Up To Date

The Time To Be BOLD^SM

In our last issue of the Broadspire Review, we announced the launch of the BOLD PPO Network. It’s important, now that the network is providing so many clients added benefit, to explain the structure behind the new network.

Workers Compensation Preferred Provider Organizations (PPOs) have been used by employers for over three decades now. Penetration rates have gone from 40 to 50% in the 1980s to more than 70% today.¹ However, as total medical spending for workers compensation continues to rise, it’s clear that the model most are using for discount networks is not delivering the desired results.

Unfortunately, stellar network penetration rates don’t necessarily mean cost savings. Many PPO networks have improved their penetration rates through contracting with virtually every provider they can reach instead of finding superior occupational and non-occupational providers.

Based on the Medical Consumer Price Index, the cost of medical services has gone up 3.4% compared to 1.1% for the entire consumer price index from November 2009 to November 2010. From a long term perspective, the cost of medical services rose 45% from 1998 through 2008.The average price for Hospital Services rose 75% during the same time period.²

The New Approach
It’s time to be BOLD. Broadspire’s Original Landmark Design (BOLD) Network takes an innovative approach to the preferred provider organization. Instead of trying to cast a wide net, only Broadspire has the clinical expertise to partner with the best networks customized to each region, industry and even company.

To create the network, our medical management team examined regional networks in-depth. By analyzing bill data and outcomes, we were able to find the best results and the coverage needed across the map. Then, instead of relying on one coverage level, we were able to identify second and even third networks with exceptional providers. This multi-layered method gives us breadth that very few other companies can provide.

Cost Drivers
Objective metrics are used to identify primary cost drivers unique and specific to different clients. To stem these costs, we partner with multiple specialty networks to improve coverage, turnaround time and client choices. From home health to physical therapy to translation and transportation services, we have found the best networks to care for your employees while controlling costs.

Out of Network Solution
As networks have grown, it has become clear that providers are not able to expand their practices through the PPO system. This has caused some providers to discontinue their PPO membership. If a provider is not in our network or in a state that doesn’t allow PPO discounts, we use medical bill negotiation services to obtain deeper savings. In 2009, this expertise saved our clients an additional savings percentage of 57.71% after the normal bill review process.

Tomorrow
Change and innovation are our constant. Broadspire will continue to analyze outcomes versus other networks. In this way, we remain flexible enough to always optimize the networks that make up the tapestry of the BOLD network.

1 Huth, David, Time PPOs Went the Way of the Dodo?, Risk and Insurance, 2009, June
2 Bureau of Labor Statistics