Better patient outcomes and program results through expert clinical management

Healthesystems' end-to-end clinical management fills workers' comp healthcare gaps to:

Identify patient and population risk
Direct clinically appropriate workflows and automation
Make better decisions across the care continuum
Drive timely interventions
Anticipate medical trends
Inform optimal clinical strategies
Ensure appropriate and affordable treatment
Healthcare provider and services shortages the #1 challenge for the industry in 2023 survey
of industry stakeholders are concerned about increasingly complex claims

Care Complexities

Treating workers’ comp patients has become more complex. Comorbidities and psychosocial concerns are impacting worker health. A fragmented and overtaxed healthcare system is causing gaps in patient care. These factors can lead to delayed recovery, increased claims duration, and higher costs.

In other words, more complex patients and medical treatments lead to more complex claims, which often require greater clinical guidance and support to manage successfully.

Healthesystems provides comprehensive clinical services to help workers’ comp payers guide each patient through a smooth and successful recovery.

Clinical Solutions

Healthesystems clinical services program and team stand apart from the industry, beginning with our depth of in-house pharmacology and occupational health experience.

Our concierge style clinical management program begins with strategic program design and continues across the life cycle of each individual claim. Clinical expertise and advanced technology work together to drive an integrated program.

Program Consultation & Support

Our clinical team is here to help optimize your medical management program strategies and outcomes. Through strategic program design and ongoing consultations with expert pharmacists, our programs include a range of high-touch services that support our customers’ specific pharmacy goals – and provide as-needed support for your claims teams.

Medication plan design and maintenance

Customized step therapy design

Cost optimization guidance

Ongoing therapeutic guidance

On-demand clinical decision support

“Ask a Pharmacist” support for front-line claims professionals

Population & Patient Management

Clinical knowledges fuses with analytics capabilities to identify risk at both the population and individual claim levels. With continuous monitoring across our customers’ populations and clinical risk models embedded throughout the claim lifecycle, we identify outliers and opportunities to reduce future negative impacts and optimize care.

Population and program analysis

Patient risk scoring

Prescriber behavior tracking

Program adherence monitoring

Clinical Minute Video Series

Hear directly from our clinical experts on medical topics and trends that impact workers’ comp claims.
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Engagement & Intervention

Collaborative outreach and intervention at multiple touchpoints across the care continuum – with patients, prescribers, and retail pharmacies– to positively impact clinical and financial outcomes.

Patient engagement counseling

Prescriber and pharmacy outreach and STAT reviews

Opioid and high-risk drug management

Advanced drug regimen and patient history reviews

of claims professionals report a lack of reliable clinical decision support information

Integrated Clinical Intelligence

Depth of experience and knowledge from clinical pharmacists and occupational health experts is operationalized within automated rules, edits, workflow decision support, and reporting.

Powerful rules engine built on expert clinical knowledge

Automated workflows to guide therapeutic decisions

Right-time clinical guidance to guide decisions

Clinically focused suite of interactive dashboards

Healthesystems’ best-in-class clinical expertise, combined with our unique store of pharmacy and ancillary medical data, insightful analytics, and consultative service, provides clients with the tools and guidance to manage complex patient scenarios and achieve their pharmacy program and cost containment goals.
Stay up to date on FDA approvals and drug alerts that are relevant to workers' comp with Healthesystems' MEDMONITOR
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