Author: Joanne Wojcik

The American Medical Association hasestablished guidelines for medical tourism that identify specific steps that should be taken by employers, insurers and others responsible for coordinating medical care and travel outside of the United States.

   Among other things, the new principles state that medical care outside of the country be voluntary; that patients should only be referred for care at institutions that have been accredited by recognized international accrediting bodies; that coverage include the costs of necessary follow-up care in the U.S.; that transfer of medical records be consistent with the Health Insurance Portability and Accountability Act; and that patients choosing to travel outside of the U.S. for medical care be informed about the potential risks of combining surgical procedures with long flights and vacation activities.

   The AMA decided to adopt these new principles in response to the growing popularity of medical tourism. The AMA estimates that as many as 150,000 Americans each year seek health care overseas, primarily because it costs significantly less than receiving such care in the United States.

   To ensure that employers, insurers and others that facilitate medical tourism adhere to the AMA’s principles, the Chicago-based organization of medical professionals plans to introduce model legislation for state lawmakers to consider.

    For more information about the AMA’s new medical tourism guidelines,click here. 

Astandardized method to judge provider performance that passes muster with critics of health plans’ previous doctor ranking efforts is likely to boost the consumerism movement by providing plan members with tools to choose their doctors, observers say.

The methodology, which is based on a set of principles developed by the Washington-based Consumer-Purchaser Disclosure Project, also should give employers greater confidence that the rankings insurers use to establish high-performance networks are based on both cost and quality, they say.

The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs was unveiled in early April by theConsumer-Purchaser Disclosure Project, a collaboration of employers, consumers, labor organizations, insurers and providers. The group has been working for more than five years to establish a set of principles to rate provider performance that would satisfy all of their competing concerns.

Elements of the Patient Charter were incorporated into an agreement last October that settled a lawsuit brought by New York Attorney General Andrew Cuomo against Bloomfield, Connecticut-based Cigna Corp. over its doctor ranking program.

According to the charter, standards will be developed and their implementation will be reviewed by independent health care quality rating organizations, such as the National Committee on Quality Assurance and/or the Utilization Review Accreditation Commission, both based in Washington.

Because the National Committee on Quality Assurance has already developed a set of standards that meet the criteria set out in the charter, the organization’s Physician and Hospital Quality Program is likely to be the first to be used, says Peter Lee, executive director for national health care policy at the San Francisco-based Pacific Business Group on Health, which is a member of the Disclosure Project. Lee is co-chair of the Disclosure Project.

The quality program, once part of the National Committee on Quality Assurance’s health plan accreditation program, now is a stand-alone program that evaluates how well health plans measure and report the quality and cost of physicians and hospitals, a committee spokesman says. The program was updated and released for public comment last month and is expected to be finalized by July, he says.

However, it is possible that more than one set of standards could meet Patient Charter criteria, eventually providing insurers with an option of choosing one or more of the accreditation programs, Lee says.

For example, the Utilization Review Accreditation Commission last week released for public comment revisions to its Health Plan and Health Network Accreditation standards that could meet criteria set forth in the charter, he says.

After the first set of standards receives the Disclosure Project’s endorsement in less than six months, the first four insurers to support the charter—Cigna, Aetna, WellPoint and UnitedHealthcare—will have three months to begin the review process and six months to complete it, says Debra Ness, president of the Washington-based National Partnership for Women & Families and co-chair of the Disclosure Project.

Cigna could become the first insurer to complete the review process since it has had a head start as a result of its work with the New York attorney general, she says.

In the meantime, the Disclosure Project will encourage other insurers to undergo the review process, Lee says.

Several members of the health benefit community view the charter as an important step that will give consumers reliable information to help them make informed choices about their health care.

“Our employees and their dependents need these programs so they can better navigate the health care system and select physicians they can put their trust in,” said Andrew Webber, president of the National Business Coalition on Health, at a press conference last week in Washington announcing the charter, according to a transcript of his speech. The coalition is made up of employer health care coalitions based in Washington and is among supporters of the accord.

“NBCH believes the Patient Charter will promote national consistency and transparency in how health care plans establish these important physician-level measurement programs, something that is critically important, particularly to national employers who have a workforce spread throughout the country,” Webber said.

Standardizing doctor performance measures also is likely to expand the health care consumerism movement by finally providing employees with the tools they need to select their doctors, says Francois de Brantes, CEO of Bridges to Excellence, an employer pay-for-performance initiative that also backs the charter.

“Consumers really don’t trust the payers to deliver objective data on the quality of physician care, even if it’s well-done. So taking it out of that setting and making it more objective should greatly improve the credibility of the data and, hopefully, its actionability by consumers,” de Brantes says.

“The move toward consumerism … will definitely get a boost from having this information available,” according to a spokeswoman for America’s Health Insurance Plans. The Washington-based health insurer trade group is among supporters of the Patient Charter, which is similar to principles endorsed by the organization’s board in November, the spokeswoman said.

But Regina Herzlinger, the Harvard Business School professor credited with launching the health care consumerism movement, says the charter may not have everything consumers need to safely navigate the health care system.

“Virtually all the measures focus on process,” Herzlinger says. “Until we have outcome measures, we are wasting our time.”

Perhaps the most significant difference between yesterday’s and today’s wellness movement is the science behind it.

Employers who are just now embarking on the wellness path are doing so methodically, collecting data from all relevant sources to better gauge the impact their programs are having, not only on health but also on productivity.

For the past six years or so, we’ve been looking at the Journal of Occupational and Environmental Medicine link to  to see what other employers have been getting in terms of return on investment,” says Patti Clavier, who works in group health and well-being strategy and operations for Santa Clara, California-based Intel Corp.

Dr. Joyce Young, well-being director for IBM Corp., has had several studies on the impact of wellness programs published in that journal, including one on an Internet-based work-site smoking cessation intervention and another on an incentive-based online physical activity intervention on employee health status.

“There is also some good data showing how much more smokers’ health care costs are,” Young says. “We also found that people who were physically active more than twice a week had costs $500 to $600 less than those who were not physically active. You have to do sophisticated analysis to understand all the reasons for that. But the patterns are there.”

A review of 56 published studies of work-site health promotion programs by the Washington-based Partnership for Prevention found they produced an average savings-to-cost ratio of $5.81 to $1. The programs also reduced annual health costs by an average of 26 percent, reduced absenteeism by 27 percent, and reduced workers compensation and disability claim costs by 32 percent.

“What you find is a very comprehensive holistic approach to health and productivity management will usually be cost neutral in year one,” says Shelly Wolff, national leader for health and productivity at Watson Wyatt Worldwide in Stamford, Connecticut. “Year two is when you start seeing return on investment, and by the time you get to three years, things really start kicking in and you really do see ROI,” she says, adding that longer-term studies have found the gains continue for at least seven years.

Many employers also are starting to measure the impact of wellness programs on productivity in addition to health care costs by combining claims data with data on absenteeism, occupational injuries and disability claims, Wolff says.

Pitney Bowes Corp., for example, won the C. Everett Koop National Health Award twice, in 1995 and in 1997, for its work measuring wellness-program ROI, which produced “good hard metrics showing that by investing in health improvement programs you actually saw reductions in absenteeism costs,” says Dr. Jack Mahoney, director of health strategies at the office equipment manufacturer, which is based in Stamford, Connecticut.

The collective impact of ill health on the workplace is what is called the “burden of illness,” says Andrew Webber, president and CEO of the National Business Coalition on Health in Washington. “You put the whole picture together in terms of what the illness burden is costing you,” he says.

“It’s not just health care costs; it’s the time away from work. That’s a big part of where the return comes from,” Wolff says. “If a company is only looking at health care cost trend as their marker of success, they’re missing the other real, important costs that are impacting the health and effectiveness of your employees and the organization.

“We do know that people with health risks, people who are overweight, people who smoke are off work more. That means someone else is doing their job, so you’ve got higher replacement costs, you’ve got overtime, and that has a cascading effect on stress, which is another part of what we saw in our research,” she says. “You kind of get this domino effect.”

Whether through a discount on premium contributions or cold hard cash, employers increasingly are using financial incentives to encourage employees to adopt healthier lifestyles.

Such incentives are governed by the Health Insurance Portability and Accountability Act and other federal and state anti-discrimination laws, which determine how generous offerings may be, among other factors.

Approximately two-thirds of the employers currently offering wellness programs are using financial incentives to encourage participation, according to a recent survey of members of the ERISA Industry Council and the National Association of Manufacturers.

The most common incentive is health insurance premium reductions, which are offered by 40 percent of employers that responded to the survey. Cash or bonuses were a strong second, offered by 29 percent of the companies surveyed.

“We think money is definitely going to encourage better participation,” says Mark Cauthen, benefits manager for the city of Colorado Springs, Colorado. Under the city’s wellness program, dubbed “Reach Your Peak,” participants earn credits for engaging in certain activities, such as health screenings, stopping tobacco use or losing weight. The credits are then redeemed for cash.

“Originally we had quarterly prizes,” such as T-shirts and journals, Cauthen says. “But administratively, it was a nightmare. Now, instead, they get a $250 taxable check.”

Because company officials were disappointed in some of the participation rates, Marysville, Ohio-based Scotts Miracle-Gro Co. decided to get more aggressive with its incentive program.

In 2004, the company offered $120 in cash to employees who completed a health risk appraisal, but there was only a 70 percent participation rate.

The next year, those who didn’t take a health risk appraisal upon enrolling in the health plan were required to pay an additional $40 per month in premium contributions. That change resulted in 90 percent participation.

Then, in 2006, employees identified as moderate- to high-risk in the appraisal were assigned health coaches, and if they didn’t use them, they were required to pay an additional $67 per month the next calendar year. This resulted in 88 percent participation in the first year.

“It’s kind of a tough-love program, but we’ve eliminated all of the barriers and we’ve made upfront investments (in wellness programs), so we don’t want to make it difficult for people to seek care from a financial perspective,” says Pam Kuryla, vice president of global total rewards for Scotts.

While such a punitive approach may seem harsh, it’s legal, according to Alison Earls, CEO of Atlanta-based ACE Ideas. Earls is a benefit consultant and attorney who recently conducted an analysis of federal and state laws affecting health promotion programs for the Washington-based National Business Group on Health.

“Although there’s still lack of clarity about the [Americans With Disabilities Act] and there are some things that the [Equal Employment Opportunity Commission] has not clarified, I think there’s a lot of good and fair guidance” from the HIPAA nondiscrimination rule, she says.

“You can really design incentives in conjunction with your health plan for healthy behavior and even health improvement, and if you follow the five-part exception to the HIPAA nondiscrimination rule, you can provide incentives for not only education and learning about health, but actually for changing your blood pressure, your weight, your cholesterol, getting certain kinds of treatment,” Earls says.

The lingering uncertainty, though, has caused some employers, such as Indianapolis-based Clarian Health, to back off from imposing more stringent penalties on their employees.

After it received negative publicity and flak from employees, Clarian Health abandoned its plan to fine workers for unhealthy behavior, a company spokesman says.

Clarian Health announced in August that it wasn’t going to charge employees an extra $5 per paycheck fee on employees who did not meet minimum standards for nonuse of tobacco, body mass index, cholesterol, blood glucose and blood pressure.

“Although much of the plan had been presented as final, we have maintained in our communications that the final details of the plan were not fully developed,” the company said in an August 31 statement.

Rather than assessing penalties, “we will now offer employees incentives on their health insurance premiums for meeting parameters for known health risks including smoking, high body mass index, elevated blood pressure, and other factors,” the company statement said.

Pitney Bowes Corp. a few years ago implemented a non-smoking incentive program but later rescinded it, according to Dr. Jack Mahoney, director of strategic health initiatives at the Stamford, Connecticut-based office equipment manufacturer.

“We used to have a nonsmoking discount [on premiums], but it was eliminated after the Department of Labor” ruling, he says.

Under the Department of Labor’s clarification of the nondiscrimination rules under HIPAA, tobacco use is considered a health status rather than a behavior, making any wellness plan incentives or penalties subject to the five-part exception to the rules, Earls says.

Although most employers cite “legal compliance” as the reasoning behind their various wellness program incentive or penalty decisions, the real motive is that “employers don’t want to make employees mad,” which could cause their efforts to backfire, according to Marianne Fazen, executive director of the Dallas-Fort Worth Business Group on Health.

That’s precisely what happened to Scotts when it banned smoking by employees both at work and on their own time as part of the company’s wellness initiatives.

A Scotts employee, Scott Rodrigues, filed a lawsuit in U.S. District Court in Massachusetts in January 2007, claiming that the company’s anti-smoking policy “violates the Employee Retirement Income Security Act because it discriminates against participants in the corporation’s health benefits plans for the purpose of interfering with their receipt of medical benefits.”

Scotts executives declined to comment because the litigation is pending. The company’s lawyers have filed a motion to dismiss on which the court has yet to rule.

However, Howard Weyers, former president of Lansing, Michigan-based Weyco Inc., which was sold to Meritain Health in August, says his former company will continue to enforce its policy banning tobacco use. Weyco in 2005 made tobacco use grounds for termination and instituted mandatory testing.

“I think there should be a consequence. If employees are doing something that has a negative effect on the company and the other employees, the company should do something about it,” he says.

Workforce Management Online, April 2008 — Register Now!  

A new modeling tool that measures the financial impact of value-based health plan designs may persuade more employers to implement them, its creators hope.

    The tool, which was developed by researchers at Harvard Medical School and the University of Michigan using several large, national employers as test subjects, initially was used to determine the medical efficacy of implementing value-based health plan designs, which emphasize high-value medication and services by lowering or eliminating co-payments to encourage plan members to use them.

    But Hewitt Associates has found a way to adapt the tool to help employers make implementation of a value-based health plan cost-neutral by projecting the additional plan costs if members avail themselves of the newly discounted drugs and services so that employers can, in turn, raise the co-payments for other less-valued drugs and services.

    Although the value-based insurance design concept is nearly a decade old, the early adopters—such as Pitney Bowes Corp.; Marriott International Inc. and Juno, Florida-based utility company FPL Group Inc.—pretty much did so based on “faith” rather than science, benefit experts acknowledge.

    Although these companies publicly encouraged more employers to follow their lead, “the later adopters are more skeptical and hesitant,” said Craig Dolezal, a senior health care consultant for Hewitt in Atlanta.

    “The universal question that employers ask is if there always is an increased cost,” he said. “This model takes prescription drug cost and utilization data at the most detailed level, calculates and organizes the data to show compliance … then imports the data into a clinical actuarial model” that employers can use “to calculate the cost and utilization impact on their plan and how to spread those costs.”

    For example, “if an employer wants to add incentives for diabetes and heart medications, but it doesn’t have additional money to spend, the tool will help determine how much to increase costs for other therapeutic classes and non-chronic condition-treating drugs to offset the additional cost,” Dolezal said.

    “Value-based designs are attractive because they are designed in a way that removes financial barriers to care and encourages employees to seek and receive the essential care they need to manage their health,” said Melissa Miller, director of employee benefits and services at FPL, which was among the employers involved in the development of the Hewitt tool.

    “But the biggest question for many employers is how to design these programs in the most cost-effective way,” she said in an August statement announcing Hewitt’s release of the tool.

    Before now, most studies have measured the negative impact on utilization of raising drug co-payments, but little research has examined lowering co-payments, said Clive Riddle, founder and president of Managed Care On-Line Inc., an online medical and health benefit technology vendor based in Modesto, California, who was not involved in the development of the Hewitt tool.

    Since “cost shifting to the patient has been the big mantra this decade,” Riddle said, “usually studies look at the opposite: If they raise co-payments, what impact will it have on utilization?”

    Riddle cited a study of two employer-sponsored drug plans published in 2003 that found a significant number of employees stopped taking certain medications—rather than switching to generics—when their employers moved to a prescription drug plan that charged significantly more for brand-name drugs.

    Moreover, any estimates of potential savings of implementing value-based insurance designs “have historically been not research- or tool-based,” he said. “It’s been more quick-and-dirty, comparing projected expenses against actual.”

    “They look at the prior year’s drug spend and try to project, but they’re always off,” Hewitt’s Dolezal agreed. “Quantifying of the investment is a really big step for employers.”

    “For a number of employers, this type of tool would give them a much better comfort level. These kind of tools are required to get the next layer of employers to move” into value-based health plan design, Riddle said.

    Using a tool to reallocate health care expenses also “allows companies to meet cost targets without sacrificing the quality of care their workers receive,” said Michael Chernew, professor of health care policy at Harvard Medical School in Boston, a collaborator on the tool’s development.

    “The other question is to figure out how much savings would be produced by reducing adverse events that might occur if a person suffering from a chronic condition does not take their drugs,” he said.

    “Value-based design initiatives recognize that it is imperative that as employers continue to control health care costs, they also have the responsibility, and the vested interest, in doing so in a manner that does not jeopardize employee health. The principles behind value-based insurance design, and the tool developed by Hewitt Associates, enable employers to meet these two important goals,” Chernew said in an August statement announcing the new tool.

    “What the tool is designed to do is to allow a firm to meet whatever financial target they want to meet in a way that incorporates value-based insurance design as opposed to across-the-board clinically insensitive ways,” Chernew said in an interview.

    “Before value-based design, they would just raise co-pays across the board to meet a financial target. But this doesn’t recognize the differences in value for different services,” he said.

    Chernew and Dr. A. Mark Fendrick, director of the Ann Arbor, Michigan-based Center for Value-Based Insurance Design at the University of Michigan, published the conceptual framework for value-based plan design nearly a decade ago, and founded the center, which was created to promote, implement and evaluate value-based designs.

    New York-based ActiveHealth Management has been using a similar tool, also developed in conjunction with Chernew and Fendrick, in a three-year pilot program involving Marriott, said Dr. Steve Rosenberg, senior vice president of outcomes research at the disease management and clinical decision support firm. ActiveHealth also has technology that identifies patients in particular need of interventions who are not getting them for one reason or another, he said.

    “We use it in two ways: If a company or a health insurer is interested in implementing the value-based insurance design and they want to know the estimate of the cost or savings, we can run this model on their data to produce an estimate,” Rosenberg said. “For customers we already have, we use the model to report to them every six months on the savings their program is achieving.”

    While not divulging individually identifiable health information, the tool “measures how many people receive notices” telling them about the program and “how many comply after getting the notice,” he said. “We also measure the people already taking the drugs to see how many continue taking them.”

    In general, “we find there’s a 10 percent to 15 percent improvement in long-term compliance when co-pay is reduced or eliminated,” Rosenberg said.

    In addition, “what we find routinely is that the cost for medication for the employer always increases, the non-drug costs for the employer are reduced by the same amount or a little more, so it’s basically a wash,” he added.

    In the Marriott study, which was reported at the March annual meeting of the Washington-based National Business Group on Health, generic co-pays were eliminated and brand-name drug co-payments were halved for the types of medication used to treat diabetes, asthma and heart disease.

    Researchers are still studying the experiment’s outcomes, but “as we implement this technology, we are finding these strategies are creating a positive difference in trend,” Jill Berger, Marriott’s vice president of health and welfare, said at last spring’s National Business Group on Health meeting.

Workforce Management, October 22, 2007, p. 23 — Subscribe Now!

Final regulations issued in December 2006 by the U.S. departments of Labor, Health and Human Services and Treasury provide guidelines for employers seeking to add incentives or penalties to encourage participation in wellness programs.

    Under the final Health Insurance Portability and Accountability Act rules, employers may vary the amount of premium contributions required from employees as long as the wellness program meets the following criteria:

• The reward or penalty must not exceed 20 percent of the cost of employee-only coverage under the plan.
• The program must be reasonably designed to promote health or prevent disease.
• Employees must be eligible to qualify for the reward at least annually.
• The reward must be available to all similarly situated individuals.
• A reasonable alternative standard or waiver must be available to individuals for whom it is unreasonably difficult to satisfy the otherwise applicable standard due to a medical condition.

    Employers are also permitted to seek verification, such as a statement from an employee’s physician, when a health factor makes it unreasonably difficult or medically inadvisable for that employee to satisfy or attempt to satisfy the otherwise applicable standard.

    The complete HIPAA regulations governing wellness programs which apply to plan years beginning on or after July 1, 2007, were published in the December 13, 2006, issue of the Federal Register.

W hile many injured workers may swear by chiropractors, most employers are more likely to swear at them when they see one listed as a treating physician on a workers compensation claim.

    Unchecked chiropractic care can, and often does, drive up the cost of medical care, many employers assert.

    But there are times when chiropractic care can actually save employers money in temporary disability costs by returning injured employees to work faster, some workers comp experts say.

    The key, they say, is to monitor treatment to ensure that claimants are receiving appropriate care.

    In workers comp cases in which chiropractors are the exclusive provider, total costs per claim are 16 percent to 25 percent higher than in cases in which care is directed by physicians, according to a 2002 study by the Boston-based Workers Compensation Research Institute. Medical costs are 17 percent to 21 percent higher in chiropractor-treated cases when considering the costs of complete medical treatment, including physical medicine, radiology, supplies and drugs, the study also found.

    “It’s the kiss of death whenever I see a chiropractor on a claim,” said Nancy Axtell, director of safety and risk management at PRIDE Industries in Roseville, Calif. PRIDE specializes in placing disabled workers in jobs. “They’ll treat the patient for the rest of their lives.”

    In fact, Ms. Axtell says she has several claims in which chiropractors have been treating claimants for a year or more after an injury.

    “I believe there are some reputable chiropractors out there,” she said. “But once they get in the comp system, it’s like giving them an open checkbook.”

    Ms. Axtell said the situation is particularly acute in California, which recently enacted legislation to limit the number of chiropractic visits workers compensation claim-ants may have.

    “In California, employees can sign up to use chiropractors as a comp doctor,” she said. Under state law, an employee can predesignate whom he or she would like to have as a treating physician when the individual is injured.

    And even in cases where the employee did not predesignate a physician, “the employer has only 30 days of control,” she said, after which the injured worker is free to “doctor shop” until finding one he or she likes.

    “There are some people who can get better faster with manipulation,” observed Dr. Charles Kelley, who heads up the workers compensation program at Outrigger Enterprises Inc. “On the other hand, there are some chiropractors who use long-term manipulation as a therapy, and that just adds to the cost,” said Dr. Kelley, who is director of sales-special markets at Outrigger in Honolulu.

    “If you have a patient who has an underlying need for attention and medical care and perhaps they have some underlying personality disorder, they can get into the hands of a provider who’s being paid to treat them, and it could go on forever,” he said.

    But not all chiropractors are bad actors, asserted Tara Schilling, senior vp at Keenan & Associates in Torrance, Calif., a broker that provides third-party administration services for workers compensation.

    “Everybody is jaded on chiropractors, and all you’ll hear is horror stories; and there are a lot of them,” she said, “but there are chiropractors that help people.”

    Ms. Schilling cited two “success stories” to support her assertion.

    In one, an injured worker who was getting no relief after five weeks of physical therapy was referred to a chiropractor. The chiropractor treated the claimant for two weeks, and the claimant returned to work. The temporary disability savings amounted to $1,508, and avoiding litigation saved the employer an estimated $5,000.

    “He was threatening to go to a lawyer,” she explained.

    In another instance, a claimant seeing an orthopedic specialist whose prescribed treatment included wearing a back brace, medication and physical therapy was referred to a chiropractor.

    “He had two adjustments and was back to work the following week,” said Ms. Schilling, adding that the temporary disability savings to the employer amounted to approximately $3,500.

    “There are clearly subsets of chiropractors out there who are overutilizing, and this overutilization of care, does, in fact, drive up the cost of workers compensation claims,” said Dr. David Deitz, national medical director at Liberty Mutual Insurance Co. in Boston. “I think what’s a mistake is to automatically assume that all chiropractors are practicing the same way. There are chiropractors in the United States who practice appropriately and who do good physical med-icine treatments and take good care of claimants.”

    While moves by states such as California and Florida to limit chiropractic visits may offer a partial solution to the problem, they are not the cure, according to Dr. Deitz.

    “It’s a quick fix to a complex problem. It’s certainly worked in Florida, where costs have been reasonably well managed with their regulatory solution,” he said.

    In Florida, where chiropractic visits were limited by law to 18 visits over eight weeks, medical costs per claim average 20 percent less when chiropractors are directing care than when physicians are in charge, according to the WCRI study.

    But the Florida Chiropractic Assn. has since successfully lobbied to raise the limit to 24 visits over 12 weeks.

    Perhaps a more effective way to ensure claimants are receiving appropriate chiropractic care is to monitor the treatment, intervening where necessary, and measure outcomes, according to Dr. Deitz.

    “When we find that we have people whose treatment plans are off track and are involved with multiple visits and things like that, we try to move those cases not only to case management but, if necessary, to medical peer review, as quickly as we can,” he said.

    Ms. Schilling concurred.

    “As a third-party administrator, what we do is put a nurse case manager on the case,” she said. “They facilitate the injured worker’s getting to a permanent and stationary status. And that’s critical, because medical treatment–whether it’s chiro or orthoped–runs rampant.”

    Using prescreened network chiropractors can also ensure quality treatment, said Fred Scardellette, vp of product development and marketing in disability management at Intracorp in Philadelphia.

    “Use of a network can result in unit cost reductions of 10percent to 25 percent,” he said. “For best results, a network must include providers of the most-utilized treatments.”

Source: Business Insurance magazine.