By Kate Farley-Agee, Vice President, Network Products, Coventry
Recovery is a word we use a lot in workers’ compensation. It’s a simple term with a sometimes equally straightforward path to its end. A repetitive strain injury might require physical therapy and time to heal. Yet when it comes to treating an opioid use disorder, the concept of recovery tends to oversimplify all that must occur to move an injured worker toward a successful outcome.
There are numerous aspects of care that must unfold in coordination to increase the likelihood of success in treating an opioid use disorder. The keystone element of a solid recovery plan is ensuring an injured worker has access to clinical expertise. Having providers who are experienced in addiction recovery is essential; they can deploy a full complement of tools focused on the issues in order to help injured workers.
Therefore, a specialty network built around addiction recovery plays an important, if unsung, role in helping injured workers pull away from the ravages of opioid use disorder. These networks channel to the best, most accomplished providers in the recovery realm to give injured workers the best shot at bouncing back.
Last week, my colleague Nikki Wilson, PharmD, MBA, Coventry’s director of pharmacy product development, shared how deploying the right resources at the right time along with a focus on the biopsychosocial aspects of recovery is the best way to help injured workers recover from opioid use disorder. Here, we will examine some of the related considerations around provider networks.
What’s most important about a network when considering treatment of opioid use disorder is that its providers have expertise in this work, have repeatable protocols, and have a multidisciplinary team in place. The team would include an experienced intake coordinator and someone with expertise in behavioral health. Possessing this kind of bench strength makes it possible to assemble a complete and experienced recovery team.
Because there are numerous considerations around the treatment of injured workers, there can be value in seeking network partners armed with knowhow about both injured workers and addiction recovery. This might take the form of a network within a broader network. It’s akin to the individual wires within a thick cable: There oftentimes are multiple color-coded strands that serve specific functions yet also work in conjunction with each other for a broader purpose. A well-established network can feature complementary conduits specializing in opioid use disorder, behavioral health, diagnostics, and other relevant services.
A network that is well-suited to helping an injured worker suffering from an opioid use disorder is also likely to offer various treatment options for the injured worker including inpatient, outpatient and residential. This enables clinicians and others who are a part of the injured worker’s recovery team to customize the treatment plan.
In workers’ comp, the pathway into treatment for an injured worker can be shorter than in group health. That’s because in workers’ comp the treating provider might be an occupational health provider or perhaps a primary care clinician or even an urgent care or the emergency department provider. In other cases, a call to a nurse triage hotline might result in a direct referral to an orthopedic specialist. Whereas in group health, reaching this level of care might first require numerous tests and visits with specialists.
Those who are experienced in addressing the unique concerns of injured workers can more readily identify what interventions might be needed. That cut-to-the-chase urgency can help get an injured worker into a treatment plan that much sooner. In part that’s because occupational injuries often have more well-defined parameters around the cause and nature of an injury as well as specific medical treatment guidelines. This means it can be possible to sidestep some of the exploratory testing that often occurs with a patient’s chronic challenges in group health.
Ultimately, it Comes Down to Expertise
The work to create a specialty network is substantial though at its core the critical and unifying component is simple: expertise. Having a record of success in treating patients with opioid use disorder is essential. The same is true for the network itself. In order to identify those providers with the most to offer patients, it’s imperative that a network screen for clinicians with the proper training who have demonstrated skill at helping patients recover. A broad-based network can mine for these types of metrics around performance and efficacy in treatment of patients experiencing opioid use disorder. And, naturally, a broad network can select providers using a larger and more diverse base of data. In short, large-scale networks typically have the breadth capable of supporting a network within a network. That subnetwork can then elevate the best providers for treating opioid use disorder.
A network with sufficient depth can not only boost the number of providers who meet quality standards for treating opioid use disorder, it also can rely on more rigorous standards for inclusion within this opioid-recovery pool of clinicians. By having more providers to choose from, a network can, in fact, be more selective about whom it includes within a specialty network, including those built around addiction and misuse or related areas of behavioral health. These providers can be further stratified to select those who have experience in treating injured workers and in treating patients with opioid use disorder. That marriage of areas of expertise could prove critical to giving an injured worker struggling with addiction the best chance at achieving a sustained recovery.
Specialty Networks Can Punch Above Their Weight
Provider networks offer several advantages. These partnerships involving clinicians, facilities, and insurers provide access to high-quality care for patients at a reasonable cost. Network parameters help ensure quality care by vetting providers and by stipulating, in some cases, standards of care. Specialty networks operate in the same way — grouping together exceptional providers in order to achieve improved outcomes.
For network clients, relying on a specialty network carved from a larger network can be reassuring because the same rigorous credentialing that would have merited inclusion in a broad-based network would also apply to any specialty network. It’s further consistent vetting of providers from a pool of those who have already been vetted.
Beyond the all-important measures of quality, there are other potential benefits to relying on a specialty network that’s part of a larger entity. For existing clients, the same parameters, data feeds, and workflow procedures in place for a broader network would apply to the specialty network. The specialty network draws strength from and is more robust by being part of a larger network. Taken together, the aligned efforts of multiple types of providers form a whole that accrues more than the proverbial sum of its parts.
As with a broad-based system, issues can bubble up in specialty networks, too. When concerns do arise, it’s helpful to have well-documented procedures for how to rectify them. When a specialty network is part of a larger network entity, such protocols are already in place. That makes it easier for network clients. In the case of injured workers who also are grappling with opioid use disorder, having a network designed around these overlapping challenges can result in fewer problems to begin with. But when issues do emerge, understanding workers’ comp, opioid use disorder, and other areas like behavioral health can help promote a speedy resolution.
There are other reasons to pay particular attention to the strength and reliability of a network within workers’ comp. For example, unlike in group health, injured workers are contacting their employers following an incident. And injured workers don’t need to engage in comparison shopping the way they might with a traditional insurance claim. Instead, injured workers might see treating providers based on a recommendation from a case manager. Under the grand bargain of workers’ comp, injured workers are putting the trust in their employer to provide access to well-qualified and accomplished clinicians.
Much of this work of promoting trust falls to experienced case managers, who often have good working relationships with top providers in a given network. That strength in the clinical realm can be matched with strength in a network itself to offer the best-possible assistance to injured workers with an opioid use disorder. The network and clinical experience, together, can direct more power toward enabling recovery. Case managers can get the injured worker to the right type of provider at the right time thereby promoting better case outcomes.
Expertise wins out in other realms as well. One such area involves data analytics. The rise of technologies including artificial intelligence is making it more likely that case managers will receive alerts that much sooner when injured workers begin to show warning signs of an opioid use disorder. As these data tools become more precise, they’ll further empower case managers to intervene early by suggesting, for example, that an injured worker be referred to a psychiatrist or an addiction specialist. Scouring the data for anomalies also can help promote safety and efficiency in other ways. This includes flagging unusual prescribing patterns or billing practices. Data insights also offer an avenue for education of patients and providers alike around emerging research concerning opioid use disorder.
While Much Work Remains, the Team Approach Offers the Best Bet
Treating injured workers who are also suffering from opioid use disorder comes down to expertise. That’s expertise in the network itself, in case management, and, of course, in providers with specific skills and experience in approaches to opioid usage. Aligning these efforts offers injured workers the best possible team for achieving recovery and returning to work.
The extraordinary challenges of opioid use disorder will remain in the U.S. for years. Yet improvements are possible. We are making progress when we turn to the best clinicians, rely on multiple treatment methods, and consider the whole patient. Together, health care professionals and their network partners must continue to work toward reducing the incalculable toll of opioid use disorder.
About the Author
Kate Farley-Agee oversees Coventry’s national broad-based provider network and state-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. Kate has over 20 years’ experience in the health care 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. In addition, she holds certificates in Managed Care and Health Care Administration.
Coventry offers workers’ compensation, auto, and disability 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. Our mission is to return 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.