A New Physical Medicine Mindset

The integration of physical medicine into our comprehensive ancillary benefits management program allows payers to more effectively manage quality and utilization of physical medicine services. We apply objective outcomes measures to accurately assess treatment efficacy and vendor performance, enabling our clients to make decisions that garner clinically and financially positive results.

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    Drive outcomes-focused care.

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    Optimize utilization.

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    Reduce overall cost.

“Physical therapy is a critical component of overall patient management. We need to change the conversation from how many visits are acceptable, and instead ask the question, what level of functional improvement is accomplished during those visits?”

– Dr. Robert Goldberg, Occupational Medicine Specialist and Chief Medical Officer, Healthesystems

An Expansion of Our ABM Success

Physical medicine marks a significant expansion to our revolutionary ancillary benefits management (ABM) program. This provides full integration with our existing ABM services. Under the new physical medicine program, we now also manage:

  • Physical therapy

  • Massage therapy

  • Aquatic therapy

  • Chiropractor

  • Occupational Therapy

  • Acupuncture

  • Work hardening/condition

  • Functional capacity evaluation (FCE)

Outcomes-Based Performance Assessment

True outcomes evaluation can only be achieved when measuring objective, comprehensive data throughout the course of the claim. Healthesystems leverages its innovative ABM platform to collect more than 30% more data than other physical medicine models. Our ability to uncover what other programs are missing helps payers to more accurately assess the quality and effectiveness of service being provided. We collect information on specific measures at key time points throughout a patient’s treatment. These measures include:

  • Clinical outcomes (e.g., range of motion, strength)
  • High-risk indicators (e.g., fear avoidance, nonadherence)
  • Administrative efficiencies
  • Vendor performance
  • Network data

Significant Savings

By focusing on clinically appropriate, quality-based care, our program drives patient outcomes while also limiting inappropriate or ineffective therapy while lowering unnecessary and/or avoidable costs. And because the physical medicine program is part of Healthesystems’ comprehensive approach to care, savings can crossover to other components of an injured worker’s treatment.

When physical medicine is properly managed, reductions may be seen in the following areas:

  • Excessive/ineffective visits
  • Prescription medications, including opioids
  • Advanced imaging
  • Therapeutic injections
  • Surgery

Clinical Decision Support, Simplified

Traditionally, claims professionals make physical medicine decisions based solely on utilization. In order to shift the model to one that is outcomes-based, they need a platform that provides them with the tools and support they need to make clinically sound decisions. Our simplified solution helps claims professionals focus on the information that is most critical.

  • Information traditionally included in physician notes is translated into objective, electronic data – eliminating time spent searching while increasing visibility
  • Claims professionals are alerted to appropriate intervention opportunities, such as risk indicators including fear avoidance, nonadherence, or lack of patient progression
  • State-specific and evidence-based medical guidelines are incorporated directly into the platform