Irvine, CA – Gregory Moore, CEO of Harbor Health Systems, a One Call Care Management company, recently presented the improvements achieved under recent regulatory changes impacting MPNs (Medical Provider Networks) in California, along with recommendations for improving results and the patient experience at the AAPAN Annual Forum (American Association of Payers, Administrators and Networks) held recently in Laguna Niguel, California.
Moore and Christine Baker, Director of Industrial Relations for the state of California, participated in the panel discussion, “Medical Provider Networks: California Implementation Efforts,” which identified how payer, network and TPA executives can work toward solutions and improved performance through MPNs.
Baker outlined the need for recent legislative changes aimed at improving the implementation and value of MPNs, while Moore described “lessons learned” and benefits post-regulatory changes.
“We view the overall outlook for California MPNs as positive, with recent regulatory enhancements lowering costs for MPN implementation by more than $100,000 for large employers,” said Moore. “The regulatory changes are working, costs are lower, and accountability to help injured workers is stronger. The next steps in improving access and care coordination for injured workers lie in streamlining the process of connecting top doctors and healthcare providers, patients and payers, in order to achieve a smoother flow of information and treatment throughout the continuum of care.”
Harbor has already implemented nine entity network MPNs, giving the company considerable experience under the new regulations. Five recommendations for next steps presented by Moore include:
- Improved access to care for injured workers is imperative. The industry must overcome the difficulty experienced while navigating the claims system and assure injured workers that experienced physicians continue to be available. A focus on the patient and addressing their needs is necessary to improve outcomes.
- The system must make it easier for injured workers to find and schedule appointments. The Medical Access Assistant reduces the difficulties that injured workers have in navigating their care plan.
- Greater MPN accountability is needed including ongoing compliance with regulations, maintaining networks, knowing data and status of doctors, and holding physicians accountable to commitments.
- A continued focus on reducing costs is required utilizing other means besides simply fee schedule reductions. For example, with the removal of the New Hire Notice, there is an upfront reduction in costs. The network-entity model reduces ongoing costs by reducing the number of MPNs required.
- Physician acknowledgements are an important part of making MPNs operate as efficiently as possible. The physicians must agree to participate and better dialogue and accountability with providers must occur.
In 2014, Harbor Health Systems announced the Harbor One™ MPN, a pioneering MPN program and approved Network Entity MPN that allows organizations to subscribe to an MPN solution without the time and expense of certifications, or dealing with ongoing compliance.