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Implementing managed care in an industrial rehabilitation program.

L O Niemeyer1, M Foto2, D Holmes-Enix2

  • 1University of California, Riverside Rehabilitation Technology Works, San Bernardino, California.

Work (Reading, Mass.)
|January 21, 2014
PubMed
Summary
This summary is machine-generated.

Managed care in workers' compensation aims to control costs by focusing on quality of care. Clinicians must partner with insurers and employers for a win-win scenario, ensuring effectiveness and retaining control over care standards.

Keywords:
Case managementIndustrial rehabilitationManaged careUtilization management

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Area of Science:

  • Healthcare Management
  • Occupational Health
  • Health Economics

Background:

  • Rising healthcare costs are a significant concern in workers' compensation systems.
  • Managed care strategies are increasingly being adopted to address these escalating expenses.

Purpose of the Study:

  • To explore the integration of managed care within workers' compensation.
  • To examine the critical shift from cost containment to quality of care in managed care.
  • To outline strategies for clinician engagement in managed care to ensure optimal outcomes.

Main Methods:

  • Analysis of managed care principles and their application in workers' compensation.
  • Review of the evolving role of clinicians in managed care settings.
  • Identification of key steps for clinician involvement in utilization management and case protocols.

Main Results:

  • Managed care offers potential benefits for cost containment in workers' compensation.
  • The future success of managed care hinges on prioritizing the quality of patient care.
  • Clinician partnership with insurers and employers is crucial for a balanced approach.

Conclusions:

  • Clinicians must embrace accountability for functional outcomes and internal management processes.
  • Proactive engagement by clinicians can lead to a "win-win" scenario balancing efficiency and effectiveness.
  • Failure to adapt may result in exclusion from networks and loss of professional autonomy in defining care standards.