When it Comes to Helping Injured Workers, Providers' Results Matter

Every day, each of us evaluates potential outcomes to help decide the best path forward. Need a car repair? Ask a friend for a good mechanic. Need an expert for a home-repair project? Ask a neighbor who might do great work. In workers’ compensation, the same is true: results matter.

When it comes to helping injured workers get back on the job in a timely manner, looking to the providers with proven success is a wise approach. After all, those providers who best understand the unique needs of injured workers — and who have experience meeting those needs — are likely best equipped to help. 

This understanding that the quality of care matters for the trajectories of injured workers’ recoveries isn’t new. Yet now the more we study the best outcomes for what went right, it’s clear that effective, high-quality medical care plays an essential role. To pull those best-performing clinicians to the front of the line when it comes to treating injured workers, many turn to outcomes-based networks (OBNs). These networks within networks can offer an injured worker the benefit of proven expertise and perhaps the best shot at a successful recovery.

To continue to achieve success, high-achieving OBNs, like the providers comprising them, aren’t static. Robust OBNs will always be evaluating new information. And these networks will always be doing the fine-tuning needed to arrive at the best-possible mix of effective care at a reasonable price so that injured workers can regain their footing as quickly as possible.

There’s good reason to look for quality in workers’ comp. We know it works. Taking steps such as doubling down on injured-worker outcomes and relying on networks that prioritize the most effective clinicians can reduce overall workers’ compensation spending, according to McKinsey. The consultancy notes such a focus is all the more important now that medical costs make up about 60 percent of spending on a claim — up from 40 percent in the early 1980s — and as the average medical cost per claim has more than tripled in the past two decades.

Efforts to continually tweak OBNs are a natural outgrowth of our broader understanding of what makes for a successful recovery. The workers’ comp industry has always rightly focused on getting those who are injured back on the job as soon as possible to minimize the chance of a poor outcome and to save on unnecessary medical spending. But now we know to look well beyond the injury itself for insights into how a recovery might unfold.

To help remove obstacles that could forestall a return to work, we routinely consider factors that once seemed farther afield from the particulars of an injury such as workers’ mental wellbeing and the presence of comorbid conditions.

And just as we look into the details of workers’ conditions, we also need to dig into some of the variables involved in identifying the best providers. To understand who’s best equipped to help injured workers, it’s wise to have a balanced measurement design that encompasses multiple claim aspect outcomes such as:

• Medical utilization
• Clinical benchmarks
• Indemnity spend
• Return to work
• Financial performance
• Quality measures

An OBN, which operates as a subset of a traditional broad-based network, gathers those providers who have shown particular success in aspects such as these and therefore in helping injured workers recover in a timely, effective, and efficient manner.

At Coventry, our OBN is a subset of the Coventry Integrated Network®. It includes in-network workers’ comp providers who produce effective patient outcomes and who control claims costs. Out-of-network providers who meet OBN criteria are eligible to contract with Coventry to be included in the OBN.

While some outcomes-based networks might only consider medical costs, there are other important factors that shouldn’t be overlooked. A recent routine refresh of our OBN provider panel underscores the perhaps surprising complexity revealed by looking under the hood of an OBN. Factors we consider range from claim acuity to evaluation & management utilization to physical medicine utilization.

Examining these metrics (and many more) allows for assembly of an OBN in which providers demonstrate clear depth of experience in treating workers’ comp injuries. Reviewing all claim types and comparing providers to their peers will help identify those providers with the best overall claim outcomes. To be included in the OBN, providers must show consistently better measures of clinical outcomes, medical utilization, pharmacy utilization, return to work, and financial outcomes when compared to their peers.

Quality of care matters. So it’s little surprise that the best providers are more adept at treating injured workers more quickly and with better outcomes. That’s good for all involved.

To learn more about OBNs and how they can help injured workers achieve the best outcomes, download our whitepaper.

By Melissa McGarry

Melissa McGarry has been with Coventry for more than 10 years and oversees multiple network products including its Outcomes-based Network Program, Exclusive Provider Program, Telemedicine Networks and Auto Network. She has more than 30 years’ experience in the health care industry, and is a regular contributor to Coventry’s blog, The Sounding Board.

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