Message From David Donn

Around 2000 through 2001, I noticed concurrent trends happening in the workers’ compensation managed care space (comprising products like medical bill review, hospital and provider PPO, UR and nurse and medical case management) – there was tremendous growth in the number of bill review companies to well over 50 and a tripling of bill review and PPO software lease companies to almost 20 (they lease their software to insurance companies and TPAs primarily). There was also an increasing complexity of cost containment services and options available to the employers. At the same time, the available time and resources at the purchasing decision level – Risk Managers and executives at all levels within workers compensation – was being reduced through budget cutbacks, layoffs and resource shifting. This was creating a volatile situation for the employer because they knew they needed to have and monitor these cost containment services but didn’t have the time, knowledge in some cases and resources to do it. The clients became largely reliant on what the managed care service providers including the TPAs supplying these services were saying and doing and trust became a primary policing system. Monitoring and oversight was being done without comprehensive comparative pricing and performance data, inside knowledge, and few “tools” at their disposal to sharpen performance and fees.

It’s interesting that these are the same conditions that exist today with the exception of the number of service providers, which has since more than doubled.

Managed care is a business with as many moving parts as a car engine and with the exception of the true hobbyist who likes to fix his or her own, most people rely on their mechanics to be dealt with fairly and honestly.