By Kate Farley-Agee, VP Provider Network Product Development, Coventry
The role of provider networks, particularly in workers’ compensation, is evolving. Networks are going beyond simply acting as a bridge between patients and clinicians. Instead, there is a heightened focus on both efficacy and efficiency.
Last week, we looked at how these new network iterations in workers’ comp — what might be called Network 2.0 — are focusing more on striking robust partnerships between payors and providers. Here we’ll examine some of the characteristics we’re seeing emerge in newer and revamped networks.
Payors and the companies they represent are eager to get injured workers back on their feet and back on the job. Many of these companies represent the heavyweights of corporate America. Major employers like manufacturers, large retailers, and airlines rely on comprehensive return-to-work programs to help their injured employees recover. The best programs do far more than safeguard the bottom line. They focus on truly addressing the needs of injured workers themselves. That’s because the longer workers are away, the less likely it is they will return to the workplace.
The Department of Labor found in a study of federal workers that among those who were away at least a year, nearly half (PDF) did not return within the three-year study period. The New York State Workers’ Compensation Board breaks down similar statistics (PDF). The agency reports there is only a 50 percent chance that an injured employee will return-to-work after a six-month absence. That drops to a 25 percent chance following a one-year absence. After two years away, the likelihood a worker will return plunges to a 1 percent chance.
The New York State Workers’ Compensation Board reports there is only a 50 percent chance that an injured employee will return-to-work after a six-month absence.
These figures underscore the importance of helping injured workers return to the job. Those who are out of work longer face greater risks from an array of challenges that include social isolation and depression in addition to financial stress to loss of skills and medical complications resulting from potentially being forced into a more sedentary lifestyle.
Top companies understand that having a worker return to the job either under modified duty or, if possible, full duty, is the best outcome for workers and for business. Therefore, these employers offer fair reimbursements to providers and pay on time. That’s because top-tier employers recognize the irreplaceable value providers bring. Alongside employers and payors, providers are part of a three-legged stool that helps injured workers return to the job. This rewarding role is what helps set marquee workers’ comp networks apart; it’s the shared focus on return-to-work that is essential to a patient’s ultimate success. The focus on functionality — getting someone back on their feet and back to their daily life — fits well with most providers’ sense of purpose in the care they give. The empirical threshold of whether someone makes it back to work and to proper function is also an important one because successful return to modified or full duty affords employees the chance to earn a full paycheck. That’s important to workers, of course. The National Safety Council, a nonprofit chartered by Congress, estimated that in 2017 the average cost per worker following an injury on the job totaled $1,100. This includes expenses the worker faced to help offset the cost of work injuries.
How Network 2.0 looks today
The benefits that workers’ comp networks bring to employees, employers, and providers are clear. What’s most interesting is how networks are evolving to meet the needs of employers and patients. These next-generation networks often are tighter, specialty-focused, smaller — right-sized — and they benefit providers by grouping together the best of the best. Many such networks pull together smaller groups of providers with specific expertise who can best help injured workers.
These next-generation networks often are tighter, specialty-focused, smaller — right-sized — and they benefit providers by grouping together the best of the best.
And, of course, specialty networks focus on narrow areas to let clinicians do more of what drives them and what they’re best at doing. These newer networks present providers with opportunities to keep up with how some of their peers are utilizing new treatment regimens with emerging technologies such as telemedicine and remote patient monitoring.
Workers’ comp networks today are also doing more to support providers than some of their predecessors. In essence, a strong network means providers have someone blocking and tackling on a range of issues so clinicians can focus on injured workers. These include:
- Aiding providers with education and interaction on policies, procedures, and efficiency.
- Assisting providers’ office staff with quick-reference guides and query support.
- Offering providers streamlined utilization review programs and scheduling services.
- Sharing insights into state and federal regulations.
Amid all the changes in health care — and all the challenges that remain — there are bright spots. One of them is the new form of networks. In Network 2.0, we see constructive partnerships between providers and payors in service of injured workers. This allows networks to promote both efficacy and efficiency. They allow the best providers, with the support of payors, to deploy top clinical skills to help injured workers return-to-work.
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.