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How Discussions Affect Outcomes of Medical Cost Projections

Recent studies of our extensive databases have revealed that the most serious cases with underlying chronic medical conditions can have a large effect on the outcomes of your medical cost projections. The early analysis and careful management of these issues could reduce your damages by 40-60%.

The old adage of “an ounce of prevention is worth a pound of cure” is really true when you are managing a difficult occurrence, disease, or health matter. Knowing where you stand at the beginning of a claim, then continually monitoring the situation using advanced technology tools is imperative. Are you prepared to handle planned and unplanned communication with your high-value, chronic conditions cases? Knowing the differences between these types of communication may help alleviate the stresses for everyone concerned…and produce better, less costly outcomes.

So, what do planned and unplanned conversations look like in a chronic conditions case?

Planned conversations happen when the subject matter has been given ample thought, and are scheduled at a specific time and place that are convenient for everyone involved. Meetings, phone calls, etc. have better outcomes when there is an agenda, and everyone has had time to research, review and reflect upon all of the variables to meet the desired goals. Often, these conversations are difficult by their very nature. It is best to take enough time to prepare for the expected outcomes, and to feel comfortable delivering the “next steps” in a flexible manner. The key is to try to eliminate as much emotion from the conversation as possible.

Conversely, unplanned conversations happen at any time and place, and they are typically highly charged with emotion. As a professional risk or claim manager, the best approach is to listen to the claimant and family with sympathy or empathy, then lay the groundwork for a future planned conversation. If possible, at the end of the “listening” session of the conversation, kind thoughts, words and planning can help transition someone beyond their anger and frustration to a reasonable agreement about what more needs to be done to resolve the situation.

Next, how are you able to know the right path to take when dealing with a chronic conditions case? By being prepared to ask the critical questions to determine the cause of the situation. For example, if the claimant has slipped and fallen at your client’s place of business, a thorough site investigation is important to determine the nature and conditions of the occurrence. Additionally, you should send and obtain medical record release forms to review the claimant’s medical records. In your review of the records, it is helpful to isolate the medical treatments associated with the occurrence from all other medical treatments. For cases involving underlying chronic medical conditions, send the medical records package to a qualified medical cost projection specialist to properly benchmark and determine the accurate reasonable and customary charges for your situation.

Finally, plan to have a conversation or meeting with the claimant and/or their representatives and family to clearly establish the financial responsibilities of your client. By calmly and accurately describing the underlying criteria you have established to resolve the case utilizing the medical cost projection specialist’s report, the parties should be able to agree about the value and future administration of the case. Thereafter, be prepared to deal with unplanned, emotional discussions from the claimant and their representatives to try to advance their perspective. After these types of discussions, it may be necessary to update the medical cost projections for additional resources like related Lien Negotiations, Medicare/Medicaid Set Asides, Life Care Plans, Structured Settlements, and Special Needs Trusts.

By having a strong, flexible plan with qualitative and quantitative approaches, you will be in a position to handle any situation involving an underlying chronic condition in an objective manner.

Blackburn Group, Inc.   RiskPro® is a registered trademark of Blackburn Group, Inc.