Insights
The Sounding Board
Ideas and inspirations for the managed care industry
Overview of the 2019 Texas Department of Insurance Workers’ Compensation Network Report Card
December 2, 2019
The Texas Department of Insurance recently released its annual Workers’ Compensation Network Report Card. The 2019 Report Card includes medical cost and utilization measures for 17 workers’ compensation health care networks (HCNs), including the Coventry HCN, First Health HCN, and several other HCNs supported by Coventry. Various measures were calculated for injuries occurring between June 1, 2017 and May 31, 2018.
Pharmacy Nurse – When specialized attention is what’s needed
November 25, 2019
Workers’ comp pharmacy costs represent approximately 18% of total medical spend. That translates to $5 billion in pharmacy spend nationwide.1 Most employers and payors utilize Pharmacy Benefit Managers (PBMs) which offer an excellent line of defense in managing these ever-increasing pharmacy costs. But PBMs, by design, only manage the pharmacy related aspects of a claim. What if you could extend the reach of your PBM by combining it with the knowledge, care and one-on-one delivery model used in case management? With a pharmacy nurse, you can.
Catastrophic Case Management: Immediate coordinated response by clinical experts
November 18, 2019
Most illnesses or injuries progress well with traditional case management services. However, a small percentage of cases require more intense and careful management. Early intervention and proper procedure are imperative in the treatment of catastrophically injured people. Clinical situations that require catastrophic case management are characterized by diagnosis, complexity of treatment, and high dollar exposure.
Spread the Kids’ Chance Mission
November 11, 2019
November 11-15, 2019 is Kids’ Chance Awareness week. It’s a time to highlight and raise awareness of this ever-growing organization that provides educational opportunities and scholarships for children affected by workplace injuries. Coventry is a proud supporter of Kids’ Chance of America and actively participates with many of the organization’s state chapters. Earlier this year we created a first of its kind Catastrophic Care Referral Program designed to refer affected parties directly to Kids’ Chance. The program provides a monthly report that flags eligible cases where the injured worker is gravely injured or killed in the course of a work-related accident.
Why do customers love live chat?
November 4, 2019
In conversations regarding Coventry Connect (Coventry’s proprietary client portal), one feature that rises to the surface is Live Chat. When discussing with our users, it seems that the opportunity to address an issue the moment it arises is what they like most. Even if the issue is not immediately resolved, it can be quickly escalated by one of our customer service representatives to someone who can help.
Texas Non-subscriber Case Management
October 28, 2019
Legislation in most states mandates that businesses provide workers’ compensation benefits to their employees. Texas law, however, gives employers the option to opt-out of workers’ compensation, thus becoming a “non-subscriber.” This option has been available since 1913 in Texas. Approximately 22% of Texas businesses are operating as non-subscribers.
Specialty Medication Trends in 2018
October 21, 2019
Emerging trends in pharmaceutical design and drug manufacturing are shifting toward presenting the market with new ways to develop medications. Specialty medications continue to be a major area of pharmaceutical development, and have become widely discussed in workers’ comp due to their significant costs.
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