Orientation Module Outline:

1. Introduction to Workers’ Compensation Medical Care
2. The Access, Costs and Quality Connection
3. Access to Care for Workers
   • Primary Access Issues:
     • Insurance Coverage and the Uninsured
     • Establishing Causation
     • Claim Denials
     • Under-Reporting of Injuries and Claim Filing
   • Secondary Access Issues:
     • Restrictions on Provider Choice
     • Authorization and Utilization Review
     • Out of Pocket Expenses
     • Geography
     • Providers Unwilling to Treat
   • Tertiary Access Issues:
     • Socio-cultural
     • Education and Awareness of Rights and Responsibilities
4. Cost and Utilization of Care for Occupational Injuries
   • Cost of Care Varies Tremendously by State and Within States
   • Utilization of Services Varies by State
   • Cost Containment Strategies Used by States
5. Defining Quality of Care
   • Evidence of Quality Problems in WC
   • The Workers’ Perspective
6. Measuring Quality Care
   • Examples of Quality Measures:
     • URAC MCO Performance Measures
     • Rhode Island Technical Resource Center Surveys
     • WCRI Workers’ Survey
     • Texas School of Public Health “WINS” Survey
   • The Role of Clinical Practice Guidelines
     • Evaluating the Minnesota Workers’ Compensation Practice Guidelines
     • ACOEM Treatment Guidelines
     • Efforts to Simplify Reporting
7. Return to Work Assistance and Outcomes
   • Communication and Coordination
     • Mid-America Collaboration
     • North Country On The Job Network
   • Training Case Managers
     • Georgetown/FECA RTS Training
8. Improving Quality Care
   • A Summary