Newport Beach, CA – Identifying and using high performing physicians in medical networks treating workers’ compensation claimants can have a significant impact in reducing overall claims costs and duration.
Harbor Health Systems, a One Call Care Management company, presented these findings at the California Orthopaedic Association annual meeting in Carlsbad, Calif. earlier this month as part of a panel entitled, “How Workers’ Compensation Medical Provider Network (MPN) Physicians are Rated/Selected.” Kent Spafford, who sits on One Call’s Board of Directors and serves as an advisor to Harbor Health Systems, co-presented with an executive from Coventry Health.
“Benchmarking and scoring are the first steps in identifying high performing physicians,” Spafford said. “When this intelligence is used in MPN management to assure regulatory compliance and direct patients to these physicians, payers are seeing outstanding results in lower costs and improved outcomes.”
Harbor manages or owns 154 medical provider networks nationwide with 1.7 million employees enrolled. The company has developed a proprietary software suite, MD 360, that examines 20 different variables within the MPNs treating workers’ compensation claimants. Harbor does not evaluate medical skills of individual physicians, but uses a scoring method based on a retrospective analysis of closed claims. Among the criteria examined are cost of treatment, duration of treatment, recidivism of the patient, and litigation involving the claim. Harbor’s proprietary software suite is then used to schedule patients to be cared for by the higher-scoring physicians, and to manage and measure the outcomes.
As a result, Harbor has been able to cut overall claims costs by nearly 20 percent and indemnity-related costs by nearly one-third, compared to some other workers’ compensation management firms. In one instance where a third-party administrator (TPA) used the Harbor Health’s platforms, closed claims increased by 50 percent and the average claim amount dropped by 9.1 percent within nine months.
Source: Harbor Health Systems