Coventry appears to be wasting no time in flexing its market-share muscles. Sources indicate they have begun efforts to restructure deals with their network resellers – the bill review and managed care companies that have traditionally marketed Coventry’s networks to their customers.
Now that Coventry has the three largest WC networks in its’ product portfolio it is in a rather enviable position – any WC payer seeking national coverage has (realistically) two options – either work with Coventry or patch together a network from regional and state players. While the results from the latter may be better, the work involved is rather daunting. And many WC payers are easily daunted by work.
Which brings up an interesting market opportunity. Seems that a managed care or bill review firm that does the heavy lifting of piecing together a best-in-state network solution may find payers eager to listen.
I agree that there is opportunity to build best in state networks and believe the basis should be on quality and outcomes. How about a “Return to Work network” with pay for performance as an innovative model? Anyone interested?
There is yet another WC (large Managed Care Network)on the horizon – it will be able to compete with Coventry effectively and with #’s that will be lower than Coventrys
Stay Tuned
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Judy is on point. Would be helpful to see a profile of the competition in the outcome-based network space.
I am in reading this late so my comments may be too late to spur conversation but…Judy the problem with outcomes based networks is that it is difficult for anyone to charge for it such that they can make money AND the claim payers are willing to pay for it.
Our Providers have worked very hard to achieve a fair contract with FHN and Focus. I would hate to see just when we are all “playing nicely” that Coventry will come in and backdoor these contracts with Aetna’s low low reimbursement. I have refused to participate with Aetna in an effort to keep them out of our market area, along with other Providers in this area. Aetna will drive down physician reimbursment even lower than what the networks want to pay us now, which will in turn drive down quality of care. I have not heard one Employer say they have recognized a great deal of savings from their carrier or network that they have used. And as far as the network bringing us additional employers, well that doesn’t happen either. They are just another hand in the pocket of the Provider. It is time for Providers to direct contract with our clients/employers and cut out this middle man managed care mentality that the networks and payors are trying to sell to the employers that use us. If the Employers want to save money they should contract direct with the Provider.
Our practice also declined Aetna’s invite (which was actually an ‘opt-out’ amendment to our group contract)…20% discount off the FL work comp fee schedule?…I don’t think so. Payers who are evaluating the Coventry/Aetna network should review the AETNA provider directory and then call some key providers to see if they know they are in the network.
The development of quilting together “best in class” regional networks that provide national coverage and the deepest discounts has already been done by VIIAD..with an emphasis on compliance and preventing litigation.
Trust me on this..Don’t worry about Coventry’s..As an employee their WC Dept,the industry doesn’t have much too worry.