Workers’ Comp Provider Networks Need to Consider Social Determinants of Health

Traditional methods for measuring physician quality in workers’ comp have used quality measures based on adverse events: mortality rates, hospital readmissions and, in terms of Workers Comp, delayed return to work. As such, the process for selecting WC Network Physicians, may unintentionally overlook providers who do a better job of treating injured workers impacted by Social Determinants of Health (SDOH). Why? Because injured workers with SDOH factors such as restricted access to care, low income or education, lack of transportation and housing are the workers most likely to experience adverse health outcomes. Providers treating that group are measured poorly – not due to the quality of their medical care, but because of adverse events coming from SDOH factors totally out of their control.

Transparency in Coverage Raw Data Files Can Ensure Employer Health Plans Are Paying Fair Prices

Self-insured employers have a new tool to ensure they are paying fair prices for medical services. The Consolidated Appropriations Act, 2021 (CAA) established protections for consumers related to surprise billing and transparency in health care. It created a unique opportunity by establishing the Transparency in Coverage (TiC) requirements, making available all negotiated prices from every healthcare payer to every medical provider for every service in the U.S., beginning in the latter half of 2022, updated monthly. These rules provided unprecedented access to proprietary price information.