By: Horizon Casualty Services, Inc. (HCS)
With medical costs continuing to trend upward, identifying and maintaining best-in-class preferred provider organizations (PPOs) continues to be of paramount importance.
Medical cost control continues to be the most challenging component of workers’ compensation expenses. For this reason, contracting with best in class workers’ compensation PPOs should be the goal of every insurer in order to assure superior medical outcomes at the lowest cost. But with so many PPOs out there, how do you know which one to choose?
Though many workers’ compensation PPOs claim to be the biggest and the best, due diligence on the part of executive decision makers is critical. In order to stay ahead of the competition, workers’ compensation PPOs must consistently achieve the medical care quality triple aim.
The triple aim summarized:
- Best doctors – Contracting with the best providers at the most competitive rates
- Long-term provider retention
- Effectively steering injured workers to those PPO providers most qualified to treat their specific work injury
Horizon Casualty Services, Inc. (HCS), an affiliate of Horizon Blue Cross Blue Shield of New Jersey, provides workers’ compensation and personal injury protection (PIP) PPO services throughout New Jersey processing over $2.8 billion in medical bills annually. With that scale, HCS successfully leverages its experience and data to drive the best medical outcomes for injured workers at the lowest cost.
Here are five tips for making the right workers’ comp PPO network decision:
Tip #1: Demand providers who put quality first.
For injured workers and their families, nothing is more important than rapid recovery and timely return to work. And that means the right treatment, from the right specialist, from the very first appointment. Your PPO should be adept at identifying the highest rated providers that are best in class within their specialties. This is especially critical for orthopedics and pain management providers, which should achieve superior outcomes by using nationally accepted, evidence-based guidelines as well as a conservative approach to surgery and prescribing opioid narcotics.
At HCS, this is our Outcomes Focused Network Strategy. The objective is to achieve the best medical outcomes with the lowest per unit costs.
Tip #2: Ask Your PPO to provide the road map.
Let’s face it, claims adjusters are busy. Having a standard provider directory that only features provider names displayed alphabetically does not make it easy to find best in class providers. Your PPO provider directory should feature premier providers at the top of any search along with their board specialty and principal area of practice (for example, knee, shoulder or spine).
HCS provides the road map by featuring Outcomes Focused Providers at the top of their provider search tool, along with the medical specialty, area of practice, hospital and ambulatory surgical center affiliations. By having a strategic provider directory, it allows claims adjusters to give consistent referrals to trusted best-in-class providers; a benefit for injured workers and insurers – clearly a win-win!
Tip #3: Make them put their money where their mouth is.
The difference in the results between a good PPO and a great one is millions of dollars. “Ask your PPO to show evidence of cost savings and positive outcomes,” recommends Jacqueline Alonso, President of Horizon Casualty Services, Inc. “We partner with our clients and network of providers in a collaborative effort to identify savings opportunities while streamlining the administrative process. At the end of the day, we want to make it easy for our customers to do business with us, and we work closely with them to provide appropriate patient treatment that results in positive outcomes.”
Workers’ compensation claims may last from one day to a lifetime. Long tail claims can result in significant cost and reserving challenges. However, significantly controlling medical cost requires selecting a PPO with a sufficiently large provider network, with high quality providers and contracted rates far below what insurers would pay if there were no PPO in place.
Being an affiliate of the largest health insurer in New Jersey, Horizon Casualty Services, has the size, referral volume and goodwill of the provider community. This enables the company to successfully contract at extremely competitive rates with important health care providers in the Garden State.
Tip #4: Network utilization (or penetration) is an important metric.
Under New Jersey workers’ compensation law, the insurer has the ability to steer injured workers to providers of the insurer’s choice. This provides opportunity to leverage contracted PPO rates and optimize results. For this reason, network utilization is a key metric. A broad PPO facilities network is very important because payments to facilities such as acute care hospitals, rehab hospitals and ambulatory surgery centers represent a significant portion of the medical spend.
HCS contracts with almost all acute care hospitals, all major rehabilitation hospitals and a vast array of ambulatory surgery centers. The company also contracts with physicians and other health care professionals specializing in musculoskeletal medicine. As a result, client network utilization levels are extremely high.
Tip #5: Do they sweat the details?
A disorganized PPO operation with unacceptable levels of medical bill processing errors can create reputational damage for carriers and employers. This can also lead to unnecessary administrative costs. The best workers’ compensation PPOs process bills promptly and accurately.
A leading indicator of an efficient PPO is their appeal rate. At HCS, flawless execution is key. With HCS’s focus on maintaining pristine provider demographic data, precise medical bill pricing results and excellent relationships with its provider network participants – The Company’s workers’ compensation appeals rate is 0.2%!
In summary, your workers’ compensation PPO should be strong and stable. HCS will put quality first and provide the road map to superior care at the right price. The Company also provides access to an exclusive medical network in New Jersey which will deliver significant savings. Rest assured, HCS will always sweat the details … so you don’t have to!
About Horizon Casualty Services, Inc.
Horizon Casualty Services Inc., an affiliate of Horizon Blue Cross Blue Shield of New Jersey, in business since 1994, is a leading PPO in New Jersey workers’ compensation and personal injury protection. The company’s 100% direct-contracted provider network includes almost all New Jersey acute care hospitals, significant overall WC savings and, with its deep focus on precision, an extremely low WC appeals rate of 0.2%. Its PPO results, combined with its WC healthcare value and OFN strategy, enables insurers to be the best at delivering quality medical care to claimants at the right cost — clearly a win-win for all.
This is a sponsored post from WorkCompWire marketing partner Horizon Casualty Services.