2016 Network Report Card: Network Care Costs Less with Better Outcomes

For the first time since the 2005 implementation of health care networks in the Texas workers’ compensation system, the overall average medical cost per claim was lower for network injured employees at six months maturity than for non-network injured employees, according to a newly released study from the Department of Insurance’s Research and Evaluation Group.

The 2016 Network Report Card also demonstrates that more claimants are treating within networks than ever before. The percentage of new claims treated in networks represents 47 percent of all new claims, up from 20 percent in 2010, a 135 percent increase over that period.

Overall, network health care has improved cost performance relative to non-network care. Networks’ average medical cost fell by 4 percent, from $2,917 in report year 2010 to $2,801 in report year 2016. Over the same time frame, non-network average medical cost increased by 27 percent, from $2,217 in report year 2010 to $2,813 in report year 2016.
All 16 network entities reported higher return-to-work rates than non-network. Moreover, although past studies have shown that network injured employees, as a group, have consistently scored higher physical functioning scores than non-network injured employees, the new study revealed, for the first time, that all 16 network entities had higher physical functioning scores among their injured employees than non-network injured employees.

The findings presented in this report are based on completed telephone surveys of 4,007 injured employees with new claims. In order to analyze the outcomes of individual networks, injured employees of all injury durations within the study period were surveyed in July 2016 and an age-of-injury control was included in the analyses.