Workers Compensation Medical - Broward County...rx3 Q-c cu > o Proven Process Talented Experienced...
Transcript of Workers Compensation Medical - Broward County...rx3 Q-c cu > o Proven Process Talented Experienced...
Workers Compensation MedicalCost Containment and Case
Management Services
October 18, 2018
Slide 2
PRESENTATION AGENDA
INTRODUCTION
MEDICAL MANAGEMENT
PROVIDER NETWORKS
COST CONTAINMENT
CONCLUSION
AmeriSys''
Slide 3
LEADERSHIP TEAM
AmeriSys*
Slide 4
Flexible ^ Adaptive CompliantCO
Q)u
Communication"D(V
-M
c(D
03Q-
CCD>O
Q-
Proven Process Talented
Experiencedu
Licensed
CDU
I
<u
£o4-»to
3
U
Information
Customization
Commitment
CO
3CO
CDCC
cCD>o
03
o
iD
Tested
Technology
Slides
200+ Public Entities ©
FHMs
Wljffv BcrtdaIk^Uw.
noKiuitomiitAnsKFKii; ..nH(TM(TOB*SSOCMn(llLt)C.
Slide 6
Flexible•D
CU Adaptive Compliant
<DC
<Uu
Communication•D
CU+-»
cCU
O
"too
(TJQ.
CU>o
Proven Process Talented
ExperiencedU
Licensed
CCUu
!
CU
Eo
-M(A
3
u
Information
Customization
Commitment
CO
3CO
CUq:
c<u>o 2007
:r5-
Technology
Slide 7
AmeriSys*
i
Slides
Flexible ^ Adaptive Compliantc/)
<Uc
cuu
Communication"O<u
+-»
c
(U• mmm
o
"too
rx3Q-
ccu>o
Proven Process Talented
Experienced
Licensed
ccuu
IL.
cu
Eo
uu
Information
Customization
Commitment
(/)
a
<UGC
CCU>o Tested
Technology
Slide 9
J
EARLY INTERVENTION /TRIAGE
^ 24/7/365 Service
On Call Nurse for Emergencies
Electronic Download within 24 hours
^ Timely Medical Treatment
AmeriPass
. ini,]fi
AmeriSys*
Slide 10
J
!!
NURSE CASE MANGEMENT
BR:<iWARD
Motcn CcMrtUBsa
II I
(r«)tUJ5T.M9Am
SwO^MKtJJ'r*:u(F«5 ^JrJOlt
Dwrfiewr
I KM MTMmA mrnnn .
myMatrixx
h«c«w«r eiMme
ctrriwum
rj m/!«* tfM4l*r««'j
N A# «V»W
Prefetittl AiclOftt^' Pmldn^rp^rtt 0m »wbm«i,uimlatat mabffWSSi^
fAfw .4«/*w#wNir N.lUUiHiiiiirifc, ,1
M-Xm^-a»,»»S7v
7to»*>TWw mMxm
III
OMrtonaIr-BHW 1
•••<wen AilewKw MwtiVIw•
AHteri53',**
AmeriSys*
Slide 11
Flexible ^ Adaptive CompliantCOV—
O)C
fOO-
ccu>o
CDu
Communication
Proven Process Talented
Experiencedu
Information
CO
3CO
CDDC
C(D>O
•DQ)4-i
c
CD
CDOej
Tested
Licensed
CQJU
(U
£o
•MCO
3
u
Customization
CommitmentTechnology
Slide 12
>
"The nurse's talent and skills drive
benefits, Includingfaster return to workat a lower cost
Nurses are able to use the connections to
facilitate Innovation and guide decisionsthat lead to better outcomes for Injured
workers and businesses."
Confmnce Chronicles
2015 Nellonal Workers'Conipent*tlon& DtssbilttyConference, MecyO'OonDthue, VicePresident. Medical
Services, Helmsmen Menegement Services and StephaniePetllN,Senior Director. Medical & Health Manetemenc.
The Home Depot
AmeriSys*
Slide 13
J ACCREDITATION
1
urac
OMMM>»Nata <R3a*MU. IMWa
J
•\
CERTIFICATE OF AWARD
HSIS, Inc. dba AmeriSys5728 Major Blvd, Suite 450
Orlando, Florida 32819
ura^Workers' Compcnsniion I'lilizntion Mansigemeni, 7.3 Accrediiaiion
Program
Full Accreditation
ACCREDITED
L1L4^ v n igrn/mair
^ —
Effrftiir_/iw«3/rtni 01, /Ol' tinn^ Aliini 01. JOJOrtr
rMayr .«• xmMkv Mto
-
KriumcGiraiPinidnit ft Ourf Eifojtn* OtBm
Urn I<y
-
AmeriSys*
Slide 14
Flexible
fgt
"DCU
Q)U
Adaptive Compliant
Communication"O
CD
re Proven Process Talentedin
-M
13in
CDQC
CCD>O
cCD
• ^mm
O
"too
Tested
W,-;
01
nLicensed
U• 9mm
cCDU
CD
Eo
-M</)
Z3
u
Experienced
Information
Customization
CommitmentTechnology
Slide 15
PHARMACY PROGRAM
J
I
myMatrixx
#1 #
i\i
riJilfK\-\
riSys\
Slide 16
PROVIDER SERVICES
Reporting
Provider
Services
AmeriSys*
Slide 17
•rayMatnxx
PROVIDER NETWORK
Coventry
—«THEBAPYL)TI* DIRECT
TREAMLINE
IMAGING
HealihMed' \ Wl.LTION-5Ciimcoi SoMiori$
'Awr coTCEficnn
^ AnclllarY RFP every 3 years
Performance Guarantees
Competitive Pricing
enac^lcAre
Total
JW SERVICES
COMPAS»g^ED
' HtmiCtnCanneti
PHYilO
Slide 18
Flexible"D
CU Adaptive Compliant
Communicationt/>
CDC
f0Q.
Ccu>o
cuCJ
Proven Process Talented
c Experienced
Information
</>
15
CUcr:
cCU>o
X5O)
cCUL-
o
"too
e?
Tested
Licensed
CCUU
L.
CU
Eo
l/>
u
Customization
CommitmentTechnology
J
di
J
J
Slide 19
LIFE OF A BILL
IrtC&TBrqF^armKYE(*ar«Ae rat
3-f
&
•^^^leri^s*
J
J
J
il
Slide 20
COST CONTAINIVIENT
Turnaround ReportFiscal Year End: October 2016 - September 2017
Average Days from Average Days Average Days Average Days
Count Bf""Receipt toASI from ASl Receipt from Bill Review fromBrowardReceipt to Posted Receipt to Export Received to Paid
4,091
Medical BDI Fliiitg Parromunee
0.45
0.18
.04
0.18
FEBie MAR19 APR 19 MAri9 JUNie JUL19
Repelling Month (ihontr bar* likdtcai*bttlar performance)
•Average rwreer ofOayt IDMe(Suomnei 093) B>nr»ge murbe' cf oayi lo ON|AI 9<janatn)
6.84
4.91
6.21
5.00
6.85
4.87
6.28
10.12
7.86
9.01
7.95
Oilginai Medical Sill Submlsalon Acceptance Performance
aeaMOef eaa Ceneerad Is Ai agMBn. M|t lei9
AiMsaraiFeiTie
AmeriSys^
Slide 21
J
J
d
EOB INFORMATION
AmeriSys Provider EOBR Search Ull MM It MB <V(
IN ^ we » w veeeee w b»
AmertSy Pntvithr eOBA Search
i('ic'53BK"'o--^t ilT!
•Z [
ttm
vi/MU vnawW
AmeriSys*
J
J
Slide 22
Flexible"D
CU*+-.
Adaptive Compliant
m "S Communication "S1 u ^ro Proven Process Talented ^ cd. 3 LJ
-
C<u>01
u
i-
cCUu
i-
Experienced(U rooc o
c ^<u
o Tested" Q- Information
- LicensedCU
£o
Customization1
m
+-»to
3u
CommitmentTechnology
j1
j
J
•d
Slide 23
PPO/CONTRACTED SAVINGS
Fiscal Year End: October 2016 - September 2017
GRAND TOTAL Bilts Btll ChargesFeoSclu'dul,'
Olll^t P(>0
Physicians 3,965 8,109 $1,971,032.69 $996,909.36 $191,623.76 $13,460.95Hospital inpAlicr^t 15 228 5644,505.80 $335,311.69 $25,217.46 $7,376.89Hospitjl Oulpjtienf 182 1,130 $1,047,769,37 $415,781.19 $92,495.85 $41,522.26Ambuialotv St.tglcdl 62 178 $840,674.47 $412,638.11 $62,756.90 $14,163.02Physk^lTheraoy 2490 5,773 $543,987.01 $210,284.30 $5,636.60 $77,635.98Didgnostics 124 135 $174,471.66 $109,866.03 $3,177.17 $12,669.98Chiropractic 4 24 $1,457.12 $821.12 $0 $0DME 179 307 $104,531.84 $23,302.98 $4,189.40 $27,902.12Prescriptions 1,217 1,713 $438,687,37 $13,893.55 $14,953.30 $79,136.68Other 336 1,072 $134,576.06 $44,398.06 $17,085.49 $10,226.27TOTAL 8,474 18,669 $5,901,688.39 $2,563,226.39 $417,135.93 $284,094.15
Savings
Reduction %43.43K 7J)7K
4.81K
(9.72K belowfee sdiidula)
PPO/Contracted Savings Billed Charges% of Overall Redjction reialed to PRO/
Contracted Saving
PPO/Contracted Savings Billed Charges Fee Schedule and Other Savings % of PPO Savings below Fee Schedule
9.72%
AmeriSys*
Slide 24
Flexible ^ Adaptive ComplianttoL-
O)c
roD-
ccu>o
cuu
Communication
Proven Process Talented ^
Experienced
13to
CUcd
"Ocu
-M
c(U
03
O
Tested
Licensed
c(Uu
t
OJ
£o-MQO
Du
Information
Customization
Commitment
cu>o
Q.
Technology
Slide 25
INFORMATION SYSTEMS
Corrus
/
Programs That Work For You
AmeriSys*
a
Slide 26
INFORMATION SYSTEMS
> Setup of your systems
> Software for adjusters
> Software for First Report Notice of Injury
> Security protocol
AmeriSys*
Slide 27
Ll
Flexible cu Adaptive Compliant
CommunicationiA
djc
fOCL
c0)>o
o.
cuu
Proven Process Talented
ExperiencedU
Information
Licensed
c<uu
Eo
+-»tn
3
u
Customization
Commitment
to
to
<UDC
cq;>o
a.
•acu
c
'l-
o
"iio
Tested
Technology
J Slide 28
AmeriSys hascontracted and
added numerous
vendors on
behalf of Broward
V P CLAIMS
Since 2016, USIS
has been
handlingBroward County
VIP claims
AmeriSys*
Slide 29
OPTIONAL SERVICES
USIS/AmeriSys will contract with the service providers ofBroward County's choice.
OCCUPATIONAL, MEDICAL, DRUG, AND ALCOHOL POLICIES
DRUG AND ALCOHOL SCREENS
OCCUPATIONAL MEDICAL CONSULTATION
SUBSTANCE ABUSE SERVICES
INVESTIGATIVE SERVICES AND SURVEILLANCE
SAFETY AND OCCUPATIONAL HEALTH SERVICES
ALL-LINES CLAIMS ADJUSTING
^ USIS currently provides VIP claims adjusting services
AmeriSys*
J
J Slide 30
j
USIS/AmerTSys take PridejrtPrdvidi% Custorrier^Getitrici
THANK YO