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For example, ergonomic disorders, like carpal tunnel syndrome, are the fastest growing category of work-related illnesses. They are also among the most expensive to treat.

Risk managers should consider an ergonomics program that addresses carpal tunnel concerns. Compared to the potential high costs of a workers comp claim, a few hundred dollars spent on a new workstation, ergonomically-correct keyboard or mouse system seem insignificant.

Health and wellness programs generally fall beyond the scope of risk management, but can make a significant impact on reducing medical costs and lost time.

For example, it is generally recognized that obesity increases the risk of some musculoskeletal maladies, such as joint disorders of the knee. Risk managers might consider taking advantage of weight management and exercise programs to help reduce the incidence of work-related injuries in these areas.

Risk managers need credible information about cost drivers and program impact to make effective decisions. Traditional means of measuring financial impact by disability duration, diagnosis and injury severity may not provide a total or accurate picture.

Some companies use data mining software to identify injury patterns and other trends in claim data that might otherwise be overlooked.

Recently, such software has become more sophisticated and reliable. Combined with predictive modeling to calculate future opportunities for savings, data mining tools can offer a reliable projection of future workers comp claim costs.

But all the ergonomics, safety and wellness programs cant prevent every injury. Improving program results today requires not only maximizing medical and indemnity savings, but reducing the "price" that the company pays when an employee isnt at work.

Two key issues are optimizing network contracts and increasing penetration. Use of a network can result in discounts between 10 and 25 percent. The challenge is obtaining the deepest discounts possible.

A traditional contract with a single national preferred provider organization network may not deliver adequate results. A diversified network portfolio that includes contracts with multiple best-in-class national, regional and specialty networks can offer the best discounts for employers, wherever their employees are located.

The broader provider coverage of a network portfolio can also increase penetration–and thus increase savings–by including more of the providers that employees would select in both employee and non-employee choice states.

For the best results, a network must include providers of the most utilized treatments; otherwise employees will go out of network for these services. If claims data reveal high use of chiropractic or physical therapy, for example, then ensure that those specialties are well represented, so more claims stay in your network.

Case management is a powerful cost control tool. For an even more effective program, identify cost drivers within the population, such as injury type, and establish claim triggers specific to those drivers.

With the case management approach, managed care organizations can apply the most appropriate resource at any point, including assigning vocational experts and/or physician advisors who can intervene at the most optimal time.

Case managers act as liaisons between patient, employer, provider and payer, but their role can be broadened to include network channeling, review of treatment for appropriateness, researching transitional duty alternatives or negotiating return to work with providers.

Proactive use of independent medical exams, where permissible, and physician advisors may also reduce workers comp claim costs. A second medical opinion is most often used retrospectively, when losses have already occurred. It can, however, also be used to help direct and channel care.

For example, if an injured worker is undergoing aggressive physical therapy at 60 days, when the guidelines call for job transitioning to light duty, an objective evaluation may help get treatment back on schedule, ultimately decreasing lost time and medical costs.

Triggerssuch as excessive testing or a change in provider after 60 days of treatmentcan be built into the bill review system to ensure that the right cases are targeted for the best results.

Following an injury, the emphasis shifts to minimizing lost time and its associated costs. Many risk managers find a formalized return-to-work program provides the best results by reducing direct expenses, such as wage replacement and indemnity costs, while enhancing productivity.

Its extremely beneficial to have a list of transitional and modified duties in place before an injury occurs. This contingency planning can expand work possibilities beyond light duty and schedule accommodations and take better advantage of an employees knowledge capital.

For example, an injured equipment operator may be unable to run machinery, but could perform quality assurance checks. With more available options, theres a better chance of an appropriate matchand a quicker return to work.

If transitional duties have been identified, but are not formally documented, consider warehousing the information more efficiently. New database applications can match a disabled worker with appropriate standard and customized transitional duties in a few keystrokes.

The case manager can give the health care provider a list of possible tasks immediately after the first report of injury, allowing for the provider to introduce return to work as a natural consideration in treatment planning–ultimately reducing lost time.

To stay competitive, risk managers must look beyond the customary approaches to medical management. Broader strategies such as those highlighted here can make a meaningful difference in medical savings and lost time results.

Fred Scardellette is vice president for disability management product development and marketing for Intracorp, a Philadelphia-based medical management firm.

Reproduced from National Underwriter Edition, May 12, 2003. Copyright 2003 by The National Underwriter Company in the serial publication. All rights reserved. Copyright in this article as an independent work may be held by the author.