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Moore: Medical Networks Key to Employee Health and Savings

By James Moore

Friday, February 23, 2018 | 644 | 0 | min read

Workers' compensation medical networks have always provided a large return on investment.  Injured employees receive the best medical treatment, and the employer cuts its workers comp costs.

James Moore

James Moore

The insurance carrier or third-party administrator of claims staff being able to work with the treating physicians to obtain work statuses and medical information will always lower your workers comp reserves.   

This is the first area in workers' comp that I realized benefits all parties. In fact, in the old days as an adjuster, I had built informal medical treatment networks for the largest home builder in the nation, two huge fast food restaurant chains on the East Coast, and any manufacturing plants.

There were many other companies that benefited from my informal workers' compensation medical networks. I did this while adjusting claims, not as a special project. 

I began the Six Keys list soon after that.   

This key comes with a caveat: The medical networks built by me were not necessarily from a TPA or insurance carrier provider list. The providers on those lists usually provide a 15% reduction in services, but are they the proper industrially minded physicians you wish to treat your injured employees?

We have to remember that one of the goals is to keep the injured employees as healthy as possible while they recover and return to work. 

The win-win-win of great informal workers' comp medical networks come from four different aspects:

  1. The information flow among provider, injured employee and carrier has no logjams. 
  2. The provider is listed on the carrier/TPA’s medical provider list, usually resulting in a 15% discount.
  3. Managing one of my other Six Keys — return to work — becomes much easier.
  4. The injured employee receives the best treatment possible in his area. 

This key actually links to more of the other Six Keys than all the other keys combined. 

Having a great workers' comp medical network is another key, treatment of employee (not medical). The great research organization Workers Compensation Research Institute studied this area heavily. And yes, how an employee is treated by his employer has a large effect on the outcome of the file. 

As a side note, I recently had a very severe case of the flu. It was awful. I ambled to my general practitioner. As I take blood thinners, that complicated the issue. Having the doctor run tests and then tell me I was going to be 100% fine meant quite a bit to me. Bedside manner goes a long one when treating workers' comp patients. 

One question is often asked in this area: What if the state permits employer-directed care? A study was conducted on this point and showed that most employees will go to the physician recommended by their employer regardless of who directs the medical control in the state. Unfortunately, I cannot locate the source article as I write this passage. 

This key is one of the more difficult to immediately install in your workers' comp program.  However, once that you do, the benefits of a workers' compensation medical network becomes quickly apparent.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.


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