Newsletter Sign-up

By MATTHEW BRODSKY, senior editor/Web editor of Risk & InsuranceŽ

Here's the question: What are the secret ingredients to high-performance healthcare provider networks for workers' comp claims payers? Your answer?

"Evidence-based medicine is certainly the gold standard. It's here to stay," said Denise Gillen-Algire, a registered nurse and practice leader of integrated health and network design at Risk Navigation Group, speaking at a session on Wednesday at the 19th Annual National Workers' Compensation and Disability ConferenceŽ & Expo in Las Vegas.

But how do you ensure this quality? Ah, you see, that's where the other secret ingredients come into play, which can help workers' comp claims payers to get away from the "necessary evil" provider networks that focus on volume and discounts.

A key ingredient, according to Gillen-Algire and consultant Dr. Bernyce Poplowski, is building relationships.

Gillen-Algire used the description "grass roots" to explain how you should go about building a network. It shouldn't be about loading up a network with all the docs in a given region. It's about finding the right docs and building relationships with them.

A simple bit of talking would allow all the stakeholders to understand each other better, and ensure that everyone gets what makes them happy. Clinicians, for instance, care about better outcomes, not just money, according to Poplowski. They want to be able to practice medicine as an art, delivering the individualized care to each patient as they see fit. They want payment for cognitive services and a reduction of paperwork.

What does an employer and payer want from their clinicians? Poplowski said getting people back to work and better outcomes and lower costs.

In such a conversation, stakeholders would realize they all want the same thing: a little R&R, which in Poplowski's book means relationships and respect.

Gillen-Algire pointed for proof to the Triple Aim study, carried out by the Institute for Healthcare Improvement, in which the researchers found that partnering with providers leads to better outcomes and lower costs.

Of course, you need to be talking and partnering with the right providers to make it all work. Poplowski suggested that what separates high-performing docs from others is their focus on return to function, the minimization of the use of narcotics, the willingness to investigate other treatments and diagnoses if the current ones aren't seeming right, and the ability to like and respect all of their patients.

November 12, 2010

Copyright 2010© LRP Publications