Strategic Vision: Improving Medical Care for Injured Workers

Gary Franklin, L&I Medical Director

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Health Care Strategy

Goal: Improve worker outcomes

Prevent/reduce disability by providing highest quality medical care

Every provider is a high quality provider

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100%

56.3%

44.7%

37.7%33.1%

29.8% 27.2% 25.1% 23.4% 21.9% 20.6% 19.6% 18.6%

0%

10%

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100%

0 1 2 3 4 5 6 7 8 9 10 11 12

Percentage of time-loss claims with duration beyond given month

Average of fiscal accident years 2009 to 2011

Queried: May 28, 2014Actuarial Servicesincludes time-loss and LEP claims

Duration of disability in Months

Disability Prevention is the Key Health Policy Issue

70% Return to work in first 3 monthsDisability and Chronic pain coincide at 3 months 8% account for

85% of costLess than 1% catastrophic

injury

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Time loss duration (months)2014 L&I Actuarial Services Analysis (for fiscal accident yrs 2009-2011).

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L&I Quality Expansion Vision

1. Set Minimum Standards• Medical Provider Network and Risk of Harm• Evidence based coverage decisions

2. Incentivize Collaborative Model and Best Practice Use• COHE Expansion • Top Tier• Evidence based treatment guidelines

3. New Best Practices – Identify and Pilot• UW Expert Group Identification of Best Practices• Functional Recovery Questionnaire/Intervention• Activity Coaching• Surgical Best Practice

4. Identify areas of ongoing need• Behavioral health• Long term disability/Chronic pain

• Years lived with disability 2010– Low back pain 3.18 million YLD• Major depressive disorder 3.05 million YLD• Other MSK disorders 2.6 million YLD• Neck pain 2.13 YLD• Anxiety disorders 1.86 million YLD

• Diabetes (#8) 1.16 million YLD• Alzheimers (#17) .83 million YLD• Stroke (#23) .63 million YLD

Burden of Diseases, Injuries, and Risk Factors The State of US Health, 1990-2010, JAMA 2013; 310: 591-608

Innovation in Collaborative, Accountable Care

PrimaryOccupational Health Best

PracticesSurgical & Specialty

Best Practices

Chronic Pain Best Practices

Behavioral Health

Prosthetics

HSCsOHMS

Burns