Provider Network Advisory Group

1. Provider Network Advisory Group COHE Expansion July 25, 2013

2. Provider/Employer Contact Topics for Discussion • History of Best Practice • Lit Review, Provider Focus Groups • Use of Best Practice • COHE • Top Tier • Implementation Challenges • Measurement Challenges • Modification of Best Practice • Process • Results

3. Provider/Employer Contact COHE Best Practices • Learning and Using Best Practices • Report of accident (ROA) in 2 days • Quick start to claim initiation/adjudication and employer notification • Activity prescription form • Communication between injured worker, provider, and employer • Provider call to employer • Discussion about restrictions and modified work • Barriers to recovery • Injured worker assessment typically at 2 to 4 weeks of time loss • Health Services Coordination • Assistance with return to work

4. Provider/Employer Contact Top Tier Criteria • Experienced Attending Providers • Average of ≥ 12 claims annually • In good standing • Higher certification • Committed to quality improvement • Include patients with complex claims in practice • Demonstrated best practices • Exceeding benchmarks in best practices: ROA, APF, Provider/Employer contact • Care coordination • Knowledge and expertise in core competencies: • Collaboration & communication • Pain management • Workers’ Compensation knowledge

5. Provider/Employer Contact Definition of this best practice:two-way communication about return to work between provider and employer

6. Provider/Employer Contact Implementation Challenges • Identifying appropriate claims • Finding the correct employer contact • Playing “phone tag” with employer • Knowing what information to share • Responding to employer questions about claim adjudication

7. Provider/Employer Contact Measurement Challenges • Using billing data • Time lag • Providers’ billing staff remembering to bill and use modifier • Providers using methods for contact other than telephone call • Developing a benchmark • Knowing when a claim needs this best practice • Recognizing that some providers do not bill for service or do not use modifier

8. Provider/Employer Contact Modification Process • Review original intent of best practice from focus groups • Review alternatives/options with COHE Medical Directors and L&I staff • Agree on alternatives that meet original intent • Identify opportunities to explore in future • OHMS risk factors and identification of claims • OHMS documentation of appropriate employer contacts

9. Provider/Employer Contact Results-How can best practice be met? • Attending provider telephone call to employer of injury • Billing code with modifier, or • OHMS documentation (in future) • Care Coordinator Initial Evaluation and Coordination (IEC) • IEC billing code, or • IEC notes in OHMS • Job description signed by provider • Billing code • Stay at Work benefit paid to employer within 1st 12 weeks • Signed job description required

10. Provider/Employer Contact Provider Adoption of COHE Practices:

11. Provider/Employer Contact COHE and Top Tier Goals • Increase provider use of best practices. • Add methods to facilitate provider/employer contact • Test benchmark for provider/employer contact • Increase number of high and medium adopters of best practices • Identify opportunities for Occupational Health Management System (OHMS) to improve use and measurement of best practices