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… [Read more]
Leaders Speak
Kate Farley-Agee: The Best Workers’ Comp Networks Let Providers Be Providers
By Kate Farley-Agee, VP Provider Network Product Development, Coventry Most discussions about the state of U.S. health care quickly lead to a simple but grim diagnosis: The system is broken. The evidence abounds and it’s compelling. The U.S. spends more per capita than any other country yet often produces only lackluster outcomes. Access to care… [Read more]
Scott Rogers: The Essence of Service Partnerships: Maximizing Service Provider Performance
By: Scott Rogers, Chief Client Officer, Sedgwick Most employers find that a partnership with the right third party administrator can help them meet their risk management goals and create a positive experience for their injured employees and customers. In Part I of this article series, we looked at how to evaluate and select the right… [Read more]
Scott Rogers: The Essence of Service Partnerships: Identifying and Selecting the Right Service Partner
By: Scott Rogers, Chief Client Officer, Sedgwick Cultural and technology changes have rapidly evolved the claims management industry. Employers have many choices to make to ensure that when a workers’ compensation claim occurs, the employee is cared for properly and returns to productivity. The interaction with employees when an unfortunate event occurs impacts their feeling… [Read more]
Dan Maldonado: How Can You Ensure Your UR Vendor is the Hiring the Right Physicians?
By Dan Maldonado, DC, Clinical Director for Utilization Review and Physician Advisory Services, Genex Services The success of a utilization review organization depends on the quality of its physician network. UR physicians impact all stakeholders on a workers’ compensation claim when they render a determination of medical necessity. For this reason, it’s important to know… [Read more]
Mariellen Blue: Five Initial Evaluation Issues That May Delay Return to Work
By Mariellen Blue, National Director of Case Management at Genex Services “You only get one chance to make a first impression.” This common phrase is especially true in establishing a positive relationship between an injured employee and the treating physician in a workers’ compensation case. A thorough initial evaluation sets the course for a successful… [Read more]
Mike Cirillo: Transparent Pricing: It’s about Clarity and Choice
By Mike Cirillo, President, myMatrixx As mentioned in last week’s article, the concept of transparent pricing has spawned several new entrants in the workers’ compensation pharmacy benefit management (PBM) space. All with the promise of a lower price per script through transparent pricing. Established PBMs, like myMatrixx, are also offering transparency pricing models. Buyers need… [Read more]
Mike Cirillo: Understanding Value in Pharmacy Management
By Mike Cirillo, President, myMatrixx As the worker’s compensation pharmacy benefit management (PBM) landscape evolves and consolidates, several startups have entered the marketplace with promises of low rates and transparency. But what exactly does that mean? Transparency means different things to different people. Knowing how much a medicine costs is transparency. Understanding the exact amount… [Read more]
Dr. Mitch Freeman: Pondering Pot: Recent Updates and Research that Underline the Need for More Insights
By Dr. Mitch Freeman, PharmD, Chief Clinical Officer, Mitchell International Pharmacy Solutions The U.S. Surgeon General’s recent advisory on marijuana use during adolescence and pregnancy highlights a critical perspective in the push to legalize marijuana: we still do not yet know enough about the drug. As the opioid crisis continues and states look for ways… [Read more]
Rebecca Morgan: Five Inevitable Technologies That Will Transform the Claims Process
By Rebecca Morgan, Senior Director, Product Management, Mitchell The other day while FaceTiming with my daughter who is away at college, I was reminiscing about my own time away at college. While I was at school, I wrote hand-written letters back home every week to keep in touch with my family. I called home every… [Read more]