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ODG Strategic Solutions: Opportunities for Optimizing Claims Management

ODG Strategic Solutions can help organizations optimize claims management systems.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 deliver quick, accurate decisions and help providers deliver appropriate care to their patients.

The mission of the ODG Strategic Solutions team is to help organizations such as insurance entities (claims and medical departments), managed care organizations (utilization review, case, pharmacy, and ancillary benefits management), governmental agencies, and third-party administrators (or TPAs) both maximize and quantify the value they get from ODG solutions.

Solution Areas and Implementation

The ODG Strategic Solutions team provides support in three primary areas of focus:

  1. A guidelines assessment is performed to understand current utilization and business objectives to help develop a gap analysis.
  2. Analytics of customer claims data will be provided at intake, measuring and reporting performance against ODG’s extensive industry database to identify data-driven areas for improvement. The analytics solution is ODG-certified to give confidence in results.
  3. ODG’s team will use the guidelines assessment and the analytics to tailor and help execute a customized implementation plan designed exclusively to meet client needs. Updated analytics will be reported at various milestones post-implementation to measure performance vs goals.

The implementation plan generally includes both workflow and systems integration of ODG solutions with significant opportunities for automation across business units, such as:

  • Staff training with guidance for workflow integration and engagement of ODG
  • ODG systems integration via API
  • Delivery of evidence-based, best practice guidance throughout the ‘veins’ of an organization’s claims, medical, and communication platforms
  • Auto-adjudication and auto-authorization of treatment
  • Automated risk scoring with interventional triage when claims or bills are “off-track”
  • Benchmarking and reporting savings
  • Provider profiling

The solution, as part of the implementation plan, may include the use of systems and technology staff, third-party software vendors, recommendations involving medical and case management department functions, claims management functions, and discussions with external service providers (IME, peer review, etc.).

Measuring Outcomes

These solutions have helped clients achieve more than a 25% reduction in lost time days and more than a 33% reduction in costs.

Through ODG Strategic Solutions’ involvement and the adoption of ODG treatment and disability duration guidelines, clients have an opportunity to certify implementation results for marketing purposes and know that they are operating at or above best-in-class for their industry.

The ODG Strategic Solutions team has a wide range of industry knowledge for supporting customers in moving toward best practices. This allows for a better implementation plan and if desired, periodic monitoring of results both internally and against our extensive industry database using dashboards and KPI reporting. First-in-class ODG Helpdesk support and training are hallmarks of Strategic Solutions deliverables.

When appropriate care can be delivered in an efficient fashion, everyone wins, especially the patient.

https://www.mcg.com/odg/odg-strategic-solutions/ for more information.

By Troy Prevot, MBA PA-C, Director of ODG Strategic Solutions, and Jacob Speer, ODG Strategic Alliance Project Manager.

Published July 27, 2023.

The information contained in this article concerns the ODG guidelines (or solutions) as of the date of publication, and may not reflect revisions made to the guidelines (or solutions) or any other developments in the subject matter after the publication date of the article.

Images courtesy Shutterstock/Ground Picture

The post ODG Strategic Solutions: Opportunities for Optimizing Claims Management appeared first on ODG by MCG.

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