October 2011

Health care networks

Implementation going smoothly

By Gordon Leff

The 79th Legislature passed House Bill 7 that, among other changes, allowed for workers’ compensation health care networks (HCN). Later, HB 473, 81st RS, disallowed voluntary or informal networks such as preferred provider organizations (PPOs) as of Jan. 1, 2011. This resulted in a loss of PPO contracted discounts. In response, SORM contracted with Forté Inc.’s workers’ compensation HCN, CompKey+, in February 2011. Implementation began in September, with all agencies covered by the SORM program expected to be rolled in by the end of 2011.

The CompKey+ network is a product of Forté, Inc. Forté has operated in Texas since 1988 and has been a strong partner of SORM since 2004 as a medical bill review and preauthorization review provider. The CompKey+ network has a number of important features.

The goal of the HCN is to deliver quality medical services to injured workers and help injured employees recover more quickly from their injuries. The physicians and other medical providers on the CompKey+ network panel are experienced at treating work-related injuries. As part of the network panel, these physicians have agreed to abide by nationally recognized treatment protocols, cooperate with telephonic case management, work with all parties to coordinate care, and return the injured worker to productive employment as soon as it is medically feasible. The panel includes all specialties necessary for the treatment of work-related injuries.

The network has also created a case management component, designed to work closely with SORM, focusing on care coordination, return-to-work, and treatment plan monitoring. Through this function, the network monitors treatment plans, facilitates peer-to-peer conversations, when needed, and addresses any barriers to recovery in a timely manner.

Preauthorization of medical care has always been a part of workers’ compensation. CompKey+ has refined the list of medical procedures requiring preauthorization, decreasing delays in medical treatment over the non-network model. This approach provides the right level of utilization oversight to facilitate the recovery of the injured worker.

Quality assurance is a big part of the CompKey+ program. The network has a comprehensive program ensuring injured workers receive the highest quality of care focusing on returning to productive employment. All quality issues will be thoroughly investigated and resolved in a timely manner.

The implementation of the CompKey+ network brings some changes to the claim handling process and will require additional documentation from each of the agencies at the time of implementation, hiring, and when new injuries occur. However, since implementation began in September, there has been little procedural difference from the non-network model.

SORM continues to assist its agency clients with implementation of the CompKey+ network. This includes letters and materials to help promote and explain the program and its requirements to employers and informational letters and videos to help employees understand the program. In addition, Forté’s network management department stands ready to answer questions and help SORM’s clients through the implementation process. If you have any HCN questions, please visit our website at www.sorm.state.tx.us/Workers'_Compensation/HCN/hcn.php.

Gordon Leff is director of the Claims Operations division.