September 21, 2021 Workers' Comp

Workers’ compensation networks are evolving to meet changing healthcare needs

Experienced workers’ compensation networks are evolving to meet the changing needs of providers, injured workers, and employers.

Experienced workers’ compensation networks are evolving to meet the changing needs of providers, injured workers, and employers. Today, we see constructive partnerships between providers and payers that include a wide variety of provider types and a range of specialty services to support injured workers. The following are just a few of the ways workers’ comp networks are shifting to meet the many challenges and changes in healthcare.

Strong foundations

Successful networks are built on a foundation set in provider access, specialization, compliance capabilities, and quality controls. Comprehensive networks leverage industry experience, knowledge, and data analytics to provide greater discounts, specialties, and a geographic footprint that ensures clients have access to providers who support the needs of the injured workers they serve.

Provider engagement

It’s beneficial for networks to take their engagement to the next level. Strong networks need highly skilled, cost-effective providers who offer clinically appropriate, quality treatment to injured workers, and when backed with additional clinical resources and support systems can achieve the best outcome.

Outcomes-based networks (OBN)

OBNs provide a channeling mechanism to health care providers who demonstrate a depth of experience in treating workers’ compensation injuries. One of the most important yardsticks for their success is the ability to help injured workers return to work, and to achieve this highly successful OBNs are always evolving and evaluating new information to arrive at the best-possible mix of effective care.

Customization

Customization of provider networks supports compliance through built-in measures that allow the right provider selection for each employer’s specific program. Customized networks can also be integrated with nurse triage, clinical programs, telemedicine, pharmacy, and other specialty networks to deliver even greater overall outcomes.

Clinical resources

Incorporating additional clinical resources facilitates better outcomes. For example, nurse triage is an ideal way to establish a road map for success when an injury occurs. Case managers are also at the heart of a workers’ comp claim, typically knowing the doctors and other treating providers.

Specialty services

By including specialty services, clients gain the benefit of an array of supports at reduced rates through existing network relationships. Contractual relationships with providers of durable medical equipment, diagnostics, physical therapy, home health, and other services within an extended network can further streamline patient care.

Mental health

To achieve the best-possible outcomes for injured workers we’ve come to understand that it’s wise to focus on the whole person, including mental health issues. Today, successful workers’ comp models of care consider these aspects from the start and incorporate strong mental health provider networks.

Expanding workers’ compensation networks to recruit highly experienced providers, offer customization, and incorporate additional services creates value and increases networks’ abilities to comprehensively manage overall needs.

To find out more about the benefits of evolving networks, be sure to check out this whitepaper titled Workers’ comp networks are constantly evolving on the Coventry publications page.

This post, by Jill Harris, senior vice president of network operations for Coventry, first appeared on workerscompensation.com.

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