Utilization Review in Workers' Compensation: Review of Current Status and Recommendations for Future Improvement.

: Utilization review (UR) is a process that assesses aspects of a treating provider's care plans and then provides recommendations to payors/insurance carriers, third party administrators, etc, concerning the appropriateness of the proposed care. UR has become an integral part of medical practice and has influenced medical care within the workers' compensation (WC) system and is mandated in several states and jurisdictions. This guidance statement from the American College of Occupational and Environmental Medicine (ACOEM) reviews structural elements of UR programs and proposes a possible template for operational standards. UR has a unique role in protecting patients and educating providers on evidence-based guidelines, new research, and best practices.

Assessing disease and wellness in the occupational setting: Electrodiagnostic Functional Assessment from wired to wireless.

Technology Assessment is the study and evaluation of new technologies. It is based on the premise that developments and discoveries within the scientific and medical communities are relevant to the population at large. Proper technology assessment is an approach that is vital to address the current limitations of the worker's compensation system. The aim of this presentation is to discuss the need for objective diagnostic tools, such as Electrodiagnostic Functional Assessment (EFA), in the workers' compensation system with a focus on musculoskeletal disorders (MSD). Workers' compensation musculoskeletal claims may benefit from a wireless assessment to diagnose and monitor soft tissue injuries and this technology may be applicable to wellness and healthcare programs.

Health promotion site selection blues: barriers to participation and implementation.

OBJECTIVE: To shed light on research-to-practice challenges in workplace health promotion research. METHODS: More than 1200 companies serviced by a national insurer were assessed by measures, including management surveys, and insurance premium costs and risk profile. A 21-item Workplace Readiness Checklist was the core assessment tool. Quantitative and qualitative measures were used to identify 12 to 14 companies deemed most "ready for change." RESULTS: The four priority candidate companies decided against participation. A post hoc survey to evaluate reasons for non-participation identified factors such as time allocations, the deteriorating economic environment, and the participatory nature of the interventions proposed for half of the study sites. Differing priorities within management also seemed to interfere with participation. CONCLUSIONS: A highly structured process for determining corporate readiness for participatory health promotion produced contradictory results.