Comments on: Coventry Work Comp PPO Strategy

By: Dorrence

Dorrence — Fri, 09 Nov 2007 21:51:32 +0000

I like the concept of a reseller alliance. It is time for resellers to do two key things to secure their position within the industry. First, recognize the new paradyms that are shaping up, particularly with the Coventry/Aetna alliance. The day of doing business with networks that now have units directly competing for the same business the reseller is hoping to hold onto is over. A reseller alliance makes perfect sense to block out those networks who are trying to form the “monopoly” of the marketplace. Second, and this is key, resellers have to form tighter alliances with their clients to refer to the networks that they are using for repricing! The day of repricers just taking the hit when it happens is over. Technology and innovation in how we deliver the information to adjustors, case managers and UM nurses is such that the industry should be able to deliver real time information to make sure that referrals are going to those providers that are in-network and offering savings. The resellers that learn how to do this effectively will be the successful ones long term.

By: Brian Sharp

Brian Sharp — Mon, 05 Nov 2007 02:46:54 +0000

yes Bethany, you are very correct in that the payors can only blame themselves to some extent. The options have always been in place, it’s just a matter of them not believing that Coventry is the only answer. Most of the people in the comp industry tend to be very conservative, thus making it hard for them to make quick decisions.

By: Bethany

Bethany — Sun, 04 Nov 2007 03:48:36 +0000

Going to market with no resellers for Coventry is definitely the buzz this week. I’ve talked to a couple of them and they are expressing a desire to refuse to give in to Coventry’s bullying. One even expressed a desire to create a reseller alliance. Meaning, no Coventry implementation even if a large payor requests them. In my opinion, this will only work if all of them agree and none of them ever give in. This will require some serious risk on their part, but it would work.
Rates for access will definitely go up, with Coventry leading the increase. The payors can only blame themselves for this, as most of their eggs are in one basket. I keep wondering what it will take for some PPO/Payor diversification. Will it be increased rates by Coventry? Or will the payors just adjust to it?