Available National Work Comp PPO Networks
I continue to be amazed that many in the work comp industry do not understand the PPO industry, although it is a mature business model. Many payors and consultants believe payors are limited to only Aetna or Coventry work comp PPO networks. See the below statement from joepaduda.com:
“Unstated but obvious is the most important rationale - as the Coventry combo is the last big WC network standing, national WC payers have no other options. Yes, CorVel does have a national network, but none of the payers surveyed consider it a serious option.”
The above is simply not true. There are several quality national workers’ compensation PPO networks in the marketplace. Prime Health Services, Beechstreet, IHP, and others. The market simply does not have to be stuck with Coventry and Aetna. Payors and consultants need to pay attention to the market options. Otherwise, they are going to be paying more than necessary for their PPO.
October 24th, 2007 at 3:29 pm
Agreed. It’s amazing to me how many payors out there express their fear of the Aetna/Coventry partnership due to the possiblity and fact that they are now going to raise fees and require even more loyalty from the payor. However, the payor community’s pace of looking and choosing other options doesn’t seem to match their fear. They are too scared to stay and too scared to move. It’s just going to take one large payor to make the move and the others will follow, which is in everyone’s best interest (other than the gorilla). I’m not sure why the other PPO choices aren’t being referred to as altenatives more than they are. All the networks you mention are valid and strong comp networks.
October 30th, 2007 at 7:46 am
Perhaps it is because Payors are clinging to yesterday’s news. Gone are the days of hospital perdieums for the most part. Hospitals-hospital systems are getting more and more difficult to negotiate with. The older more mature networks still have some of these perdieums. But we all need to look a little further. Payors need to look into the networks they are using. With these gorilla networks you may find that providers in various state markets are leaving the network. We want to believe as payors that the savings will stay and that it wont change. This simply will never happen. Our marketplace is too fluid. Change is happening so fast and law reform is coming at such are rate in various states that it is challenging to keep up with.
I can see the challenge that the Payors face. I just hope they look at networks in the marketplace and begin to evaluate them now. If all of these changes are any indication on what’s to come payors need to start looking at alternatives.