Kate Farley-Agee
Vice President, Network Product Management
Provider Networks are essential when managing workers’ compensation and auto injuries, but what best practices can you employ when selecting a provider network?
1. Network Size & Reach
The first thing you should do is ensure that your selected partner has access to a large national network that consists of any and all provider specialties that may treat a workplace injury or an auto accident at any time during a claim.
2. Provider Support
Choosing a partner who emphasizes supporting providers can lead to better outcomes. Doctors, nurses, psychologists and counselors all have one thing in common - they want to help people. If a provider network organization finds ways to better support providers, in turn, they can help those providers better support your injured individuals.
To better support providers, a sophisticated provider network looks for opportunities to engage with providers and connect them to the clients. A robust provider services department that has deep knowledge about the administrative needs of the provider allows the practice to focus on patient needs, thereby providing a better outcome.
Also, best-in-class networks have a defined strategy and structure for rates, terms and conditions as well as a streamlined process for answering questions from the provider. This enables the office to feel confident in the relationship with the network and focus their attention on delivering best in class patient care.
3. Provider Quality
To ensure provider network quality, you should choose a provider network that has oversight procedures in place, including:
- Regular reviews of their provider credentialing process
- Ongoing monitoring of physician licenses, sanctions, or quality issues
- Feedback mechanisms from clients, and even patients
4. Advanced Data Analytics
You will also benefit by working with a partner who emphasizes learning through advanced data analytics. We’ve seen data analytics and technology give the workers’ compensation & auto industries the horsepower needed to better manage populations of injured individuals through predictive analytics applied to claims adjusting, reserving, and even case management placement. An advanced provider network will take the same data‑driven approach to identify quality providers. These tools incorporate new and deeper data to render more detailed insights about provider utilization patterns and the factors impacting a claim’s outcome.
This information can be anything from broad information about a physician's practice or precise predictions about an adverse surprise claim. Harnessing technology to connect the dots between physician choice, utilization patterns, and a claim’s outcome is becoming more important in an individual’s recovery, and a provider network is at the heart of that support.
To learn more about what else you should look for in a provider network, check out our in-depth podcast, “What to Look for When Choosing a Network Provider”.