Challenge
Chargeback costs of workers’ compensation claims within many Veterans Health Administration (VHA) facilities are high and result in excessive lost productivity and escalating compensation and medical costs. Congress aims to curb these costs, and VHA is working to reduce the cost and lost productivity associated with these claims by identifying claimants on the periodic roll with work capacity, or those whose workers compensation injuries/illnesses have been resolved and thus require reclassification.
Solution
The Atlas Research automated case management and document management system, WebOPUS®, provides a secure firewall and password-protected web-based platform for tracking case management activities and storing documents, and for setting triggers for follow-up with injured workers, health care providers, and Office of Workers’ Compensation Programs (OWCP) personnel. WebOPUS® was also approved for use by VHA for case management activities provided in Veterans Integrated Service Networks (VISNs) 4, 5, and 8. WebOPUS® is designed to maximize data capture, manage workflow, guide clinical decision-making, integrate disability management functions, and create useful and customizable reports.
The Atlas Team has had significant success in assisting VHA and other federal agencies in organizing, managing, and resolving large quantities of legacy claims, and provided the same exceptional services to VHA under this Multi-VISN Legacy Case Management initiative. Atlas developed a series of standard protocols and work processes for effectively managing legacy claims, using a protocol-guided approach to case management focused on prioritizing next actions based on several different decision trees that have been refined over time. The team identified and prioritized high-value claims, and focused on determining effective and efficient next actions to move cases through the claims process to resolution.
Result
The Atlas Team’s standard protocols and work processes served to collect, store, report, and track case information necessary to effectively manage case activities and processes. By providing large scale triage, evaluation, prioritization, Atlas reduced the cost of existing workers’ compensation claims to enable VHA to serve the best interests of injured employees and maintain compliance within federal Employees’ Compensation Act (FECA) standards. Data and updated documentation for more than 500 Periodic Roll cases were collected to identify areas of deficient administrative and clinical documents.