Compmed Advantage - Preferred Provider Network

PREFERRED PROVIDER NETWORK

Exclusive Preferred Provider (EPP) Network

The CompMed Partnership can work with clients to develop a client specific EPP network, whereby client can offer a unique network to the market. In addition, the EPP Network is available outside of the State of New York in the event that client is interested in utilizing this network. This specialized subset network focuses on point-of-entry providers and specialists who are instrumental to the workers’ compensation marketplace, e.g., orthopedic physicians, neurologists, physical therapists and occupational medicine providers. The network reflects and takes advantage of naturally occurring care and referral patterns in the workers’ compensation marketplace. The network providers not only engage in the prompt coordination and treatment of a broad range of occupational injuries, but they are also highly focused on return-to-work initiatives.

The CompMed Partnership has completed extensive research and data analysis to identify which point-of-entry providers meet the structural requirements to be included in the subset network. The requirements include:

A belief in an early return to work philosophy.
Providers who encourage employees to return to the workplace for modified or light-duty work as soon as it is safely possible.
Providers who accommodate non-life-threatening, urgent-injury care on a walk-in basis.
Providers who are willing to accept to new workers’ compensation patients.
Providers that are certified to provide treatment to workers’ compensation patients in states where certification is required.
Providers who employ office staff that will promptly provide information to payers or their representatives, consistent with workers’ compensation state requirements.
Offices and clinics that have a physician on duty during normal business hours.
Facilities that provide lab drawing services, routine radiology and minor surgery services, e.g., lacerations, on the premises or nearby.

Providers who potentially will be a member of the specialized subset network are further analyzed based on performance measures. These measures include:

Average cost-per-injury type.
Identification of patterns of potential over-treatment.
Percentage of in-network referrals.
Specific quality indicators.

To complete the analysis on identifying providers to be included in the subset network, an evaluation methodology is applied to these providers. The evaluation approach compares providers against their peers from the same market. A series of scores across several dimensions are compiled and combined into a composite score. Once the scores are calculated, they are multiplied by their respective weighting factors. The composite scores themselves are converted to quartiles to produce an overall rating.

Providers who meet and exceed the structural requirements, performance measures and peer comparison are chosen to be included in this higher-level subset network.

Our goal for this specialized subset network offering is to help providers better understand employer job specifications and focus on return to work. The end result is a strong, productive, provider/employer relationship that guides injured employees back to work.