October 12, 2016 – Chicago, IL – Industry leaders agree that transitioning to value-based care from fee-for-service reimbursement will benefit workers’ compensation by tying medical provider payments to patient outcomes. But widespread implementation of value-based models requires overcoming challenges unique to the industry.
The “overhead cost” to deliver workers’ comp benefits also clutters adjusting work. In her second installment on curbing ALAE, Rising CCO and VP of Care Management Anne Kirby illustrates – in detail – how claims organizations can use a lean strategy to migrate away from this enormous overhead burden.
America has become more productive by applying Lean Six Sigma principles to running businesses. Now we have evidence that a lean approach works in managing medical treatment for work injuries. Anne Kirby, Chief Compliance Officer & VP of Care Management, discusses this approach that stands conventional medical management on its head.
Bundled care programs – an alternative care model emphasizing quality over quantity – has gained significant adoption amongst Medicare and group health providers. Robert Evans, VP of Repricing Solutions, shares Rising’s experience as one of the first organizations to bring bundled arrangements to the workers’ comp market.
July 21, 2016 – Chicago, IL – Rising Medical Solutions is broadening its bundled payment, surgical program in the southeast with the addition of North Carolina and Georgia. The states join Florida, as well as New Jersey and Illinois in Rising’s Surgical Care Program (SCP) – one of the first value-based, bundled reimbursement programs in workers’ compensation that has provided all-inclusive case rates for orthopedic surgical procedures since 2013.
Compound prescription growth in workers’ compensation is a striking example of how the lack of consumer involvement can cause treatment to expand from reasonable to rampant care. In his Risk & Insurance Risk Insider column, Rising CEO Jason Beans outlines how state oversight and inroads from within claims payer and managed care organizations can help rein in compounding.
June 21, 2016 — Cranston, RI & Chicago, IL — Updated Rhode Island Workers’ Compensation Fee Schedules have been released. The new Hospital Fee Schedule will go into effect on July 1, 2016, and the new Medical Fee Schedule will go into effect on July 15, 2016, for services on or after those dates.
This article features thoughts from Mark Walls, Vice President of Communications and Strategic Analysis for Safety National and an Advisory Council member for the Workers’ Compensation Benchmarking Study, on why the study matters and its value to the workers’ compensation community.
June 17, 2016 – Boston, MA – Rising Chief Compliance Officer and Vice President of Care Management Anne Kirby presented at the 2016 Nurse Innovation & Entrepreneurship Summit in Boston at Northeastern University. The three-day event attracted nursing students and expert speakers with diverse backgrounds in clinical care, academic research, engineering, and game design.
As California officials are calling for a review of workers’ comp fraud fighting practices in the state, some cost containment providers are saying that bill review can be an effective tool for detecting fraud. Jason Beans, Rising’s Chief Executive Officer, shares some of the company’s bill review practices for detecting fraud.