Specialty Managed Care in Workers' Compensation

In: Compensation and benefits review, Band 35, Heft 4, S. 18-26

Abstract

Workers' compensation costs are rapidly rising, driven in large part by annual increases of 15% in medical expenses. Many workers' compensation insurers and third-party administrators have been surprised by the renewed virulence of medical inflation. Although many had adopted managed care approaches, including networks, bill review or audit, case management and precertification, medical savings levels are actually declining. Specialty managed care companies are the next generation of workers' compensation managed care, and they represent an evolution from a broad and general approach to a deep and narrow focus. Specialty managed care companies concentrate on a geographical area and the type of care or provider specialty in which their expertise and focus enables them to deliver outcomes. Old habits, legacy systems and inertia can be difficult obstacles. Savings, which are typically two to three times as great as in generalist firms, must be balanced against implementation and operational challenges.