Abstract

The California MPN provides an excellent legisl ative model for managing a health-care medical network in workers’ compensation. This managed care model provides payers with the control to create and certify a medical network from which all injured employees must select physicians and medical services. This containment of patient traffic ensures higher rates of compliance in the use of approved providers than typical healthcare and workers’ compensation models.

MPNs that select providers based primarily on fee discounts may generate higher total claim costs if they provide poor quality care that results in more numerous treatments and delays returns to work. Harbor Health Systems, LLC has been engaged in a nine-year effort to develop the tools, systems, and data needed to identify providers that truly reduce total claim costs by providing superior medical care which reduces the number of treatments required for recovery and enables employees to return to work more quickly. Many practical lessons have been learned about identifying, building and managing outcomes-based network of quality providers through a pilot implementation that has produced significant positive results.