Employee compensation – a plus for participating providers
- 12/16/20
- The soundboard
Most discussions about the state of U.S. health care quickly lead to a simple but grim diagnosis: the system is broken. The evidence is abundant and compelling. The US spends more per capita than any other country, but it is often poor. Access to care can be poor. Even the average life expectancy, which has been increasing steadily for decades, has fallen in recent years.
But it’s not all bad news. Unpacking the health status shows that not every aspect of the system is disturbed. In fact, some parts have never been better. A wealth of medical research offers doctors deeper insights into how the body works. Previously unimaginable treatments are the order of the day. Technology sometimes erases enormous distances between caregiver and patient. Data analysis, including artificial intelligence, affects priorities and decisions in the system.
There’s another element of service delivery that’s excitingly reinventing: networks. In times of rapid changes in the healthcare system, networks are more important than ever. They are developing from relatively simple mechanisms for patient management and cost control to cooperation partnerships between payers and providers. Let’s call it Network 2.0. This development of networks, especially those focused on employee compensation, prioritizes both effectiveness and efficiency. The best clinicians can easily climb to the top of the pile with deeper insights into patient histories. In the emerging scenarios, powerful analytics and algorithms pull data to evaluate the results and share data to help clinicians do what they do best. They take care of the patients to support their return to work and return to their daily routines.
How networks can help
In the beginning, networks can still focus on doing the best they’ve always done: managing the relationship with the provider. In addition, worker-comp networks provide providers with another source of income with less administrative overhead. Networks continue to work with vendors to streamline administration. These steps include leasing providers:
- Billing insurers direct, often electronically, which reduces the guesswork and debt collection burden
- Grow and diversify your patient base
- Benefit from the independent authorization
- Forge long-term relationships with patients that go beyond caring for work-related injuries or illnesses
- Support employers in their communities
- Reduce the need to coordinate services with multiple payers
Worker compensation networks are unique in other ways. The pool of injured workers extends beyond patients who may only be cared for by a specific payer or, for example, Medicare. This enables providers to expand the reach of their practice to new segments of the community in which they operate. And when providers try to refer injured workers to other clinicians, a network provides an extension of their current referral patterns.
Employee comp networks circumvent patient financial challenges
The treatment of those injured in the workplace is also useful for providers for other reasons. The injured employee is not responsible for any deductible or co-payment. This is becoming an increasingly important differentiator. This is because patients can find it difficult to manage costs out of pocket, especially as many are expected to pay more of the medical costs with the advent of high-deductible commercial plans. It is worth considering how burdensome this burden has become for many people, the provider, the patient and the insurance company.
By avoiding the need to collect copays, it is easier for providers to receive full contractual reimbursement directly from the payer in a timely manner. Another benefit is not having to chase patients for overdue bills, especially in terms of the medical and administrative costs associated with debt collection activities.
There are other long-standing employee benefits of comp networking that seem to be growing all the time. The reimbursement rates for providers are still significantly higher than those for group health. Research by the National Council on Compensation Insurance (NCCI) found that the prices for employee compensation are 12 percent higher than group health. It is worth remembering that part of the reason reimbursements are higher is because workers’ reimbursements are intended to cover the real cost of managing care. Too often, providers simply cannot cover their expenses. Research highlights the problem. For example, the impartial Congressional Budget Office (CBO) found that private insurers pay doctors and hospitals well above what Medicare pays for a basket of shared services. Of course, doctors didn’t need the CBO report to understand the problem. A recent survey of around 475 doctors found that two-thirds believed Medicare payments in 2019 would not be enough to cover the cost of care. Some respondents claim that the complexities and comorbidities often associated with caring for the elderly make Medicare reimbursement all the more inadequate when compared to employee reimbursement.
Courtesy Coventry The soundboard
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Disclaimer: WorkersCompensation.com publishes independently produced writings by various stakeholders in the compensation industry. The opinions expressed are solely those of the author and do not necessarily reflect those of WorkersCompensation.com.
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