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PPACA's effect on workers' comp

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Speculation stirs around the Patient Protection and Affordable Care Act (PPACA) and its impact on workers’ compensation. Consider the implications for your organization of possible changes to access to care, consolidation of providers and facilities and the use of accountable care organizations. Could a potential increase in demand for services strain the health care system? Should providers and facilities consolidate, will this affect the availability of occupational health care and work-related injury treatment? Can the accountable care organization model incorporate quality care initiatives, medical provider networks and administrative processes?

A recent session at the 2014 RIMS Conference & Exhibition addressed these issues. Speaking were Mark Walls, workers’ comp market research leader at Marsh USA; Kimberly George, senior VP, senior health care advisor at Sedgwick; and Misty Hambright, manager, people services at American Airlines. 

“The biggest issue I see around PPACA and workers’ comp is the access to care issue,” said Walls. “PPACA is going to accelerate a change because it’s really going to be important to identify who those physicians are that are delivering the best medical outcome for those patients.”

Walls asked the crowd: Who is going to work with your return-to-work program? What is the incentive of the good physicians to work with us if we are going to cut their fees or delay payments?

“As an industry we need to look at ourselves and the way we do business with the medical community,” he said. “We want the best physicians but I think we need to change the model. We need to incentivize those people to treat our patients. We need to make the process more efficient.”

The panel acknowledged, however, that it all comes at a price.

“We can’t be scared as employers to pay more for quality health care,” said Hambright. “It’s not going to be those giant networks anymore. You’re going to be competing for doctors and single employers are probably no longer going to have the buying power.”

Employers want their injured workers in the front of the line with the best physicians. But, again, it comes down to money.

“You have to pay for it,” said Hambright. “That’s a very uncomfortable thing for us in workers’ comp. But the right care at the right time with the right provider is always the best way. We have all got to step out of our comfort zone because it’s a new world under the ACA.”

But how does an employer or workers’ comp manager select the best physicians? The panelists agreed that you can’t just punch numbers into a spreadsheet and get the answer.

“You have to roll up your sleeves,” said Walls. “Talk to the nurse case managers, the adjusters, the medical providers. Make sure they all understand your goals. Make sure they understand that you have modified work available and they understand what goes on in your workplace. Bring them to your facility to see the job. Going that extra mile to work on the relationship with medical providers is huge.”

The goal, of course, is to ensure that workers receive the best possible treatment so they can return to their job as soon as possible.   

For Kim George, the future of workers’ comp, under PPACA or otherwise, is telehealth, or the delivery of health-related services and information via telecommunications technologies. 

“If workers’ comp doesn’t come to realize that digital health is a key component — and we’re not engaging in it — we really will be missing the boat,” said George. “Teleheatlh is really important right now.”

Some believe the new health care law will mean everyone will have health care, and therefore, all of society will be healthier and therefore, workers’ comp concerns will ease. 

This is not true, obviously. And Walls agrees.

“I’ve had health insurance my entire life,” he said. “I’m fat, I have high blood pressure and cholesterol. I’m living proof. I don’t see a correlation between having health insurance and being healthy.” 

All panelists did agree on one thing, however: the goal of workers’ comp, with or without a health care overhaul, is to ensure that workers receive the best possible treatment so they can return to their job as soon as possible.