Situation

A large county was looking for better quality managed care services for employees injured on the job. The county has approximately 4,000 employees throughout several departments such as administrative operations, facilities management, planning and budget, courts of law, emergency services, transportation and natural resources. As a large public employer, they needed a well-structured managed care program combined with experienced staff to help them control costs.

Action

In 1998, the county selected a comprehensive managed care program through Avizent’s independently owned and operated managed care program, which provided them with customized services including medical bill review, pre-authorization, case management and peer review. Avizent also developed a complete return-to-work program with written job descriptions for all modified duty positions available within the county.

For each claim, Avizent’s telephonic case manager advocates a strong return-to-work focus during the recovery process to ensure that the injured employee returns to full or modified duty in a safe, timely manner. The case manager screens each case, contacts the providers and coordinates medical care. Nationally recognized treatment and return-to-work guidelines are utilized in all cases.

The case management, utilization review and bill review components are seamless. Avizent’s case manager reviews questionable medical bills and works to ensure that the utilization review nurses have all of the information they need to make determinations. The case manager also works closely with the claims adjuster to provide status updates, and suggests when issues should be disputed or accepted.

Avizent’s dedicated case management team takes ownership of any return-to-work issues or questions that arise, and provides thorough information for the employer, injured worker and providers. Early intervention and timely responses provided by Avizent’s experienced staff help expedite medical care, so injured workers can get back on the job sooner.

Results

Avizent’s services helped the county save 67% on medical bills in one year, which represented a 42-to-1 return on their investment. By working with Avizent, they were also able to decrease the average overall cost per claim by 50% during a five-year period. In addition, the county saved an average of 24% in one year through Avizent’s pre-authorization review services.

Avizent’s managed care program also played a role in helping the county’s taxpayers save more than $1 million over a six-year period—an added benefit for a county with more than 900,000 residents.

Avizent is focused on providing prompt, medically necessary care and returning injured employees to work as soon as it is appropriate. As a result, the county averages only four to six lost-time cases at any given time and nearly all are postoperative care cases.

Avizent consistently provides high-quality services and strives to exceed expectations. The county recognizes Avizent’s efforts, and is pleased with the expert services they receive from their professional staff.