There’s been a lot of talk in the news about Medicare Set-Asides (MSAs) lately – and much of it focuses on explaining what they are and what purpose they serve. Although Medicare set-asides can be useful, they can also interfere with settling the medical part of file. Here are some successful approaches to reducing Medicare set-asides, while still keeping the injured worker’s best interest at the forefront.

The Three Levels of Medicare Set-Asides

The best way to mitigate and resolve Medicare set-asides is by addressing each case at three different, distinct levels.

• Medical: The first priority in reducing Medicare set-asides is ensuring that the underlying medical issues have all been properly and comprehensively addressed. By confirming the diagnosis, using an evidence-based treatment plan and defining a functional restoration outcome, the injured worker and company are better positioned for success. By focusing on these medical issues, it’s possible to account for reasonable future treatment and alternative plans if necessary.
• Cognitive: In addition to the physiological needs of casein injured worker, it’s important to address the cognitive behavioral factors, as well. If an injured worker has issues such as poor coping strategies, dysfunctional thought patterns, or a reluctance or lack of readiness to change, it could diminish the outcomes or derail the treatment plan. These issues must be addressed in order to properly treat the injured worker.
• Social: There are many social forces that are unique to each individual, which must be addressed, especially in cases with Medicare set-asides. Family dynamics, social support and secondary gain factors must all be identified and properly mitigated in order to engage the injured worker in a functional restoration plan and future self-management.

Settling cases with high Medicare set-asides can be problematic, especially if there isn’t a clear road map that leads toward a positive outcome. By taking a comprehensive approach to cases involving Medicare set-asides, we can be better equipped to help facilitate a settlement, creating a win-win for everyone.

At Paradigm Outcomes, we pride ourselves in managing a wide range of complex cases, with the end goal of providing the best possible outcome for the injured worker. Our experience with Medicare set-asides helps us create comprehensive case management plans that not only help improve the bottom line for a company, but also help improve the lives of injured workers.