Ancillary services play an important role in an injured worker’s recovery journey. They each serve different purposes for the patient – from physical therapy to durable medical equipment to diagnostics – and by virtue of these differences, they each bring their own reimbursement approaches, performance considerations, and opportunities for optimization. Together, these areas of specialization can create a complex landscape.
That landscape can in some ways make ancillary benefits challenging to manage – because visibility, consistency, and performance management don’t happen automatically. In this environment, how can payers build an ancillary network that reflects their needs today and can evolve tomorrow? How can they create consistency across claims teams while preserving flexibility? And how can they understand what is driving performance across a program – and adapt as conditions change?
Two decades ago, Healthesystems endeavored to answer these questions with our Ancillary Benefits Management (ABM) model, a uniquely integrated approach to connecting, managing, and optimizing ancillary programs that creates a structure in which specialized partners can contribute their strengths as part of a more coordinated whole. Since 2006, this model has helped workers’ comp payers bring greater coordination, visibility, and performance management opportunities to ancillary care.
And while technology and regulations in workers’ comp have evolved over the years, many of the challenges in ancillary benefits management remain the same today: increasing pressure on claims organizations to do more with less, the complexity of managing numerous services, partners, workflows and data, and demand for greater accountability, to name a few. As a result, the need for coordinated ancillary benefits management remains just as relevant now as it was when we first introduced our ABM model.
Let’s look at some core challenges inherent to the complexity of ancillary services, and how they can be overcome:
Building the “Right” Ancillary Network
Every payer wants access to quality ancillary providers. The challenge is building a network that delivers the right coverage today while preserving flexibility to evolve tomorrow. Ancillary network management is rarely a one-time decision; it’s an ongoing process of balancing coverage, performance, flexibility, and operational efficiency.
The solution lies in flexibility. Rather than being constrained by a fixed network structure, payers have an opportunity to tap into flexible network strategies while simplifying the operational and technological complexity that often comes with change. Because all ancillary vendors bring something unique to the table, an optimal network will provide multiple options as well as allow for the addition of new vendors and/or services without placing the burden of technical integration on the payer.
Creating Consistency Across Claims Operations
Managing ancillary services has traditionally required claims professionals to work across multiple vendors, systems, workflows, and communication channels. For instance, creating a physical medicine referral may look very different from arranging transportation or obtaining diagnostic services. Information lives in different places, processes vary by vendor, and even simple tasks can require navigating multiple systems. These differences create operational friction and inefficiencies – and they can make driving utilization toward preferred vendors or networks more difficult.
A common operational framework across all ancillary services can preserve the nuances each service requires while creating greater consistency in how claims teams interact with the program. Bringing referrals, workflows, status tracking, communications, and program oversight into a unified experience empowers claims teams to apply a more consistent management approach across services, vendors, jurisdictions, and claim scenarios – while making it easier to identify where human expertise is most needed.
Improving Transparency and Visibility
The way data is structured across ancillary services can make it difficult to manage costs – both at a transactional level and at scale. Payers routinely deal with inconsistent billing, ambiguous fee codes or modifier codes, and service categories where standard benchmarking approaches, such as fee schedules, may be limited. They need confidence that the underlying data accurately reflects what was delivered, how it was billed, and how it compares across services and vendors.
Greater transparency begins with creating a more consistent view of that underlying information. Once payers can clearly understand what they are paying for, they are better positioned to evaluate costs, identify patterns, and make more informed program decisions. The objective is not simply clearer coding or lower pricing; it is better visibility into the activity and trends shaping overall program performance.
Measuring Success and Adapting Over Time
Even once a payer has built the right ancillary network, created operational consistency, and achieved pricing transparency, they still need to know whether their ancillary program is delivering the right results. How can they understand if a vendor is performing well? If network penetration is where it should be? If service outcomes are improving?
Answering these questions becomes easier when payers have access to meaningful benchmarks by which to compare. Having performance data from across a broad ancillary ecosystem helps them to better understand utilization patterns, vendor performance, network penetration, and program outcomes. That broader perspective creates valuable context for evaluating performance, identifying opportunities for improvement, and making informed adjustments over time – and ultimately helps to ensure accountability through the payer’s ancillary network.
ABM: An Enduring Solution
Twenty years after its introduction, the core idea behind Healthesystems’ ABM model remains unchanged: ancillary programs perform best when specialized services, partners, and workflows are managed as part of a connected, coordinated whole. While the tools, technologies, and market dynamics surrounding ancillary care may change over time, the need for a coordinated framework that helps payers manage complexity remains as relevant as ever.
To learn about more about ancillary benefits management (ABM), see the Healthesystems website.
Partner Post:
This is a sponsored post from WorkCompWire marketing partner Healthesystems.