By DAN REYNOLDS, senior editor of Risk & Insurance®
If Thursday morning's executive summit at the 20th Annual National Workers' Compensation and Disability Conference & Expo in Las Vegas represented workers' compensation management at the macroscopic level, an afternoon medical management roundtable could be said to have explored the microscopic level.
Denise Gillen-Algire, a practice leader with Albuquerque, N.M.-based Risk Navigation Group, led about 40 conference attendees in a discussion on medical management.
Claims and risk managers from around the country gave their views on building effective provider networks, and on the drawbacks and advantages in sharing performance data with physicians. The managers also provided a window into the reality that what might be best practice in one state can be a disaster in another, depending on the regulatory environment and the political power of physician's organizations.
A representative of the Political Subdivision Workers' Compensation Alliance, a union of five of the largest public sector risk pools in Texas, for example, gave his account of a grassroots effort that has created a medical provider network rated among the very best.
By utilizing state medical board reports on physicians who have violated regulations, that alliance has been able to cull poorly performing doctors from a provider network that now numbers close to 8,000, providers, about 6,500 of them physicians.
November 11, 2011
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