I’m hoping this is the last post on the state of Texas’ report on work comp networks.
Believe me.
As I’ve noted in two posts earlier this week my concerns with various aspects of the REG report, concerns which I – and other observers – believe are real and relevant.
There’s a larger concern and that is the effect of the report on decision makers at work comp payers. Several managed care execs I’ve spoken to since the report came out last week said they are scrambling to explain the results of their HCN and why it
makes sense to continue the program despite the negative implications of the report. Their bosses and some peers are asking why they are spending so much in the way of time and energy and legal resources on a program that doesn’t deliver any better results than their ‘old’ managed care program.
The primary reason HCNs may not deliver better results (although one shouldn’t make that assumption based on the REG report) is simple – the HCNs aren’t much different that those ‘old’ managed care programs. The underlying network, bill review, utilization review and ancillary programs employed in the HCN are all but indistinguishable from the non-HCN managed care programs.
Sure there are differences in denial rates and appeals processes and reporting requirements – but the basic nuts and bolts are identical.
What does this mean for you?
That may be – MAY BE – one reason it’s hard to see how HCNs are more effective than non-HCN managed care programs.
Oct
7
The networks in Texas basically just put more people between the healthcare provider and the insurance company. Now the networks are making 20-30% that was paid to the providers since the networks drove down the reimbursement. There is the same utilization that existed before, just different companies doing it. Some employees are getting less medical help and they have to wait for more approvals. This isn’t progress.