During our time at NWCDC 2015, 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 Greg Moore, Senior Vice President of Innovation for One Call Care Management had to say:
1. Looking back on 2015, what do you believe was the most significant development for the Workers’ Comp industry? (If you did RIMS Review, how did your prediction pan out?)
One of the more significant developments in 2015 was the adoption of outcomes-based programs by larger carriers. In the past, only about 15 percent of California claims were going into tightly managed MPN panels. With that level of adoption doctors may have been slightly impacted if they were not on these panels, but on the whole it was not a significant driver of practice business. If we see 30 percent or more of the claims going into these networks we are going to see a tipping point that opens up a whole new game for workers’ compensation. On the positive side, good doctors should start to see more flexibility and engagement as a result of (1) the competition for their time, and (2) as a result of being part of a provider population that has earned more trust with a larger segment of the market. On the negative side, good doctors who may struggle with managing malingering patients and may not understand fully the legal aspects of patient management in workers’ compensation will end up excluded from a material portion of the business available in states with closed network models like California or tight direction models like Florida. Certainly, doctors who have abused the system will have fewer places to find patients and it is unlikely they will leave the industry without a fight. This tipping point will likely lead to more specific case law on selection and exclusion of providers, but also will likely result in more doctors focusing on their patients and resolution of cases as they compete to gain or keep access to the shifting market.
This is a whole new ball game for doctors. While only a small percentage of doctors are abusing the system, a large number struggle with the legal aspects and the unique patient relationships that malingering and negative incentives can bring. Doctors will need to compete based on their overall impact on claims, and payers will need to be very careful about how they select or remove doctors as the crossing of the tipping point means the decision to not include a doctor.
2. What do you think Workers’ Compensation as a concept/industry really needs now, and into the future?
Our industry needs to find ways to narrow the gap between what is needed to practice medicine in group health and our world. Pressures from Obamacare are an incentive for good doctors to begin to consider more workers’ compensation patients, as are increasing fee schedules that are likely to occur as the existing pool of doctors narrows. But, if they have to change how they bill, get authorizations, and document their care, the less likely they will ultimately commit to seeing injured workers. We need more good doctors, and we need to find better alignment between streamlined processes in group health if we are going to be successful in getting practices to open their doors. This is particularly true for specialists, who currently have a very difficult time managing mixed patient practices.
The generational trend in healthcare is consumer-based care. As this next generation begins to enter the age demographic more likely to use the workers’ compensation system, the significant differences between accessing care in group health and workers’ compensation will become a source of friction for a population that is far more accustomed to getting their way. Now would be a good time for our industry to consider how we can facilitate better alignment so that workers’ compensation care can begin to look a lot more like healthcare to the consumer who just wants to get help with their injury at work the same way they got help with their injury at home.
3. What is one thing you’d like to promote?
In taking on a new role focused on innovation, I am eager to be a catalyst for significant change in our industry. One Call is uniquely positioned as one of the largest companies in our space with strong partnerships committed to improving how injured workers access care. Our goal is to define the future of care coordination by leveraging today’s capabilities in new ways, and making an affirmative effort to find or develop capabilities that have a positive impact on our industry moving forward. We look forward to engaging with our partners committed to changing the status quo and refocusing solutions on patient care – cure the patient, cure the system.
About Greg Moore
Greg Moore, MPH, Senior Vice President of Innovation for One Call Care Management, supports innovation and success within Harbor Health Systems while bringing his relationships, creativity and experience to identify innovative strategies that drive improved outcomes for all One Call clients. Greg founded Harbor Health Systems in 2001.