Work Comp insurer Texas Mutual has launched their network initiative, partnering with Concentra on their private-labeled “Texas Star Network Option”. For now, the network will only be available to employers in the Austin, San Antonio, DFW and Houston metro areas, but expectations are the coverage area will expand significantly in the near future.
Texas Mutual has prepared excellent powerpoint presentations for employers employees and agents; anyone interested in an overview of the impact of the new legislation and regulatory changes would be well-served to review the presentations.
While Concentra’s network includes thousands of providers in Texas, Texas Mutual claims to have selected only certain providers for the Texas Star Network. One hopes this is the case, as the best feature of many workers comp networks is their ability to exclude docs who don’t get workers comp.

An article in today’s Baltimore Business Journal highlights a study by the American College of Occupational and Environmental Medicine on the impact of disability on employers’ bottom lines.
It will come as no surprise to industry experts that disability costs a ton of money, both hard dollars and soft, for insurance premiums, wage replacement, medical expenses, replacement workers and lost productivity. And, while it is good to see ACOEM publicizing the real costs of disability, this is not something that has not been addressed by many employers and experts in the past.
Jennifer Christian, MD, is the most articulate and insightful expert on the role of the physician in disability management. Tom Lynch of Lynch Ryan is the industry’s leading expert on safety and return to work planning. There are any number of physicians in private practice who focus deeply on return to work – Jorge Trujillo and Yemi Owi are two occupational medicine physicians who focus on what the patient can do, rather than what they can’t, and as a result have a stellar record in this area. Choice Medical Management has proven that sending injured workers to the right docs can dramatically improve return to work results.
And I’ve argued till blue in the face that any group health payer that wants to really differentiate in the market can do so by demonstrating their impact on absenteeism and productivity. Here’s hoping that a nascent initiative to do just that (evaluating a large HMO’s impact on a large University) gets things rolling (I’m involved as the chief nag to keep things moving along).

WorkingRx’s suit against the Workers Comp Fund of Utah will likely shed some light on Working’s billing practices, methodology, and legal strategy. Working is a third party biller; a company that buys WC scripts from retail pharmacies and tries to get insurers to pay for them.
While that’s fine, and is a time-honored business practice in many retail and other industries with large receiveables, Working’s approach tends to be a bit more combative.
Working submits bills for reimbursement after applying their version of usual and customary, and then demands payment. Sources indicate that the WCF’s position is they have paid for the scripts already, and that Working’s demands are unreasonable. If Working’s other legal and collection actions are any indication, WCF may have a good point.
The issue is this; Working gets the bill from the retail pharmacy, and then reprices it using their own “usual and customary” methodology and/or adds an administrative fee. This last was shot down pretty abruptly in the WorkingRx-ScripNet legal battle, and WorkingRx’s U&C methodology is, well, unique.
One of the factors driving WorkingRx’s aggressive posturing and actions may well be the incentives of their legal team. Sources indicate that Working’s legal folk are, at least in part, financially rewarded for success in getting payers to cough up additional payments.

Industry sources indicate that managed care company IntraCorp is having its problems of late. It’s bill review business has declined rather drastically, with Sedgwick and ESIS both moving their work to other vendors. These two payers likely represent over 2 million bills annually, which may amount to 40% of IntraCorp’s business.
Organizationally, IntraCorp has been required to move into shared space, and is also using CIGNA corporate counsel and other G&A resources. This is a departure from the previously jealously-guarded independence enjoyed by IntraCorp.
IntraCorp’s new disability management chief, Archie Anderson, is a well-respected sales executive with a long history in the industry. It is most likely that these losses were well in the works before his arrival from Genex. It is likely that one of Archie’s challenges will be to generate enough case volume for Intracorp’s 2400 nurses. While the company continues to lead the industry in terms of sheer volume of cases managed, given the recent trend to reduce the role of field case management Intracorp may find itself with more nurses than it needs.
Unlike Concentra and First Health, Intracorp does not have a large cash-generating PPO network to drive profits. However, with the recent decline in popularity of these big discount-driven networks, this may not be too problematic. If Intracorp can develop or acquire technology that enables it to truly integrate and manage specialty managed care services on a custom basis, it may be able to leapfrog the competition.
That’s a big “if”.

California HealthLine picked up a story from the journal Science on transmission of the flu. Turns out that business travelers are a key vector in the spread of the disease around the US.
As one who spends way too much time on planes trains and waiting around for same, I guess I’m an occasional carrier as well. Sorry.
So here’s the interesting question – aren’t those traveling on business who return home with the aches pains and other nasty effects of the flu covered under workers comp? Their travel is business-related, and if they are in an accident that’s a comp claim, so…?