Texas Workers' Comp Network Report Card Released


The Workers’ Compensation Research and Evaluation Group (WCREG) has released the 2020 Workers’ Compensation Network Report Card results. The report can be viewed here

WCREG is required by Chapter 405 of the Texas Labor Code to study and research various system issues, including: the delivery of benefits; litigation and controversy related to workers' compensation; insurance rates and ratemaking procedures; rehabilitation and reemployment of injured employees; the quality and cost of medical benefits; employer participation in the workers' compensation system; employment health and safety issues; and other matters relevant to the cost, quality, and operational effectiveness of the workers' compensation system.

What Does the Report Card Show? 

A snapshot” overview of the report noted the following key findings: 

  • 48 percent of all new workers’ compensation claims in 2020 have been treated in networks, up from 28 percent in 2010.
  • Overall, medical costs in networks still outperform those in non-network. In 2020, network medical costs were about 9 percent lower per claim at 18 months post-injury compared with non-network claims.
  • The medical cost gap widened between network and non-network claims at 18 months post-injury (using claims from the previous report card). Network medical costs were about 9 percent lower per claim at 18 months post-injury compared with non-network claims.
  • The percentage of network injured employees who went back to work after their injury increased to 95 percent in 2020, an eight percent increase since 2011. The return-to-work rate for non-network injured employees declined slightly to 89 percent for the same timeframe.
  • Physical functioning measures a person’s ability to do everyday tasks. Mental functioning measures a person’s ability to think and reason. All networks had higher physical functioning scores among their injured employees than non-network. Most network patients had better or equal mental functioning scores as well. Both scores among network injured employees have consistently been higher than those of non-network injured employees and the U.S. population since 2012.
  • Network claims get medical care sooner than non-network claims.

Other Key Findings

  • A higher percentage of network injured employees received evaluation and management, physical medicine, and pharmacy services than non-network claims. A higher percentage of nonnetwork injured employees received hospital services.
  • Most networks had a higher percentage of injured employees who reported that they had no problems getting needed medical care after their injury than non-network claims.
  • While overall satisfaction with medical care was mixed for network and non-network claims, many network injured employees reported higher levels of satisfaction with their treating doctor.

Additional report card findings are available here.

COVID-19 Impact on Networks Not Measured

The report card analyzed medical costs, utilization of care, and some access to care measures using administrative data for services provided to injured employees as of December 31, 2019. As a result, any impact of COVID-19 on the networks is not reflected in the card.

Report Takeaways

Overall, the 2020 network report card demonstrates that the Texas workers’ compensation certified networks healthcare is more cost-efficient than non-network healthcare treatment. This is due, in part, to lower hospital utilization and lower prices per service.

There are 30 networks covering 254 Texas counties that are certified to provide workers’ compensation health care services to insurance carriers as of June 1, 2020. Twenty-one certified networks actively treated injured employees as of May 31, 2019.

Since 2006, about 1.1 million injured employees have been treated in workers’ compensation networks.

The Bottom Line

The performance of the certified workers’ compensation networks in Texas and the successful implementation and utilization of the ODG Treatment Guidelines by networks, insurers, and healthcare providers have played a significant role in improved performance of the Texas workers’ compensation system. The networks have played a major role in the improved return to work of injured employees and increased the quality of care that injured employees receive.

Employers and insurers alike should consider requiring all injured employees to be treated in network. Such an approach would provide additional improvement in Texas system medical costs, the return to work rate of injured employees, and further improve the overall quality of care received by injured employees.

By Steve Nichols

Steve Nichols, the president of Sentinel Governmental Affairs, is an accomplished government and public affairs professional with over 30 years of experience with workers' compensation issues and regulatory advocacy representing insurance companies and other organizations. Steve is a recognized thought leader on workers’ compensation and other insurance issues. He previously served as the manager of workers’ compensation services at the nation's largest state property and casualty insurance trade association – the Insurance Council of Texas (ICT) – where he served as an advocate for the insurance industry and a vibrant workers’ compensation system. He is a passionate champion of telemedicine. In Steve’s current role, he provides consultation, business development, and lobbying services to a wide range of business and organization within and outside of the insurance industry. Learn more about Steve by visiting his website at https://www.stevewnichols.com/


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