With the appointment of Danielle Lisenby as CEO, Broadspire’s board affirmed the TPA’s focus on medical management, and served notice that the company will compete based on that focus.
Lisenby’s replacement as Broadspire SVP medical management is Erica Fichter, who has been with the company in various roles in and around medical management for years. Fichter’s reputation is one of a steady, seasoned professional with long experience in the industry.
With the re-emergence of medical cost as a primary driver of workers comp losses, the focus makes eminent sense. However, some “traditionalists” may view that focus as misplaced.
They’d be mistaken.
Managing medical is a whole lot more complicated than it was even a decade ago. Selecting and employing evidence-based clinical guidelines, meshing those guidelines with state rules and regulations, coordinating utilization review with bill review, knowing when and where to employ physician advisers, understanding the role of networks, and how and why they can be cost drivers (not cost reducers), employing speciality vendors who know dealing with PT requires a much different approach than managing facility expenses, these all require a level of sophistication and deep knowledge of medical trends that few pure claims execs or underwriters have.
When one adds to this the understanding that “medical drives indemnity”, it becomes obvious why medical management expertise is critically important.
For far too long, medical management has been an afterthought, a revenue generator, necessary evil, vendor-delivered function designed on the fly, poorly coordinated and haphazardly managed.
What does this mean for you?
Time to re-evaluate with an objective eye.
Apr
25
Joe,
Utilization Review is counted as a medical cost. Your previous reports indicate the increase in medical cost is in large part due to the cost of UR. Has anyone subtracted the profits the Insurance carriers make on UR to determine the real costs.
Jeff – thanks for the comment.
I think you misread my earlier posts; I’ve NEVER said ” the increase in medical cost is in large part due to the cost of UR.”
The increase in WC medical expense is due to higher facility costs, surgical implants, and drugs.
re UR being “counted as a medical cost”, I’m not sure what you mean by this. Who does this and where? Different states treat medical management expense differently; you can’t make a blanket statement like that.
As to the profits insurers, TPAs, and managed care firms make on UR, they are undoubtedly significant, and that has given rise to the use of automated UR and other cost- and time-saving approaches.