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Texas comp networks benefit patient outcomes, costs: Report card

Posted On: Oct. 1, 2019 11:33 AM CST

Injured worker with doctor

Medical networks in the Texas workers compensation system continue to have a positive effect on patient outcomes and costs, according to the Texas Division of Workers Compensation’s 2019 Network Report Card released Tuesday.

Texas authorized the use of certified workers compensation health care networks in 2005; 30 networks have been certified since 2006, and more than a million injured workers have been treated in network since its formation.

The report card revealed that nearly half of all new workers compensation claims are now treated in networks, compared with 20% in 2010, and that the percentage of network injured employees who went back to work after their injury increased to 94% in 2019, an increase of seven percentage points since 2011. The return-to-work rate for non-network injured employees has remained relatively steady at 90% for the same time frame.

Comp health care networks also saw higher physical functioning scores among their injured employees than non-network providers, and most network patients had better or equal mental functioning scores as well, according to the report.

Other key findings from the report include:

  • The percentage of new claims treated in networks has ranged between 48% and 50% since 2015.
     
  • In-network average medical costs for claims within six months maturity fell by 15% to $2,472 in 2019 from $2,917 in 2010, but non-network average medical costs increased by 11% during that same time period to $2,560 in 2019 from $2,217 in 2010.
     
  • Overall average medical costs for network injured employees at 18 months was $3,091 vs. $3,396 for non-network, but both have been steadily declining since 2015.
     
  • Among certified network providers, Los Angeles-based Zenith Insurance Co. had the lowest overall average cost of claim at six months at $1,694, compared with the non-network average of $2,560.
     
  • Workers treated in Zenith network reported the highest rates of care satisfaction at 74%, and 80% reported no difficulty getting access to care. About 64% of workers treated non-network reported that they were satisfied with their care, and 61% reported no issues with access to care.

Medical cost, utilization of care and administrative access to care measures were calculated using the division’s medical billing and payment database. Access to care, satisfaction with care, return-to-work and health outcomes measures were calculated using the results of an injured employee survey conducted by the Public Policy Research Institute at Texas A&M University.