Florida MCA Client Newsletter Fall 2013

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1 A semi-annual educational newsletter dedicated to our clients using the Florida Managed Care Arrangement. FL MCA COMPLIANCE HIGHLIGHTS SEMI-ANNUAL NETWORK REVIEW JUN 2013 & NOVEMBER - ACCESS & AVAILABILITY Coventry remains approved for its FL MCA workers' compensation network in all 67 counties. Copies of the network approval and documentation were distributed to all FL MCA customers. If further information is needed, please contact your Coventry Account Manager. NETWORK CERTIFICATION GREAT CHANGES ARE COMING Access/Accessibility For the last year, Coventry has been working with the State and Multiplan to expand Network coverage in Florida. As of December 2013, Coventry will expand the Coventry FL MCA program to include Multiplan and Integrated Health participating providers. This positively impacts access by adding new/unique providers to the network and eliminating most of the remaining exception requests in each county. Provider Verification Coventry and its network partners continue have initiated calling campaigns on an ongoing basis to verify Network demographic information in an effort to maintain the accuracy of our network. This is a continual process Waivers & Exceptions In December, Coventry will again submit its Network Filing with new Multiplan and Integrated Health participating providers. Upon approval, Coventry will share our documentation on the exceptions to help you better manage medical services. PROVIDER CERTIFICATION Effective July 2013, rule 69L-29 was repealed. Providers no longer require certification by the state in order to render care for workers compensation. Providers who have been appropriately licensed in their specialty may render care. QUALITY IMPROVEMENT All FL MCA Certified entities should be receiving quarterly Quality Improvement documents from Coventry. Quarterly reports include: Meeting Minutes, Network Status Reports, QI Summary Reports that highlight quality of care review, Complaint & Grievance monitoring and resolution, Network Oversight Reports including credentialing, contracting, medical chart & peer review audits, satisfaction surveys, internal/external education, trends and reporting. Contact your Coventry Account Manager to obtain these documents if needed. MEDICAL CHARTS AND PEER REVIEW The purpose of the medical chart audits is to ensure that treating providers in the FL MCA are completing the required reports and are rendering care consistent with treatment and professional medical standards. Coventry selects a random sampling of contracted providers in Florida. Our goal is to request charts from at least 1 provider from every county to demonstrate a comprehensive selection of providers are being reviewed. Coventry sends requests to the sampling of providers in January and receives their medical records throughout the year. Our results are compiled and presented to our clients quarterly. This activity is a primary tool for compliance purposes and to identify additional educational opportunities to interface with providers.

2 SATISFACTION SURVEYS For compliance purposes, the certified entity is responsible for conducting surveys for insureds and injured workers using their FL MCA certified program. It is helpful for Coventry to receive the results of your surveys in relation to Coventry s Network. Please forward your survey results to your Coventry Account Manager. PROVIDER EDUCATION Coventry has received positive feedback from its Provider Education Bulletin this fall. Dr. Bean, (DO, MBA, FACOEM) our Coventry Medical Director gives physicians helpful considerations to maintain focus on returning the injured worker to productivity, including: The Health Care Provider s Role in Successful Return to Work Guidance for writing Work Restrictions Removing Barriers to Healing and Return to Work Guidelines for performing a Functional Capacity Evaluation (FCE): We welcome your feedback to advise providers how we can work better, smarter and more productively with each other. If you have a useful recommendation, let us know by advising your Coventry Account Manager and we will consider it for our next Provider Bulletin. OTHER WORKERS' COMPENSATION NETWORK NOTES ACHIEVEMENTS Workers Comp Drug Spend is on the Decline Drug Trends Reveal a 15% Decrease in Spend For Claims in Years 1-10 Despite significant outside influences on the cost of prescriptions, First Script s clients experienced a 5.3% decrease in drug utilization due to our Coventry management programs. In fact, looking at a subset of data for years one through ten we saw a decrease in spending by 15%. This, among other trends, is proving valuable insight into the workers comp industry, is outlined in the 2012 Pharmacy Trend Analysis published by Coventry Workers Comp Services (Coventry). Key notes on this are: The role of a Pharmacy Benefit Manager (PBM) has evolved to focus on minimizing the impact on new dispensing practices while monitoring utilization and reducing cost to positively impact the health of a patient. One of the most critical patient safety issues in 2012 was narcotic overutilization. Through the application of clinically-based programs and enhanced client education, First Script clients realized meaningful decreases in narcotic utilization in For claims between years one and ten, narcotic spend and scripts per claim decreased 17% and 15%, respectively, versus When discussing narcotic safety, decreases in Morphine Equivalent Dose (MED) may prove to be even more meaningful than changes in script volume or cost. MED is the conversion of various opioids to a Morphine Equivalent Dose by the use of accepted conversion tables that outline relative potency, duration of action, side effects, etc. Since 2010, the average MED for First Script injured workers has declined 11% in the first two years post-injury, and 8% in years two to five.

3 For more information on Coventry s First Script Pharmacy program, contact your Coventry Account Representative. Coventry Health Care Ranked Among FORTUNE s List of World s Most Admired Companies Coventry Health Care Inc. is ranked third in the health insurance and managed care category of FORTUNE magazine s list of World s Most Admired Companies for This prestigious ranking, which is released annually, is considered the definitive report card on corporate reputations. This recognition is a testament to the hard work of our employees and of Coventry s ability to provide excellent service and value to our clients, providers and members in a changing health care landscape, said Allen F. Wise, chairman and chief executive officer of Coventry. We are very pleased to be among the leaders on such a distinguished list. To create the World s Most Admired lists, FORTUNE s survey partners, The Hay Group, surveyed approximately 15,000 senior executives, directors, and other industry leaders to rate companies in their industry based on nine criteria: Wise use of corporate assets Financial soundness Long-term investment value Quality of management Quality of products or services Ability to attract and retain talented people Innovativeness Social responsibility to the community and the environment Effectiveness in doing business globally Coventry has been listed among the top 10 companies in health insurance and managed care since Provider Outreach Yields Improved Safety and Cost Savings Follow-Up Celexa Case Study Proves Dosage Changes Were Lasting Changes resulting from provider outreach, 6 months ago, regarding dosing recommendations for Celexa appear to have lasting effects. Last year the recommended dosage for the popular antidepressant was revised from 60 milligrams to 40 milligrams per day due to indications that the higher dose could lead to potentially fatal heart arrhythmia in some patients. In the initial study Coventry identified providers who continued to prescribe higher doses three months after the revision announcement. These providers were contacted with pertinent information about the dosage change. Ninety days after the initial outreach prescribing data was analyzed to determine if a change in prescribing patterns had occurred, and indeed 58% of the providers receiving letters did change their therapy.

4 To determine the longer-term effects a second analysis was performed at 180 days post-outreach. At this point, 47% of the affected claimants continued with the same therapy they were receiving at the 90 day mark, and an additional 35% positively changed their therapy and improved their safety profile. Our findings clearly indicate that educating providers on prescribing recommendations has a positive impact on a patient s medication regime, said Brian Carpenter R.Ph., vice president, product development. The benefits demonstrate that a simple provider communication can result in increased patient safety and savings. Coventry will continue to identify new drug changes that could benefit from outreach and report such findings as they occur. Report Shows Positive Results for Outcomes based Network Indicates Shorter Claim Durations, Lower Utilization and Lower Medical Costs In 2009, the Outcomes based Network (OBN) program was launched in Florida, providing clients an opportunity to access a more selective and focused workers compensation managed care option. Since the pilot, Coventry has been closely monitoring the program s impact and is pleased to report findings from a recent study of OBN claim results since the program s inception. Specific findings include: OBN claims averaged 40% lower medical treatment durations and approximately 20% lower claim durations than non OBN Claims The average medical cost was 50% lower for OBN claims OBN lost time claims have 30% lower indemnity cost as compared with non OBN claims For those claims with a hospital admission, hospital inpatient costs per claim were approximately 45% lower for OBN claims OBN claims experienced approximately 50% lower incidence of permanent partial disability compared with Non OBN claims at the 12 month mark as compared to 14% at the 6 month evaluation period We are pleased that the results are beginning to reflect our initial expectations of the program, and expect that we will continue to report positive results from the program as we continue to monitor it, stated Bruce Singleton, vice president, network strategy at Coventry. Coventry expanded the Outcomes based Network program into five additional states in 2011, and expects to report our initial findings on those states in the near future. Coventry also expanded the program to three additional states in By the end of the third quarter of 2013, Coventry s Outcomes based Network program will be offered in 21 states, focused primarily in states that have similar employer choice provider framework. HELPFUL STATE INFORMATION WHAT'S NEW WITH THE STATE

5 Department of Workers Compensation (DWC) Educational Courses The DWC offers a number of free classes to educate interested stakeholders on their responsibilities under Workers Compensation Law and Workplace safety. The DWC has partnered with the U.S. Department of Labor and OSHA to provide this information. Continuing Education Units are also available. For more information on available classes, go to: The state also offers other helpful topics and information at NEED MORE INFORMATION? Go to the Coventry Workers Comp Services website at for information and tools available for our clients convenience.