October 12, 2020 Workers' Comp

Unlocking the Benefits Behind Custom Networks

In this era of rapid changes to health care, networks are becoming more important than ever.

In this era of rapid changes to health care, networks are becoming more important than ever. They’re evolving from relatively straightforward mechanisms for directing patients and controlling costs to collaborative partnerships between clients, networks and providers. Part of this evolution involves the development of custom networks, which have grown nearly 30% over the last few years. These workers’ comp specific networks provide the option to meet the unique needs of specific injured workers to achieve better outcomes.

This component is essential for effective claims management for workers’ compensation injuries. Network providers are familiar with the workers’ comp system, have met necessary contracting and credentialing requirements, control claim costs by agreeing to negotiated rates and align their treatment plans with nationally recognized treatment guidelines in order to return injured employees to work as quickly and safely as possible. Network providers are also encouraged to refer to other in-network providers when possible, ensuring the majority of treatment is managed within the network.

Research shows the ability to customize providers in a work comp network leads to improved penetration rates, increased savings and lower claims duration, and 9 out of 10 clients see value in the ability to customize their own network.

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To further improve outcomes, many states allow carriers and employers the ability to customize the network they offer to injured workers.

States Allowing Customization:
Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky,
Missouri, Nevada, North Carolina, Oklahoma, Pennsylvania, South Carolina, Utah, and Virginia

Customization allows clients to design a network that meets their specific population’s needs and the ability to limit selection to those providers with proven results; all the while maintaining any required state coverage needs and/or requirements. Coventry’s Network Customization Tool (NCT) provides clients with the ability to view, add, and term providers to their client specific, proprietary networks. Customers can remove providers from view that don’t meet network criteria to ensure they are not mistakenly added to a custom network. The tool also allows customers to review and sort providers by address, specific provider information, and specialty/facility services. Customers can also submit demographic updates they’re aware of directly to Coventry through NCT. These customized networks can be integrated with nurse triage, clinical programs, telemedicine, pharmacy, durable medical equipment, and other ancillary networks to deliver improved overall outcomes.

State certified networks address compliance through built in measures that ensure the right provider selections for each program. Networks that offer customization tools enable users to search for providers that can fill gaps in coverage, in order to meet regulatory requirements. When customizing a state certified network reports are available for compliance purposes.

Implementing custom networks do far more than safeguard the bottom line. They focus on truly addressing the needs of injured workers themselves. These networks assist clients who are eager to get their 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 benefits that custom work comp networks bring to employees, employers, and providers are clear. What’s most interesting is how networks overall are evolving to meet the needs of employers and patients. These next-generation networks often are tighter, specialty-focused, smaller — right-sized — networks that benefit employers by grouping together the best of the best. Many of these networks pull together smaller groups of providers with specific expertise who can best help injured workers.

This evolution of networks, particularly those customized to focus on workers’ compensation, prioritize both efficacy and efficiency. The best clinicians can more easily rise to the top thanks to deeper insights into patient trajectories. In the emerging landscape, powerful analytics and algorithms pull data to evaluate outcomes and push data to aid clinicians in doing what they do best — taking care of patients in supporting their return- to- work and a return to their daily routines.


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