If you’re in the workers’ comp space, there are several things you should avoid at all costs.
- Do not talk about your service as innovative or cutting edge. Insurance people in general and work comp people in specific avoid innovation like the plague. Innovation is scary, risky, uncertain, and potentially career-damaging. While it might help improve results somewhere, it might also cause friction, upset employees, add stress and surprise folks.
None of this is good. - Do not focus on what’s good for the entire company.
Counter-intuitive, right? Well, not at all. Organizations don’t make decisions. People make decisions. And – intros industry – those people mostly make decisions based on what makes them look good, more important, more successful – which may – or often may not – make the organization more successful.
Example – buying healthcare based on how much of a discount you get off over-priced and often-unneeded services. - Talk about what works in other industries.
As a hugely insular, parochial, and navel-gazing industry, workers’ comp is not interested in how other payers address healthcare costs, healthcare quality, pricing, reimbursement, or evaluation thereof. Nope, worker’s comp is different, special, unique, and in a world unto itself. - Suggest you have something that is materially better than what they are doing today.
Absolutely not – because if you do, that implies what the prospective customer is doing is inadequate, ineffective, unproductive – or all of the above. Nope, most buyers would much rather not know that they can improve.
What does this mean for you?
So, is all this tongue in cheek? Heck no. After three decades in the business, I am quite sure these faux pas are much more likely to lose you prospects and customers than increase sales.
Fabulous Tips!! This is so true and helpful when getting providers to accept taking cuts to their profit margin for volume. Don’t’ insult them in the process.
Thanks for the note Maria.
be well -Joe
Thanks for the tips and good advice Joes. Generally I would agree. However, like any rule there are some exceptions. Since I am in the rehabilitation space I am aware of some innovative networks that do things differently than the usual. Take Bardavon Health as an example. They are a very different kind of network. I call them innovative based on the options available. I am not a paid promoter or have any financial arrangement with them.
Thanks for the note Mark.
Bardavon is an interesting entity. They are certainly trying to innovate, however that effort appears to have run into the reality of IT resource deficits in provider offices and among payers as well as reliance on technology that may be adding significant challenges to growing a provider base. Then there’s the issue of demonstrating outcomes and showing cost reduction, a challenge for any entity in this space.
be well Joe
Certainly Bardavon has had its challenges. As you say change and innovation is not easy in the work comp space. I know they can show the outcomes or at least have data. Yes, technology / IT and the issue of having a provider use their bNotes system is a big hurdle (who wants multiple EMR’s). More than they may realize or want to admit. I know their reasoning, but they need to get resourceful and find creative ways to deal with it.. Will see if they can survive. I know if I was an employer or self-insured I would want to take a close look at their prevention and treatment models. I do recommend such people take a look. A very different middleman approach if you will.
Like Steve, I am no fan of the middleman, but I understand why they exist. I feel there is a need for a Bardavon or an entity even better to push for outcomes, results and quality over discounts. I can go one, but will spare you and your readers of too much of this. I believe most execs know exactly what they are getting and they are content. Or, unwilling to stray from normal operating especially if profits are good. Leads full circle into the intent of your very editorial today.
Thanks for the thoughtful contribution Mark.
Maria, if the author isn’t willing to say so, I will. Your comment is right on and it is appreciated more than you know. The belief that loosing money faster, while at the same time attempting to provide appropriate, approved and medically helpful services, is a fools errand. Unfortunately many states have facilitated the role of middleman who thrive on that business model. The only way it seems to even approach workability is via factory medical care. Calling out the middlemen works. It will be an interesting day when, as a
group, the provider community stands up, looks at the math and does something about it on a large scale.
Thanks for the note Steve, always interesting to hear your perspective.
I find it intriguing that you don’t offer payers an alternative to the model you seem to object to. One that effectively manages utilization, ensures appropriate patient care, documents outcomes, assesses provider performance, channels patients preferentially to providers that deliver optimal care.
It might be that outcomes from these “factory models” are quite good.
Perhaps you can convince payers of the benefits of abandoning the current model and going back to the wonderful days of rampant over-utilization of physical medicine. Some data supporting the benefits of an alternative model might help.
Be well Joe.
Joe, your comment is unwarranted. You know as well as anyone in the business, that the alternative is stop allowing the middlemen to take the place of the payor. Middlemen by definition are a retail/wholesale proposition. When recommending providers to the injured worker, their primary criteria is the lowest contract rate because the spread is the middleman’s income.
Making referrals based on money is illegal and unethical.
And, since they also act as the payor, but do not have the obligations in law that the actual payor is subject to, middlemen obfuscate the payment process while the provider is no longer able to exercise its rights if it were dealing directly with the at-risk entity.
Regarding rampant over utilization…they certainly don’t have any right to “exercise” any payment control, after authorized services are provided.
Hello again Steve, and thanks for your response.
You stated ” When recommending providers to the injured worker, their primary criteria is the lowest contract rate because the spread is the middleman’s income.”
Really? Where did you come up with that assertion?
I’m sure you wouldn’t call out every PPO network, PBM, specialty network, carrier, TPA, self-insured employer, state, municipality, and other governmental entity and bill review vendor operating in California -unless you had concrete proof of that statement.
Please provide supporting evidence that this is indeed the case. Not your personal opinions, or what you heard from someone, but actual evidence.
Rampant over-utilization was a primary driver of reform in CA WC over a decade ago, leading to the 24 visit limit, the end of physician presumption, growth of specialty networks and enabling direction of care. Oh, and massively reduced costs for employers and taxpayers footing the bill for this unnecessary and wasteful abuse of the workers’ comp system.
Your other comments are illogical and again unsupported; Re your statement “Regarding rampant over utilization…they certainly don’t have any right to “exercise” any payment control, after authorized services are provided.” Intermediaries are bound by state and federal law and the terms of their contracts with providers – which do include payment amounts and timeliness.
Like any other contract, payment terms are part and parcel of the agreement signed by the parties.
If you don’t like the terms, don’t sign the contract.
be well – Joe