Putting The Horse Back In Front Of The Medical Cart: New Outcomes-Based Analysis, Treatment, And Guidelines

3:30 – 4:30 pm

Grand Ballroom 8A
Convention Level

Diagnosis creep, sub-optimal clinical treatment plans and proliferation of potent drugs have greatly increased complexity within the claim population; easily manipulated metrics and most current methods of medical cost containment are no match. By implementing new metrics and treatment guidelines, we can establish comprehensive measures of quality care that better enable fine tuning exactly where it’s indicated.

There is currently, quite literally, too much information. For claims professionals, it borders on the impossible to stay current on new practice patterns, coding strategies, pharmaceuticals, and scientific research (5,000 medical journal articles published monthly; 68,000 diagnoses codes; 8,000 procedural codes and 1,500 FDA approved medications). The good news is that there are new tools enabling claims professionals to make sense of this information overload. The process of developing and fine tuning better medical practices has advanced the state of the art in what we know as evidence-based medicine (EBM), but most advances have yet to be widely adopted.

In this session, our professionally-informed presenters reveal new systems which now work for them to map EBM guidelines directly onto the medical billing data to derive an index based on the percentage of care, out of a fixed total, that complies with the workers’ compensation treatment guidelines. If you work in this field, you will want to be present.

Jeffrey A. White
Sr. Vice-President of Work Comp Programs
Gallagher Bassett
Rolling Meadows, IL

Dan L. Hunt, DO
Corporate Medical Director
AF Group
Lansing, MI


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