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What to look for in a workers’ comp PPO network

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In workers’ compensation (WC), preferred provider organizations (PPOs) are networks of medical professionals designed to deliver cost-effective, quality care to workers injured on the job. Both employers and claims professionals rely on PPOs to secure timely care for injured workers and control WC program expenses. Here, I’ll explore a few important factors companies should look for in identifying the right WC PPO network to suit their needs.

Geographic coverage

For a PPO network to effectively care for a designated employee population, it must include comprehensive provider coverage in the areas where those employees live and work. Employers whose workforces are dispersed throughout the U.S. or across multiple states need to consider whether a PPO’s geographic focus aligns with the locations where their employees — especially those at highest risk for injury — are based. As a means of demonstrating network effectiveness, many administrators consistently monitor providers by location to ensure they’re offering employees convenient access to quality care.

To assist employers with concentrations of employees in certain complex jurisdictions (especially those where employers are permitted to direct care), PPO administrators may offer the option of supplementing their national networks with customized or certified state-specific ones. These provide added support to employers in addressing challenges related to particular medical specialties, regulatory compliance matters or geographic coverage. Oftentimes, premier PPO administrators that offer this option have their own teams of managed care experts who maintain relationships with state authorities, provide network oversight, and work closely with member employers.

Organizations whose programs and employees might benefit from this kind of additional support should pursue a PPO partner that can provide comprehensive national coverage as well as custom or state certified networks.

Cost savings

Another primary reason employers choose to use a PPO network for workers’ comp is to reduce their medical spend. Network administrators that manage billions of dollars in treatment costs each year can negotiate competitive rates and volume discounts with providers and partners, and they ultimately pass those savings on to employers. Most PPO networks publish their average percentage of cost savings across their books of business, so employers can use those statistics as a point of comparison. Keep in mind, however, that networks maintain differing levels of transparency, so the comparisons are not always apples-to-apples. For instance, some may choose to report saving percentages based on billing totals prior to bill review (since the savings number will be higher), while others calculate the figures post-bill review.

When considering a PPO network, it’s important to look at cost factors beyond billing totals. Networks that take an outcomes-based approach carefully monitor provider results on injury durations, rates of patient infections and secondary injuries, and more. These elements also contribute to overall workers’ compensation costs, as they affect how quickly employees can safely return to work.

Working with the right PPO network can also enable employers to save on staffing costs. Having an administrator that oversees multiple network partners, assertively manages relationships, and delivers high levels of support to employees on their behalf alleviates the need for teams to perform these functions in-house.

Caring that counts

Ultimately, workers’ compensation is about taking care of employees when it matters most, and PPO networks play an important role in helping employers make things right in the aftermath of a workplace accident.

Some networks tout the huge number of providers they comprise, but perhaps more meaningful than quantity is provider type. Employers need workers’ comp PPO networks with the right specialists for the kinds of ailments their employees sustain at work — and those specialties may vary by industry category, job type and region. Here at Careworks, we have the advantage of gleaning insights from aggregated claims data from our parent company Sedgwick regarding specialist utilization by industry group and geographic area; that helps us target the outreach and contracting efforts for our proprietary PPO network to best meet the needs of our clients and their employees.

Further, it’s important for network providers to be well-versed in the nuances of treating workers’ comp patients. Providers that bring the most value to WC PPO networks understand the complexities of occupational medicine, the value of early intervention, state and national treatment guidelines and the end goal of helping employees safely resume productive living.

Of course, PPO networks can only be effective when the employees who need their services are able to get connected to the right providers in a timely way. Many networks now offer online search tools to help employers and their injured workers find the best and closest care; some even create panels of appropriate and nearby providers for each employer location to make things easier and more convenient for employees during a stressful time. For those who need additional support finding the right qualified provider and navigating the workers’ comp process, networks should provide high-touch telephonic customer service and coordination solutions — with some including clinical case management as part of their offerings.

Careworks is here to help

At Careworks, we’re proud to offer employers the benefits of our proprietary workers’ comp PPO network. We’ve designed our solution to deliver cost-effective, high-quality care when and where your employees may need it. Please visit the Careworks website or contact us to learn more about our PPO network and all we can bring to your workers’ compensation program.

Written by:

Patricia Shupard

VP, Network Operations, Careworks

January 21, 2025

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