By Melissa McGarry, Director, Product Implementation, Coventry
The coronavirus pandemic has taught us much about disparities in health care. We know, more than ever, that access to robust care carries profound and, indeed, life-altering consequences.
For years now, we’ve understood the same holds true for helping injured workers get back on the job: quality of care matters. Relying on those providers who have proven track records of success when it comes to addressing the unique needs of injured workers is a winning formula.
This success-breeds-success ethos emerged alongside recognition that other forces, like comorbidities and mental distress, can also exert enormous influence on the trajectory of workers’ recoveries. Yet now, armed with deeper data sets and more robust analytics, we realize with even greater certainty just how important that quality-of-care aspect of a claim is — giving injured workers access to the best clinicians.
Networks, in general, enable injured workers to gain broad access to the care they need. After all, about 80 percent of payments for medical services in workers’ comp flow through medical provider networks. There is also evidence that the arrival of networks into new jurisdictions can benefit injured workers and lower costs at the same time.
Such results aren’t surprising. To be a part of a network, a provider is likely to have to meet certain criteria or have their credentials verified. Credentialling is good for injured workers. The more we work with those who get hurt on the job and the more we study the best outcomes for what went right, it’s clear that effective, high-quality medical care plays an essential role. To pull those best-performing clinicians to the front of the line when it comes to treating injured workers, many turn to outcomes-based networks (OBNs). These networks within networks can offer an injured worker the benefit of proven expertise and perhaps the best shot at a successful recovery.
To continue to achieve success, high-achieving OBNs, like the providers comprising them, aren’t static. Robust OBNs will always be evaluating new information. And these networks will always be doing the fine-tuning needed to arrive at the best-possible mix of effective care at a reasonable price so that injured workers can regain their footing as quickly as possible.
In workers’ comp, quality pays its own way. Taking steps such as doubling down on injured-worker outcomes and relying on networks that prioritize the most effective clinicians can reduce overall workers’ compensation spending, according to McKinsey.
OBNs Factor Into Overall Injured Worker Outcomes
Efforts to continually tweak OBNs are a natural outgrowth of our broader understanding of what makes for a successful recovery. The workers’ comp industry has always rightly focused on getting those who are injured back on the job as soon as possible to minimize the chance of a poor outcome and to save on unnecessary medical spending. But now we know to look well beyond the injury itself for insights into how a recovery might unfold.
To help remove obstacles that could forestall a return to work, we routinely consider factors that once seemed farther afield from the particulars of an injury: We know to take into account the mental welfare of an injured worker, the presence of comorbid conditions, and the possibility of deleterious socioeconomic factors, among others.
Beneath each of these broad factors, it’s intuitive that there are innumerable details. What might be less evident is how many variables should be factored into identifying the best providers. To understand who’s best equipped to help injured workers, it’s wise to have a balanced measurement design that encompasses multiple aspects of claim outcomes such as:
- Medical utilization
- Clinical benchmarks
- Quality measures
- Return to work
- Indemnity spend
- Financial performance
An OBN, which operates as a subset of a traditional broad-based network, gathers those providers who have shown particular success in aspects such as these and therefore in helping injured workers recover in a timely, effective, and efficient manner.
Next week, we’ll dig further into some of the factors OBNs often examine to understand how effective providers are in piloting injured workers’ successful recoveries.
About Melissa McGarry
Melissa McGarry has been with Coventry for more than 10 years and oversees multiple network products including its Outcomes-based Network Program, Exclusive Provider Program, Telemedicine Networks and Auto Network. She has more than 30 years’ experience in the health care industry with deep knowledge of networks, network products, utilization management, and behavioral health. Melissa holds a B.A. in Psychology from The University of Texas at Austin and a Master’s in Educational Psychology from the University of North Texas.
Coventry, a part of the Mitchell | Genex | Coventry organization, 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 40 years of industry experience, claims knowledge, and data analytics expertise. Our mission is returning people to work, to play, and to life, and our care-management and cost-containment solutions do just that.
Coventry is a WorkCompWire ad partner.
This is NOT a paid placement.