Column: Workers' Comp

Let’s Keep Adding Value

By: | March 1, 2016

Roberto Ceniceros is a retired senior editor of Risk & Insurance® and the former chair of the National Workers' Compensation and Disability Conference® & Expo. Read more of his columns and features.

Since the inception of Obamacare, opponents worked to scuttle the ACA and in fact are still trying to.


Whether a future president, Democratic or Republican, seeks to reshape the ACA — and funding for value-based care — remains to be seen. But it will be another two years before they can make a realistic attempt.

By then, we should have more performance data on the value-based initiatives that came to life under the ACA. If the arrangements continue to show value, future political leaders are unlikely to dismantle the incentives driving their growth. Similarly, value-based arrangements launched by the private sector should also expand.

Value-based health care initiatives include accountable-care organizations (ACOs) and bundled payment models. Both are alternatives to our current fee-for-service system that rewards medical providers for delivering volume over quality outcomes.

Whether a future president, Democratic or Republican, seeks to reshape the ACA remains to be seen. But it will be another two years before they can make a realistic attempt.

The ACA and Medicare funding pushed the spread of ACOs and bundled payments. There are now more than 700 ACOs nationwide.
Medical providers participating in ACOs bear financial risk. They accept a set payment for managing the health of a defined population, such as all the employees covered under a group health plan.

The idea aligns incentives so providers improve the population’s health. That should mean fewer care services will be necessary.

Results so far show only modest health care expense reductions. But they have improved outcome quality, said David Muhlestein, senior director of research and development at Leavitt Partners, a health care intelligence firm.

A bundled payment model of value-based health care, however, provides greater opportunity for improving workers’ comp medical outcomes than does an ACO, Muhlestein and other experts believe.

Unlike an ACO, a bundled arrangement doesn’t require providers to care for an entire population. Instead, medical providers provide all care necessary to remedy a specific medical episode, such as a workplace shoulder injury.


In return, providers accept one bundled payment for all services the patient receives from the beginning of their care for that specific injury to its conclusion.

Bundled payment arrangements are also spreading. Medicare counts 1,500 participants in these arrangements, including hospitals and doctor groups.

While Muhlestein and others believe bundled payment options provide more opportunities to improve outcomes for workers’ comp cases than do ACOs, other experts tell me they expect there will be room for ACOs to treat injured workers.

That is important for workers’ comp, because clearly, we need a better health care system. One built on measures that show positive outcomes, not one built on political whim.

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