News

Artificial intelligence (AI) is transforming industries, and healthcare is no exception. In a high-level exploration during the recent webinar “Redefining Utilization Management: The Role of AI,” MCG’s Senior Clinical Integration Analyst, Miriam Moerbe, MS, BSN, RN, provided a basic exploration on what AI is, how it relates to healthcare and utilization management (UM), and key […] Read More

Navigating the new technology landscape is challenging, even for seasoned casualty leaders. There is a new AI tool just about everywhere you look. But which ones can be relied upon? I frequently hear the question: “How do you successfully use technology to lighten workloads while simultaneously reducing the risk of poor-quality outcomes?” Claim’s culture often […] Read More

In today’s fast-paced professional landscape, the intersection of mental health and workplace productivity has become increasingly significant. The impact of mental health comorbidities—conditions where an individual experiences a mental health disorder simultaneously with a chronic medical condition—can have profound effects on employees, influencing both the duration of workplace disability and overall health outcomes. These comorbidities […] Read More

Despite the end of the public health emergency last spring, the impact of COVID-19 on how healthcare was provided, in broader society as well as in worker’s compensation, still resonates today. When governments mandated shelter-in-place and hospitals faced unprecedented patient volumes, the delivery mechanism for much of non-COVID healthcare switched almost overnight to virtual settings. […] Read More

Hippocrates said of the practice of medicine, “There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.” This quote could be interpreted to mean clinical opinions should not be considered. We know in modern medical practice that this should not be the case, though his statement on knowledge is […] Read More

A recent study published by the Texas Department of Insurance’s Workers’ Compensation Research & Evaluation Group (REG) shows that pharmaceutical costs and utilization among injured workers continue to trend down in Texas, more than a decade after the state adopted ODG by MCG’s evidence-based closed drug formulary.1 The ODG Drug Formulary lists more than 350 […] Read More

The phrase “whole person recovery management” is a relatively straightforward, self-defining term. When an individual is trying to recover from an occupational injury or illness, the team supporting that process should consider the whole person – mind, body, soul – to optimize the medical and financial outcomes and accelerate Return to Work. However, in a […] Read More

Italian sociologist Vilfredo Pareto (1848-1923) is best known for his namesake principle the “Pareto” rule, which states that for many distributions, approximately 80% of outputs are driven by just 20% of possible inputs (called “the vital few”). The converse of this is that the other 80% of inputs – “the trivial many” – drive only […] Read More

Italian sociologist Vilfredo Pareto (1848-1923) is best known for his namesake principle the “Pareto” rule, which states that for many distributions, approximately 80% of outputs are driven by just 20% of possible inputs (called “the vital few”). The converse of this is that the other 80% of inputs – “the trivial many” – drive only […] Read More

As evidence-based medicine has become the gold standard of medical care and timely return-to-work, ODG by MCG has become the industry standard for disability, workers’ compensation, and auto liability claims. ODG services a wide range of clients striving to decrease disability durations by providing treatment guidelines and analytical tools to help stakeholders in these industries […] Read More

Reliable data is critical for auto insurance carriers to accurately forecast claim costs and durations. Using such data from the Property & Casualty (P&C) side (i.e., auto or workers’ compensation claims) is incredibly helpful for this, however, we know that such claims are impacted by policy limits, liability, and litigation. It’s important to have access […] Read More

It is well-known that the workers’ compensation industry is very complex as it covers a variety of professions including medical, legal, and customer service. At the core of this multidisciplinary field is the claims adjuster. Adjusters shoulder the management of workers’ compensation claims and often handle hundreds of claims at once to help injured workers […] Read More

The auto insurance industry’s fierce price competition is forcing rapid change. Auto insurance carriers who aren’t leveraging new technology and ideas to gain efficiency are losing the price war, and in turn, market share. For decades, these carriers have faced – and attempted to combat – rising medical costs. The traditional method of negotiating and […] Read More

As the workers’ compensation industry emerges from (learns to live with?) COVID-19, stakeholders are finding many of the same pharmaceutical issues we thought we left behind in 2019. In many states, opioids, compounds, topicals, and poorly controlled drug costs are back on the radar. Among the questions accompanying them is “to formulary or not to […] Read More

The Scenario: George, a 47-year-old male, injured his back at work two days ago putting a box on a shelf. He is seeing his primary care physician for the first time. George’s physical assessment revealed low back pain with tenderness upon palpation. No leg pain or numbness. He has no confounding factors. The primary physician […] Read More

How long can the grand bargain of workers’ compensation survive if my quid starts to outweigh your quo? That’s the question some California stakeholders are posing in the face of a wrongful death lawsuit currently winding through the state’s courts. The case presents a novel question of tort immunity for a workers’ comp community still […] Read More

Quite often, stakeholders managing various aspects of workers’ compensation claims spend countless hours each day trying to do what is best for injured workers. However, knowing what is best can be elusive. Typically, claim managers focus on: Ensuring state government forms are filed in a timely manner Making three-point contacts and related calls as scheduled […] Read More

One of the most frequently asked questions at the ODG Helpdesk is: “How do I find duration values for a diagnosis, and how does it differ between diagnosis vs. claim level when managing return-to-work (RTW)?” An example of determining the difference can be found below. Let’s use ICD-10 Code S33.5 for this example. As the […] Read More

In 2015, the City of Fort Worth, Texas, had 6,250 employees and calculated total workers’ compensation costs, claims plus indemnity payments, at $9.7 million. The city leadership sought more effective ways to reduce workers’ compensation costs and still help employees received the appropriate care to support quality outcomes and return to work. However, before the city […] Read More

The ever-growing list of new federal, state, and local leave mandates has made administrative functions more crucial than ever to the effective operation of integrated absence management (IAM) programs. However, we sometimes let Health Insurance Portability and Accountability Act (HIPAA) constraints intimidate us into relinquishing medical case management. When we do this, we are forfeiting […] Read More

While compliance with the Americans with Disabilities Act (ADA) is generally assigned to human resources (HR), employers can use the help of clinicians to build programs that facilitate ADA compliance. The ADA went into effect in 1990, with major amendments effective January 2009 to expand the definition of disability. Title I of the ADA obligates […] Read More

At the beginning of a claim, it can be difficult to know if or when referring to a case manager would be helpful. Having a case manager at the beginning of every claim would seem valuable, but it would dramatically increase overall costs, stretch limited resources too thin, and might fail to focus on critical […] Read More

Long before Tiger King clawed out his fifteen minutes of fame, there was Clark Stanley, a.k.a. the “Rattlesnake King.” Stanley, a silver-tongued Texan born in 1854, found fame and fortune in the late 1800s with “Clark Stanley’s Snake Oil Liniment.” He sold his salve across the country as a cure for “pain, lameness, rheumatism, neuralgia, […] Read More

We have all seen cases involving a “simple” back sprain claim that we don’t pay much attention to, only to find ourselves with the claim remaining open a few years later with no sign of the claimant ever returning to preinjury functional level. What is the difference between this claim and a similar one that […] Read More