Cutting Costs Without Cutting Quality in Texas

Problem

A large national insurance carrier was looking for ways to decrease claim costs in Texas. The carrier was not using a Texas Health Care Nextwork (HCN) and understood that without HCN enrollment, claims often experience higher medical costs, longer claim durations and minimal oversight.

The Solution

Coventry partnered with the carrier to implement a Certified Texas Health Care Network (TX HCN): A program designed to cut costs, ensure appropriate care and accelerate recovery.

Critical success factors included access to PPO savings (not available outside the HCN), improved access to care via a statewide provider network, gatekeeper care and coordinated referrals through a treating doctor, tighter medical oversight via a robust prior authorization program and improved care alignment via early nurse case manager engagement to reduce delays and complications.ight.

The Result

Through the Certified TX HCN, the carrier gained greater control over claims, achieving more predictable costs, faster return-to-work, and a better overall care experience for injured employees. 

Learn more about Coventry's Texas Health Care Network and how it can benefit your organization's claims management approach.

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