It's a simple analogy, but follow along. Treatment and return-to-work guidelines are like speed limits.
If you set them too low (guidelines that are too restrictive), you get excessive delays, disputes, denials and friction, preventing claimants from getting needed care, driving good doctors out of your network and ample re-injury. It's a mess, characterized by waste.
Think California in 2004. Ugh.
If you set them too high (guidelines without meaningful limits), its worse than having none at all, and codifies recklessness into your claims and medical DNA. It renders case management and UR impotent.
Think of states that write their own, relying on local doctors and the device lobby. Double ugh.
When set correctly, you have balance, using evidence-based medicine to EZ-Pass quality care, while limiting excessive and inappropriate utilization, fostering timely return to transitional and then full duty.
Benefits are delivered with peak efficiency, restoring health and wellness quickly with minimal waste, encouraging good doctors to seek your networks.
Think of the early ODG adopters (Texas, Kansas, North Dakota, Ohio), with a dozen more on the way.
Balance fits on the head of a pin. You have it, or you don't. Are you using the right guidelines?
Empower your people with premium tools to deliver optimal claim outcomes from ODG.
Contact us to schedule a consultation to ensure you're getting the most from ODG.
#20 RTW Prescription
Take control, setting and sharing best practice expectations for RTW at intake.
#19 UR Advisor
Approve quality care quickly and reduce waste, engaging UR only where justified.
#18 Comorbidity Calculator
Target and tailor best practice return-to-work and benchmarking data to the individual.
#17 The Procedure Summaries
Evidence-based care and UR guidance with clear recommendation and selection criteria.
#16 Medline Plus Connect
Reliable, relevant, up-to-date patient health education / pictures in English and Spanish.
#15 Opioid Dosing Alerts
Track morphine equivalents, receive alerts at evidence-based thresholds.
#14 Reserve Calculator
Take the guesswork out of reserves with predictive analytics at the claims desk.
#13 Savings Calculator
Quantifying the impact of claims efforts in days and dollars saved
#12 Drug Formulary
Clarity, purpose and peace of mind with pharmaceutical claims
#11 Risk Assessment
Resource optimizing through real-time risk assessment, triage
#10 Brand Matters
There is no "alternate" nor anything more accurate industry-wide
#9 Crossing Borders
Medical treatment is a human experience
#8 Problem Solving
The formulas, the tools and the roadmap to repeatable results.