WC Bill Review – status update

Networks aren’t the only work comp managed care service experiencing change these days. The bill review business is also looking a bit tumultuous, with the landscape shifting in response to, as well as independent of, Coventry’s moves.
I’ll be examining the industry this week, looking at a few of the major entities at a time.

Broadly speaking, there are two versions of WC bill review – software vendors and service providers. Some software vendors also provide the services, but this distinction helps keep things clean.
Software vendors
Ingenix provides their powertrak application to managed care firms (e.g. Genex, Concentra) and payers (e.g. REM, Zurich). Known as a solid but not stellar application, indications are that United Healthcare (Ingenix’ parent) will continue to keep plodding forward with PowerTrak. UHC has long dabbled in the WC business – it used to own Focus (now Concentra networks) and MetraComp (now part of Concentra) but never really paid any attention to WC.
The PowerTrak application is considered to be production-oriented by most users; that is, speed and efficiency are more important than other capabilities. Thus it is popular with managed care firms and other vendors that get paid on the basis of through-put, and not necessarily on effective medical cost management. (I can hear the howls of protest from SLC, Ingenix’ HQ already, but that’s the market’s view…) PowerTrak has significant market share, but that share is anchored by Concentra with an annual bill volume north of 5 million. Now that Concentra is owned by Coventry (which has its own proprietary BR application), it is not clear (at least to me) whether Coventry will continue to use PowerTrak. The word on the street is that Coventry has informed Ingenix that their access fees are going up (the fee paid by Ingenix and/or PowerTrak customers to load and access the Coventry WC provider networks). It is likely UHC will continue to sell and support PowerTrak, but until and unless the company invests in the application’s rules engine (viewed as adequate but not as flexible and powerful as some rivals) and really sharpens up marketing and sales, I don’t expect PowerTrak will gain share.
Medata has long been seemingly stumbling towards extinction. With the loss of major customers (Texas Mutual and SCIF), the company’s share has been declining for some time. A new team lead by long-time (and former) Medata exec Cy King is looking to reverse course. Medata is now investing heavily in the application’s user interface (what, no more green screens?!) and account management capabilities (long an underdeveloped area, to put it kindly). King hired former Medata exec Don Theis to head up sales and marketing; Theis’ task, and it is a formidable one, is to bring a market- and customer-orientation to the company. With no ownership of networks, Medata is looking to be neutral and customer-driven regarding network access, building links to the major network vendors and assessing customers a transaction fee for access. Word from Medata is the transaction fees will be transparent and modest.
Medata’s new leadership could not have come along at a better time, and the tight focus on WC and ‘Switzerland’ approach to networks may help King and Theis reverse the company’s course.
I’ll examine Fair Isaac, Stratacare, and others next.