Innovative value added programs distinguish OMCA from a typical workers' compensation managed care organization. Our physicians, nurses and clinical case managers are specifically trained to manage the conflicting interests that are inherent among the injured worker, the employer/carrier and the medical provider. OMCA minimizes ultimate workers' compensation costs by ensuring that medical treatment plans are cost effective and appropriate, and that employees get back to work as soon as possible. The foundation of these value added programs rely on continual and comprehensive interface with the TPA/adjuster/employer/carrier.

Even the most effective and experienced adjuster needs help from time to time. OMCA can provide this assistance. This help usually centers on the injured employee's medical treatment plan but OMCA can also provide the adjuster with a fresh look at a file and make innovative suggestions to bring cases to MMI or closure.

Typically our nurse professionals meet on a pre-established schedule with adjusters. The case manager answers specific questions as to medical treatment plans, suggests courses of action that might facilitate case closure, and is the liaison for the adjuster with the injured worker, their family and employer.

Indemnity files can produce volumes of medical records that are staggering for a busy adjuster. Frequently these files are transferred among adjusters and these complicated cases don't receive the attention they need. This can result in excessive TTD payments and MMI closure opportunities that are overlooked.

OMCA case managers are in a unique position to organize prior medical records and evaluate the current status of treatment.

The primary goal for any injured worker is to reach Maximum Medical Improvement (MMI) as soon as possible. Unfortunately MMI can be an illusive and costly objective. OMCA's nurses, in conjunction with the adjuster, employer, and provider design and supervise a medical treatment plan to minimize the time and expense of getting an injured worker to MMI.

One of the hardest things an adjuster has to do is make a case to eliminate or modify pain prescriptions and long-term pain management treatments. Prescription use, abuse and black market sales of medicines are running rampant. We are literally losing a generation of some communities to abuse of oxycontin, opiates as well as manufactured illegal drugs such as meth. The workers' compensation industry is bearing a huge financial burden relating to this problem and many injured or "allegedly" injured workers speed their way through the abyss of drug abuse beginning with the workers' compensation system.

OMCA can help break the cycle of pain management and medication abuse using a holistic view of the injured worker and a complement of therapists, physiatrists, anesthesiologists and specially trained gatekeepers. This system:

1. Identifies addictive behavior traits;
   
2. Establishes protocols for adjusters to identify abuse situations;
   
3. Identify and deny misuse and overuse of pain treatment and make those denials stick;
   
4. Identify alternative treatment tracks and therapists to assist with behavioral modifications.
   

Many TPA's hire our nurse professionals even in situations when formal managed care or complex case management is not being used. Nurses may be assigned on a limited case-by-case basis to obtain medical records to interpret clinical findings and recommend appropriate action. These recommendations may include formal utilization review, peer review, IME or referral to specialty care.

OMCA realizes that returning an injured employee to full or productive light duty is one of the most critical components of managing and minimizing workers' compensation costs. Our nurses ensure that the treating and specialty physician report specifically address limitations and not whether he can return to work. Frequently, this report can result in the employees return to work with only a minimum accommodation by the employer.

To reduce time spent at home recuperating, our nurses (with physician and employer approval), will find meaningful volunteer assignments for the injured worker. Although an injured employee may have a low back injury, he can still serve at the soup kitchen or volunteer at a charitable program. These experiences assist in the physical and emotional recovery of an injured worker while getting him out of the house and away from daytime television with its constant barrage of "Lawyer Advertisements".

Our nurses case manager and case coordinators institute protocols, approved by carriers, encouraging claimants and their employers to have ongoing communication. Our experience tells us that claimants with bona fide injuries want care, understanding and empathy. Our follow up is geared to encourage compliance with the treatment plan and a timely return to work.

OMCA's modified rehab work program is based on the belief that whenever possible, injured workers should be active. In addition to being harmful to the injured employee's self esteem, inactively results in de-conditioning of the non-injured parts of the body, a weakened immune system and diminished strength and stamina.

OMCA has made cost effective arrangements with health clubs and workout facilities to improve an injured worker's overall fitness. For example, with the treating physician approval there is no reason a worker with an injured wrist cannot be walking a treadmill, improving flexibility and learning about weight management, smoking cessation or nutrition. This program monitors weight, blood pressure, etc., and serves as a reminder to an injured worker that someone is watching and someone cares.

OMCA's panel of treating gatekeepers and referral review physicians are knowledgeable in the language, protocols and time constraints adjusters face in order to deny a claim or specify medical procedures.

The keys of any effective denial compliance program are:

1. Timing
   
2. Credibility
   
3. Thorough medical explanation supporting the rationale for a denial

All carriers/employers have preferred methods by which they wish to receive their communication. OMCA is proud of its ability to adapt to any communication system whether verbal, written or electronic.

Our pharmacy program allows adjusters to establish a system where:

1. Pharmacy cards/approvals are activated upon receipt of bona fide first reports of injury;
   
2. Out of pockets to employees are eliminated;
   
3. Drugs are obtained at the lowest possible costs;
   
4. Specialized reporting available to reduce adjuster administration;
   
5. Matrix developed to monitor drug frequency, interaction and appropriateness.