The annual gathering of the tribes is happening, in Las Vegas this year, as the National Workers Comp and Disability Conference opens this evening.
Here’s what I’ll be looking for.
1. any palpable evidence of outcomes-based physician networks – or any networks that do not have large, yellow-pages-sized directories of physicians who are selected based on their ability to fog a mirror and give a discount below fee schedule or U&C. Coventry talked about such a network at their annual client meeting in Naples, but it has yet to make an appearance.
2. the next big thing – a few years ago it was emergency preparedness and recovery, then pharmacy management, then imaging and workflow, then brand spanking new networks. What will it be this year? outsourced claims? medical tourism for orthopedic surgery?
3. which company will get the award for most blatantly misogynistic marketing? Will it be cheerleaders, women in skintight superhero costumes, or shoeshine ladies? Don’t these vendors know that many risk managers are female? that more than a few companies are woman-owned and/or run?
4. will the private equity companies once again be wandering the halls, buttonholing entrepreneurs and grilling booth staff on performance, competitors, and new customers and products?
5. will we hear the same old stuff about return to work, teaming case managers with adjusters, safety and loss prevention or will there be something new and fresh?
Any bets?
Nov
18
For many years I’ve advocated for an “outcome based” payment system for workers’ comp. Pay a 10% premium for the best, pay “schedule” for the average, and pay a 10% reduction for the worst. For example, pay a 10% premium to the 10% of the surgeons whose patients have the shortest time off work and the lowest residual impairments for their diagnosis. For the 10% of surgeons whose patients have the longest time off work and the highest residual impairments for their diagnosis, pay them a 10% reduction in fee schedule. If a surgeon stays in the bottom tier for more than two review periods (perhaps 1-2 years?), bar them from the network. Similar “incentives” can be used in many medical fields based on established quality outcome metrics. This way you promote effective treatment choices and reward the good docs for their superior outcomes. Perhaps even publish the statistical results identifying the “top tier” so patients have better guidance on who to seek out to treat them.
I want to hear more about medical tourism!
Outcome based incentives would no doubt vastly improve the WC system and serve to align payers and providers. Of course, a severity index is also required to avoid cherry picking and access to care issues. Further, the severity index requires a strong objective foundation to combat the temptation of some to “game” their performance against the index. Some of this will invariably inject friction into the process but on the whole, all participants would enjoy enhanced results, save for bottom-feeding networks that impair outcomes and lead to increased costs based on their inherently flawed structure.
I am hopeful that Joe finds meaningful progress in the outcome-based space, but I am not willing to bet on it just yet.