During our time at NWCDC 2014, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “3 For NWCDC” series, focused on this year’s developments and on improving the system! Here’s what Bob Evans, National Director of Network Solutions at Rising Medical Solutions had to say:
1. Looking back on 2014, what do you believe was the most significant development for the Workers’ Comp industry?
The most significant development to me was the aggregate lack of major change in the way workers comp buys medical services or what we spend, particularly when many folks predicted the onset of cataclysmic change. Many had thought that Obamacare and/or the ACA would have quickly driven big changes to workers’ comp. Not that there hasn’t been some impact but, from what I have seen, the aggregate impact driven by healthcare reform has been limited in work comp.
2. If you could wave your magic wand, and instantly change one thing about 1) Workers’ Comp and 2) your business, what would you change?
My magic wand would be used to rapidly accelerate the migration towards more rational ways of buying healthcare services for the workers’ comp consumer. This is where CMS and commercial healthcare reform can help pioneer change. In terms of rational healthcare purchasing, think for example the lack of incentives in containing costs for implants. The most common approach of “buying” those now is “acquisition cost plus”. That model provides no incentives for maximizing value.
3. What is one thing you’d like to promote?
One thing I’d like to promote is a more global, episode-based purchasing opportunity like Rising offers with our Surgical Care Program (SCP). Under SCP, we pay our high quality provider partners a global and fixed case rate that is 100% predictable and is paid very fast. In turn, to our customer, we offer an upfront, all-inclusive case rate for all medical professional/facility and implant services, plus all the associated care coordination and utilization assessment. To me, that’s a rational way to buy surgical care.
About Robert Evans
Bob has 30-plus years of experience in the areas of: strategic provider solutions, network program optimization, provider contracting, rate and discount analysis and medical economics. At Rising Medical Solutions, Bob is responsible for developing cost-effective, quality-driven relationships with hospitals, physicians and ancillary providers across the nation. Prior to Rising, he worked at Coventry Health Care (formerly First Health/HealthCare Compare) for 21 years, where he was most recently Vice President of Network Development. There, he built and managed a provider network that profitably supported commercial risk and non-risk, network lease, workers’ compensation, Medicare Advantage and specialty lines. Bob developed his foundation in the business at Evanston Hospital Corporation, where he worked for 10 years, negotiating and managing hospital and physician group risk and non-risk contracts. Bob has a Bachelor’s degree in Business Administration and Psychology from Illinois State University.