 20.
A York Risk Services Company
2016 | PRESENTATION | CareWorks Consultants, Inc.
Self-Insured Services
Our Technology Solution¢ Web-based claims management system - RMS.
¢ Front-end imaging solution - OnBase.
¢ Access is real time to RMS through CareWorksConsultants’ ACE System.
¢ Electronic data exchange available with service partners.
A York Risk Services Company
Questions?
Krista BrowningSales Executive
Toll-free: 1-800-837-3200, ext. 57203Direct: (614) 526-7203Fax: (614) 210-5805
Email: [email protected]
A York Risk Services Company
THANK YOU
A York Risk Services Company
www.careworksconsultants.com
