FOLIO

Healthcare Networks Show Continued Improvement in HCN Report Cards

Oct 5, 2017 | by Flahive, Ogden & Latson

According to the just-published 2017 HCN Report Card, the percentage of network injured employees who went back to work after their injury increased by 6 percentage points, from 87 percent in 2011 to 93 percent in 2017. The return-to-work rate for non-network injured employees has remained relatively steady at 88 percent for the same timeframe.

And, costs are lower. Overall, networks as a group have improved cost performance relative to non-network. Networks average medical costs fell by 16 percent, from $2,917 in report year 2010 to $2,445 in report year 2017. Over the same time frame, non-network average medical cost increased by 11 percent, from $2,217 in report year 2010 to $2,469 in report year 2017.

For more than 10 years, the Research and Evaluation Group of the Texas Department of Insurance, Division of Workers’ Compensation has studied the performance of HCNs and compared that performance to outcomes for employees who are not in a network. The REG publishes its research data each year in a “Network Report Card.”

Among the key findings in this year’s Report Card:

• Overall, injured employees in seven network entities (504-Alliance, 504-Dallas County Schools, 504-Others, Coventry, IMO, Southwest and Zenith) had lower average medical costs than non-network injured employees for the first six months after the injury.
•  Regarding lost-time claims, 11 network entities (504-Alliance, 504-Dallas County Schools, 504-Others, Corvel, Coventry, Genex, IMO, Liberty, Southwest, Texas Star and Zenith) had lower average medical costs than nonnetwork claims.
• Eleven network entities (504-Alliance, 504-Dallas County Schools, 504-Others, Genex, IMO, Liberty, Southwest, Texas Star, Travelers, Zenith and Zurich) had lower average pharmacy costs than non-network.
• The Alliance’s average medical costs were lower than non-network in 17 of 19 cost categories.
• Zenith had lower average medical costs than non-network in 16 of 19 categories.
  Texas Star had lower average medical costs than non-network in 15 of 19 categories.
• IMO and Liberty’s average medical costs were lower than non-network in 14 of 19 categories.
• Zenith had lower average medical costs than non-network in 13 of 19 categories.
• 504-Dallas County Schools, 504-Others, Coventry, Genex and Southwest’s average medical costs were lower than or equal to non-network in 12 of 19 categories.
• Other networks had lower average medical costs than non-network 11 of 19 categories.
• Corvel and Travelers’ average medical costs were lower than non-network in 9 of 19 categories.
• First Health had lower average medical costs than non-network in five of 19 categories.
• All network entities had lower average medical costs than non-network in physical medicine modalities.
• All network entities except Southwest had lower average medical costs than non-network in nerve conduction diagnostic testing.
• Eight network groups (504-Alliance, 504-Dallas County Schools, Corvel, Genex, IMO, Southwest, Zenith and Zurich) had lower average hospital costs than non-network.
• All network entities except Coventry had lower average pharmacy costs than non-network.

The REG also surveyed injured workers to measure satisfaction with care and access to care. Satisfaction with care remains high.

• Seven network entities ((504-Alliance, 504-Dallas County School, 504-Others, Corvel, Texas Star, Travelers, and Zenith) reported higher or equal levels of receiving needed care than non-network injured employees.
• Injured employees from twelve network entities (504-Alliance, 504-Dallas County School, 504-Others, Corvel, Coventry, First Health, Liberty, Texas Star, Travelers, Zenith, Zurich and Other networks) reported higher or equal levels of receiving care quickly as compared to non-network injured employees.
• Ten network entities (504-Alliance, 504-Dallas County School, 504-Others, Corvel, Coventry, First Health, Liberty, Texas Star, Travelers and Zenith) reported higher or equal levels of agreement with their treating doctors than non-network injured employees.