Life Care Plans for Chronic and Legacy Claims
When people think about using Life Care Plans (LCPs), they are usually facing a contested situation and legal process involving a catastrophic injury or illness. Has the time come for the use of “mini” life care plans for all predicted chronic or legacy claims?
Life Care Plans are normally utilized when someone experiences a catastrophic injury or illness where the expected future costs are likely to be millions of dollars. Claim adjusters, attorneys and other claim and legal practitioners like to use them to assess the value of a case, and to assist in the financial reserving, judicial process and/or settlement. Recent evidence has shown that if a Life Care Planning approach is utilized as soon as a chronic or legacy case is known, the case is normally resolved sooner and with much better patient and cost outcomes.
For several years, we have engaged with clients to eliminate unnecessary costs in their programs by advocating and supporting predictive analytics with an LCP approach for 5% of the cases which drive 50% of the costs. In a recent review and analysis of our practice data, we segmented the outcomes of those cases which employed an LCP approach (full or “mini” plan) from those cases where they were not utilized. We found an average for all catastrophic and non-catastrophic cases of approximately 30% difference in costs, and a 25% difference in time of resolution. If this approach were applied to your portfolio of predicted or open legacy and chronic claims, could these methods transform your programs?
There is a good resource at Kaiser Permanente to help describe the LCP process for catastrophic care. Only about 1% of a portfolio of cases requires this level of care, with the healthcare “agent” being a spouse or close family member. However, the website is a good starting point for a conversation about what resources are needed for all catastrophic and non-catastrophic legacy or chronic cases.
At the outset of an event which leads to extended medical care for an injury or illness, most people and their families listen and take direction from their primary doctor. What if another team member were added to the healthcare circle that had LCP skills to address a wide range of physical, psychological and socioeconomic factors? The dynamics of the case would change considerably because a holistic LCP view reduces patient uncertainty and anxiety about the process of getting better, thereby improving outcomes.
To gain the advantages of a qualified full or “mini” LCP product and service team to assist in understanding the best (and less costly) case outcomes, be sure it contains:
• Inexpensive, quick, and efficient service for you and your client with a dedicated single point of contact
• Complete analysis of care requirements using an advanced technology infrastructure, data and network
• Thorough review of the entire file, obtaining the necessary information for written analysis that helps understand and forecast future costs, including an estimated short or long term cost of care for catastrophic and non-catastrophic treatments
• Medical and Legal Support including review of medical records and treatments for chronological summaries, meritorious review, treatment provider recommendations, expert witness recommendations, deposition review, deposition summary, and mediation preparation as needed
• Planning for Litigation, Trust Management, Settlement Negotiations, and Reserve Management as needed
Trust your instincts…if you think a data-driven, compassionate LCP approach will relieve unnecessary time and costs in your cases or programs, then begin investigating how to implement an LCP approach in your organization. If you and your clients need a place to start, please call us for a discussion about your unique situation.