December 21, 2020 Workers' Comp

Network 2.0 - Constructive partnerships between providers and payers

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<p>In our <a href="http://cvty.info/3oNe7bQ" target="_blank" rel="noreferrer noopener">last blog</a> post we discussed how networks help to manage the relationship with the provider and allow patients to sidestep financial challenges. Today we’ll delve into more ways work comp networks support injured workers and potential next steps in network development.</p>

In our last blog post we discussed how networks help to manage the relationship with the provider and allow patients to sidestep financial challenges. Today we’ll delve into more ways work comp networks support injured workers and potential next steps in network development.

The best companies want workers back on the job

Payers and the companies they represent are eager to get injured workers back on their feet and back on the job. Many of these companies represent the heavyweights of corporate America. Major employers like manufacturers, large retailers, and airlines rely on comprehensive return-to-work programs to help their injured employees recover. The best programs do far more than safeguard the bottom line. They focus on truly addressing the needs of injured workers themselves. That’s because the longer workers are away, the less likely it is they will return to the workplace. The New York State Workers’ Compensation Board has broken down some statistics, and reports that there is only a 50 percent chance that an injured employee will return to work after a six-month absence.16 That drops to a 25 percent chance following a one-year absence. After two years away, the likelihood a worker will return plunges to a 1 percent chance.

These figures underscore the importance of helping injured workers return to the job. Those who are out of work longer face greater risks from an array of challenges that include social isolation and depression in addition to financial stress to loss of skills and medical complications resulting from potentially being forced into a more sedentary lifestyle.17

Top companies understand that having a worker return to the job either under modified duty or, if possible, full duty, is the best outcome for workers and for business. Therefore, these employers offer fair reimbursements to providers and pay on time. That’s because top-tier employers recognize the irreplaceable value providers bring. Alongside employers and payers, providers are part of a three-legged stool that helps injured workers return to the job. This rewarding role is what helps set marquee workers’ comp networks apart; it’s the shared focus on return to work that is essential to a patient’s ultimate success.

How Network 2.0 looks today

The benefits that workers’ comp networks bring to employees, employers, and providers are clear. What’s most interesting is how networks are evolving to meet the needs of employers and patients. These next-generation networks often are tighter, specialty-focused, smaller — right-sized — networks that benefits providers by grouping together the best of the best. Many such networks pull together smaller groups of providers with specific expertise who can best help injured workers. And, of course, specialty networks focus on narrow areas to let clinicians do more of what drives them and what they’re best at doing. These newer networks present providers with opportunities to keep up with their peers who are utilizing new treatment regiments with emerging technologies such as telemedicine and remote patient monitoring.

Workers’ compensation networks today are also doing more to support providers than some of their predecessors. In essence, a strong network means providers have someone blocking and tackling on a range of issues so clinicians can focus on injured workers. These include:

  • Aiding providers with education and interaction on policies, procedures, and efficiency
  • Assisting providers’ office staff with quick-reference guides and query support
  • Offering providers streamlined utilization review programs and scheduling services
  • Sharing insights into state and federal regulations

Amid all the changes in health care — and all the challenges that remain — there are bright spots. One of them is the new form of networks. In Network 2.0, we see constructive partnerships between providers and payers in service of injured workers. This allows networks to promote both efficacy and efficiency. They allow the best providers, with the support of payers, to deploy top clinical skills to help injured workers return to work.

References:

  1. See, http://www.wcb.ny.gov/content/main/ReturnToWork/RTW_Handbook.pdf
  2. See, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635882/

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