RTW Strategies: Washington’s COHE Model

Create a "Common Language" Resource or Interface

Create a "Common Language" Resource or Interface for patients, providers, and insurance companies.

 

In a sense, patients are not in a position to be their own advocates, and need to be. Sometimes the reason a patient is not his/her own advocate is because they are in pain or unconscious. But I find that even when patients are coherent, they simply are not trained in the process of, or language of, the special jargon involved in medical care. For our own family, much of the time spent on the phone was simply understanding the "jargon" of the terminology used by the doctor trying to talk to us. We would go home and Google it afterwards, of course, but even then, frantic people don't know what's authoritative and what is quackery.

 

"If" there could be some sort of "shared" interface that a patient could consult, that provides perhaps a "matrix" of, the condition as referred to by a doctor, the "code" it involves, and a "what this means in plain English" type of column, with a "more details to an authoritative source" link for more information, we would in effect provide a way for everybody to get on the same page.

 

I think as a starting point, something like THIS page:

 

http://www.lni.wa.gov/ClaimsIns/Providers/ProjResearchComm/OHS/default.asp

It says on the upper left hand corner, that it is for Medical Providers. But as a caregiver, or as a patient, I would LOVE to have access to the same sort of information found here:

 

http://www.lni.wa.gov/ClaimsIns/Providers/Claims/Filing/default.asp

 

Here's an excerpt that was very clear, easy to understand, even for someone who is not an expert on medical jargon:

 

 

Filing Claims

 

 

The provider's responsibilities

 

If you're the first doctor to diagnose a worker for an occupational injury or disease, you're responsible for reporting to L&I or the self-insured employer.

 

If the claim might be federal, tribal, or another insurer, find out how to file claims and bill the correct entity.

 

If you aren’t sure whether you need to file, see Deciding whether to file a claim for a patient.

 

To file a claim here in Washington State, follow these 4 steps:

 

Step 1: Find out if your patient is insured through L&I or a self insured employer

 

 

There are 3 ways you can find out:

Ask the patient.

Check the self-insured employer list.

Call L&I’s Self-Insurance section at 1-800-848-0811 toll-free or 360-902-6500.

 

 

It told you who, what, where to call.

 

The point is, we should literally all be on the same page.

If a patient gets a bill with a code, that patient should be able to look up the code and see what it means in real life. That will also make the patient more "educated" and in a better position to be his own advocate.

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Idea No. 14