By Kate Farley-Agee, VP Provider Network Product Development, Coventry
Most discussions about the state of U.S. health care quickly lead to a simple but grim diagnosis: The system is broken. The evidence abounds and it’s compelling. The U.S. spends more per capita than any other country yet often produces only lackluster outcomes. Access to care can be poor. Even average life expectancy, which notched steady gains for decades, has ticked lower in recent years.
But it’s not all bad news. Unpacking the state of health care reveals that not every aspect of the system is dysfunctional. In fact, some parts have never been better. A profusion of medical research is arming clinicians with deeper insights into how the body works. Previously unimaginable treatments are poised to become commonplace. Technology is erasing enormous distances between caregiver and patient. Data analytics, including artificial intelligence, is making an impact on priorities and decisions in the system.
There is another element of care delivery that’s seeing exciting reinvention: networks. In this era of rapid changes to health care, networks are becoming more important than ever. They’re evolving from relatively straightforward mechanisms for directing patients and controlling costs to collaborative partnerships between payors and providers. Call it Network 2.0. This evolution of networks, particularly those focused on workers’ compensation, prioritize both efficacy and efficiency. The best clinicians can more easily rise to the top of the stack thanks to deeper insights into patient trajectories. In the emerging scenarios, powerful analytics and algorithms pull data to evaluate outcomes and push data to aid clinicians in doing what they do best — taking care of their patients in supporting their return-to-work and to their daily routines.
In the emerging scenarios, powerful analytics and algorithms pull data to evaluate outcomes and push data to aid clinicians in doing what they do best — taking care of their patients in supporting their return-to-work and to their daily routines.
How Networks Can Help
To start, networks can continue to lean into being the best at what they’ve always done: managing the relationship with the provider. In addition, workers’ comp networks offer providers another stream of revenue that offers less administrative effort. Networks can also work with providers to streamline administrative burdens. These include letting providers:
- Bill insurers directly, often electronically, thereby reducing the guesswork and the collections burden.
- Grow and diversify their patient base.
- Benefit from being independently credentialed.
- Establish long term relationships with patients extending beyond the care for work-related injuries or illnesses.
- Support employers in their communities.
- Reduce instances of coordination of benefits with multiple payors.
Workers’ compensation networks are unique in other ways. The pool of injured workers goes beyond patients who might solely be served by a particular payor or by Medicare, for example. This allows providers to expand the reach of their practice to new segments of the community in which they operate. And when providers seek to refer injured workers to other clinicians, a network offers an extension of their current referral patterns.
Workers’ Comp Networks Sidestep Patients’ Financial Challenges
Treating those hurt on the job makes sense for other reasons as well. The injured worker isn’t responsible for paying a deductible or copay. This is becoming an ever-more-important differentiator. That’s because out-of-pocket costs can be difficult for patients to manage, especially as many are now expected to shoulder a larger share of the medical expense with the rise of high-deductible commercial plans. It’s worth considering how onerous this burden has become for many people, the provider, the patient, and insurance company. More than one in four consumers with a credit report has at least one debt in collection. And more than half of personal debt in collection is tied to medical bills, reports the federal government’s Consumer Financial Protection Bureau. In 2018, consumers borrowed some $88 billion to pay for health care, according to a survey from Gallup and West Health, a nonprofit. The findings also revealed one in four Americans decided to forgo medical treatments because of concerns about cost.
More than one in four consumers with a credit report has at least one debt in collection. And more than half of personal debt in collection is tied to medical bills, reports the federal government’s Consumer Financial Protection Bureau. In 2018, consumers borrowed some $88 billion to pay for health care, according to a survey from Gallup and West Health, a nonprofit.
A 2016 study by credit rating firm TransUnion found that group health patients’ ability to handle rising out-of-pocket costs is declining. Increasingly, patients are having a harder time meeting the payments required by high-deductible commercial group health plans.
By sidestepping the need to collect copays, it’s easier for providers to receive the full contractual reimbursement directly from the payor in a timely manner. Not having to pursue patients for past-due bills is a help, particularly concerning medical expenses and the administrative costs associated with collections activities. That’s because some individuals put a lower priority on repaying medical debt, according to Benedic Ippolito, a research fellow and health economist with the American Enterprise Institute. He contends Americans often think medical debt is different than other types of debt. “It’s just so low priority relative to paying the mortgage, the car, they simply don’t pay it,” Ippolito notes.
Workers’ comp also faces reduced risk from the ever-shifting winds of politics and health care. The concerns about the fate of the Affordable Care Act, for example, don’t come into play when an employee is hurt at work. This reality is all the more welcome given the fractious political environment.
Next week, we’ll take a closer look at some of the characteristics of the Network 2.0 landscape and the interest that successful employers have in doing whatever they can to help their injured workers recover and return to the job.
About Kate Farley-Agee
Kate Farley-Agee is the Vice President of Network Operations for Coventry, overseeing the company’s national broad-based provider network and 18 certified managed care organizations across the country. She also leads Coventry’s Network Quality Management and Improvement department, Network Paneling and Reporting, and Network Performance groups. Ms. Farley-Agee has over 20 years’ experience in the healthcare industry with an emphasis in network development and leadership. She holds a B.A. in Business Economics and a Master’s in Management and Organizational Behavior as well as certificates in Managed Care and Health Care Administration.
Coventry offers workers’ compensation care-management and cost-containment solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 35 years of industry experience, knowledge, and data analytics. As a part of the specialty division of Aetna our mission is returning people to work, to play, and to life. And our care-management and cost-containment solutions do just that. Our networks, clinical solutions, specialty programs, and business tools will help you focus on total outcomes.
Coventry is a WorkCompWire Ad Partner.
This is not a paid placement.