A New Season of Services

Saturday, December 30, 2006 | 0

By Peter Rousmaniere

Managed-care customers are showing bigger appetites for quality medical providers, electronic connectivity and analytics, while trimming their purchases of case management. And we're seeing more crossover business in health insurance and nonoccupational lines. We're in a fun new season of ferment.

This was strikingly evident in talks I had this year with executives in large workers' comp managed-care firms. A lot of other provider networks, pharmacy-benefit managers and bill-review firms are onto this market shift.

More claims staffs are asking for these services. Large employers are demanding more. New Texas and California laws about medical providers have also been driving demand, though these market changes are visible everywhere.

Here's what some large firms (in alphabetical order) are delivering:

Aetna, a recent entry in provider networks, told me it can compare surgeons by their rates of readmission and how much ancillary services they order. It is drawing largely upon treatment history it has accumulated in this group-health business.

Concentra is bridging lines of medical care. In the connectivity area, its 305 clinics are sending out a fifth of its invoices electronically, with imaged attachments. Online connectivity is becoming the dominant channel for exchange of injury and treatment information. I can't keep up with the innovations.

Corvel has been investing for some time in computer tools. Executives in its Boston-area office showed me the most interesting treatment analysis I have seen in some time. On the computer screen I saw a calendar in which every encounter for an injured worker is recorded and annotated, day by day, instantly revealing the pattern of care over months.

Genex works closely with OCI, another UnumProvident-owned firm, which for years consolidated and analyzed the entire disability experience of employer clients. President Peter Madeja "clearly sees" more demand for analytics. Genex has also been deploying more services to its parent's disability business.

Intracorp authored, in the 1990s, some of the earliest studies of how managed care works. It showed me a recent analysis of radiology use, comparing spending within a price discount with spending within a quality provider network. The price discount network had sharply higher use. Quality docs don't refer as often.

For some years Medrisk has scored performance within its network of physical-rehabilitation providers such as stand-alone physical-therapy clinics. And it sells an online connectivity service for a claims payer to use for all outsourced services.

I've seen some claims and work safety people yawn about all this. They appear to think this stuff is silly. Well, they're right. If you're really not interested in using better doctors, what's the point of recruiting a trimmed-down provider network and tracking doctor performance?

But if you want to see an avalanche of demand, talk with disability managers from employers belonging to the Disability Management Employer Coalition. I think we will see more service innovation, for instance, in these areas. There will be more integrated analysis of medical, pharmacy and claims information. Medical provider abuse, more easily documented, will be shown as more costly than claimant fraud. California and Texas regulators will demand more electronic connectivity for invoices. We'll see more versions of Craigslist for outsourced services.

I often return to this theme because, unseen friend, it may boost - or run over - your career.

Peter Rousmaniere is a Vermont-based writer and columnist for Risk & Insurance. He can be reached at riskletters@lrp.com.

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