Workers’ comp professionals rely on the Official Disability Guidelines (ODG) to help guide the return-to-work process for injured employees. And one of the ways ODG has helped boost this effort is through its Treatment Analyzer on Outcomes or TAO Index. In today’s Inside Workers’ Comp, Mariellen Blue joins us to explain the ins and outs of TAO.
Tom Kerr (TK): Mariellen, welcome back to the show.
Mariellen Blue (MB): Thank you, Tom.
TK: Let’s start with the basics. What is TAO?
MB: Most health care providers, utilization review, case management and claims professionals who manage cases in the workers’ compensation and disability markets are familiar with the Official Disability Guidelines or ODG, which is one of the industry’s leading medical treatment and return-to-work (RTW) guidelines. The ODG combines evidence-based medicine with data-driven medicine to assist in benchmarking and improving return-to-work performance, driving quality of care while limiting inappropriate utilization of services, assessing claim risk and opportunities for intervention such as case management and other managed care services, and in setting reserves based on industry data. The 2018 release of the ODG by MCG user interface included the launch of a new metric called the Treatment Analyzer on Outcomes or TAO Index. The TAO Index measures the correlation of each medical intervention with timely return to work.
TK: Why did ODG develop TAO?
MB: In their 2018 white paper, “Evidence-Based Medicine and the New Role of Analytics: Introducing the TAO Index from ODG,” it states that “TAO is an advanced new metric leveraging claims analytics to bolster traditional literature review. TAO is designed to facilitate early access to treatments that deliver the most sought after of outcomes, and a best post-injury measure of success which correlates to health, quality of life and lower costs.” Return to work is the objective measurement defining successful outcomes.
TK: How do case managers use TAO?
MB: As defined by the Case Management Society of America, the underlying premise of case management is based on the fact that when an individual reaches the optimum level of wellness and functional capability, everyone benefits: the individuals being served; their support systems; the health care delivery systems; and the various reimbursement sources.
A key component of the case management process is initial and ongoing comparison of the current treatment plan to evidence-based treatment guidelines, including ongoing evaluation of the injured worker’s response to the treatment plan and discussion with the treating provider when treatment falls outside of guidelines or the injured worker is not progressing or meeting recovery benchmarks and RTW goals.
The ODG is one of the resources used by our case managers to enhance the case management process providing critical data and tools to drive better outcomes. The TAO Index brings an additional level of data driven tools to our case managers. Unity, our Genex case management system, incorporates a direct interface with the ODG by MCG. Through real time data exchange, each case in Unity auto-populates with critical benchmarking data such as the ODG Risk Assessment Score and expected RTW and disability durations. From within a case, the case manager can access the TAO Index by clicking on the respective ICD diagnosis code. The TAO Index enables query by ICD, CPT, or a combination of ICD diagnosis and CPT procedure codes. For each combination, it provides information on frequency, number of visits, approval flags for each treatment or procedure, which are commonly used in the UR process, that provide recommendations from ODG for approval of the procedure, and a TAO score.
The Approval or Payment Flags display as:
Green: Recommendation for evidence-based approval
Yellow: Recommendation for data-driven approval
Red: Recommendation to route for review using the evidence-based treatment summaries
Black: Recommendation to route for review with extreme caution
The TAO Index score ranges from negative 100 to positive 100. Any score above 0 indicates better than average and that the treatment or procedure is associated with good outcomes and is not causing bad outcomes. Typically, treatment or procedures associated with good outcomes on the TAO Index are considered safe to auto approve or auto authorize.
TK: What “new approach” does this analyzer offer that impacts RTW?
MB: There is a quote by Stephen Hawking that reads, “Work gives you meaning and purpose and life is empty without it.” Individuals who have sustained a work-related injury can develop issues that extend beyond the physical. Work gives individuals a sense of purpose — it is part of their identity. Prolonged inability to work can impact the person’s psychosocial well-being, increasing risk of delayed recovery. Rather than simply looking at treatment in terms of whether it is medically indicated or appropriate for the diagnosis, the TAO Index focuses on exactly how the medical intervention correlates with RTW. This is a critical shift from the traditional management of workers’ compensation claims. The focus changes to how well the treatment or procedure works in reaching the optimal goal of a successful RTW.
TK: Have there been any challenges implementing TAO?
MB: Well, Tom, I have to say we really haven’t had any major challenges with the implementation of the TAO Index. ODG by MCG has provided extensive live webinar training for our case managers on all components of the ODG, including the TAO Index. Recorded training specific to TAO is also provided on the ODG by MCG site. TAO enables our case managers to compare proposed and current treatment to the TAO Index and use this information in discussing treatment and RTW goals with health care providers.
TK: What do you like best about TAO?
MB: What I like best about the TAO Index is that focus on exactly how treatment and procedures correlate with return to work. This is particularly impactful in workers’ compensation claims and case management where our goal is to return the individual to an optimal level of health and functioning. This includes the ability to work and a renewed sense of self and purpose in life. I also feel that the work ODG by MCG has done with TAO opens the door for future research into characteristics of individuals with positive RTW outcomes related to specific treatment interventions for even greater predictive modeling and patient-specific treatment recommendations in the future.
TK: Thanks, Mariellen. In our next Inside Workers’ Comp, we’ll explore how to use technology to improve outcomes. Until then, thanks for listening.