GBCARE™

In non-emergency situations, employees and their supervisors can speak directly to a GBCARE™ nurse 24 hours a day, 7 days a week, 365 days a year via a toll-free number.

During the call, the nurse obtains all pertinent information and makes treatment recommendations and network provider referrals.

With this program, clients can:

• Avoid claims by channeling low severity injuries to self-care
• Direct injured workers to appropriate providers, including telemedicine, avoiding unnecessary ER utilization
• Improve employee experience with option for nurse virtual connection
• Track key performance indicators with comprehensive reports spanning integrated solutions.

This early advocacy solution offers innovative risk assessment and targeted clinical support to an injured worker in the critical early days following a claim.

When a claim is reported, the loss details are reviewed for risk. Our team also reaches out via text message to the injured worker to help identify care needs and potential roadblocks to recovery.

Individuals identified as having a high-risk case are then assigned to Clinical Concierge, a limited engagement nurse who provides guidance, compassion, and clinical support with a whole-person approach.

Clinical Concierge will establish a care plan to address individual risk, including co-morbid and psychosocial barriers to recovery, and partners with high performing medical providers identified by Waypoint Provider Guidance.

Cases that would benefit from ongoing clinical oversight after the first 10 days of support are recommended to GBCARE™ Clinical Services for further case management.

Identifying the best providers to treat your injured workers is the foundation for ensuring optimal claims outcomes. Beyond cost savings, identifying the highest-performing providers sets up injured workers for a successful recovery.

Merging GBCARE's™ proprietary Treatment Quality Index (TQI) scoring with Outcome-Based Network (OBN) designation, Provider Guidance prioritizes the highest-performing network providers focused on evidence-based medicine and optimal claims outcomes. This makes it simple to identify the best option when selecting a provider for referral.

Example criteria to identify best providers includes:

• Adherence to evidence-based-medicine protocols (TQI score)
• Disability duration
• Medical cost
• Litigation
• Total claim cost.

Clinical guidance is the decision support tool the GBCARE™ team uses to help identify injured workers who would benefit from clinical intervention.

Clinical Guidance dives deep into claim data, identifying hidden risk factors that could delay recovery and return to work. These risks include:

• Injured worker profile and injury severity
• Disability durations exceeding expectations
• Care delivery that deviates from evidence-based medicine per our TQI scoring model.

Leveraging this tool in addition to their own experienced insights, the clinical guidance team recommends appropriate GBCARE™ clinical services such as Field Case Management or working with a Return-to-Work Specialist.

Not all work injuries require clinical intervention to promote optimal recovery, but for high-risk claims, GBCARE™ offers nurse case management solutions, including Telephonic Case Management, Field Case Management, Catastrophic and Complex Case Management, and Return to Work Specialists.

Our nurses have a goal-oriented approach to identifying barriers to recovery and return to work, promoting optimal outcomes on a claim and program level.

The key areas of focus are:

• Taking a holistic advocacy approach to each clinical assignment by partnering with the injured worker and developing a customized care plan to support their individual needs
• Leveraging innovative decision support tools to help identify injured worker risks, measure quality care, and provide insight into disability duration and recovery progress
• Building on the foundation of our nurses' education with specialized training for Behavioral Health and Centers of Excellence.

GBCARE's™ state of the art Utilization Review program merges clinical expertise with integrated technology to improve efficiency for our claims handlers and maximize return on investment for our clients. Through our integrated platform, we have created efficiencies with expedited turn-around, quality controls and accurate determinations while seamlessly interfacing with our other managed care products. The result is industry leading performance to improve claim outcomes.

GBCARE's UR program is URAC certified, and we are also registered as a UR agent in required jurisdictions.

Workers' Compensation Utilization Management
12/01/2024