In addition to my focus on work comp medical management I'm deeply involved in governmental programs (Medicare/Medicaid/dual eligibles) and related businesses.

Here's a few things work comp would do well to understand/explore/pursue.

1. Auto-adjudication of medical bills – the standard target for auto-adjudication of medical bills is 90%. That's far higher than any workers' comp bill process, and about twice as high as the average.
2. Medical bill turn-around time (TAT) – average is at or below 20 days from receipt of complete “claim” (defined as a medical bill and needed documentation)
3. Administrative expense ratio – <10%. yes, I understand work comp is a lot more litigious, blah blah blah. But seriously – 28-35%??
4. Value-based care – is taking over the big governmental programs and corporate plans as well. Yes there have been a ton of misjudgments, errors, problems and failures, but make no mistake – in the near future VBC will be the dominant form of contracting and basis for reimbursement. (those who declare VBC isn't going to happen in work comp may want to look outside their bubble)
5. The impact of provider consolidation – this is one area where recent articles/briefs/research are starting to scratch the surface – but only just. Reality is consolidated markets are much more expensive and WC payers have way less ability to “manage” care in those markets. WC needs to get a whole lot smarter and more agile.

Whether this actually happens is up in the air. We veterans with decades in this business recall all too well what happens to claim counts/claimdurations when recessions hit.

What does this mean for you?

This is rarely helpful.

By Joe Paduda

Courtesy of Managed Care Matters

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