WHAT IS THE POLITICAL SUBDIVISION WORKERS’ COMPENSATION ALLIANCE AND HOW DOES IT RANK AT SERVING OUR MEMBERS?
Operational Excellence in Action
The Political Subdivision Workers’ Compensation Alliance (the Alliance) was formed in 2006 by five risk pools that offer workers’ compensation coverage and claims services to public entities in Texas for the express purpose of restoring the health of injured workers and returning them to work as soon as possible. Collectively, Alliance risk pools represent more than 3,000 public employers representing 500,000 employees.
Because the Alliance was formed by the member risk pools, it exclusively serves these pools and the public entities that participate in their workers’ compensation programs. Pools participating in the Alliance include:
• Texas Municipal League Intergovernmental Risk Pool
• Texas Association of School Boards Risk Management Fund
• Texas Association of Counties Risk Management Fund
• Texas Council Risk Management Fund
The Alliance is structured as depicted below:
As a quality-focused network, the Alliance is committed to matching injured employees with top-notch providers who will get them back to health, back to work, and back to their lives. Our members are known for their service to their local communities — at city hall, the county courthouse, in schools, community centers, public utility facilities, and as first responders. If they get hurt on the job, the Alliance is here to make sure these dedicated public servants have access to top-quality healthcare providers.
The Alliance is different than your typical healthcare network and does not sell its services for a profit, nor is it commercially available. As a result of 2005 workers’ compensation reforms, Texas public entities have the opportunity to directly contract with healthcare providers in order to deliver the best medical care possible to injured employees. The Alliance was established under Chapter 504.053 of the Texas Labor Code to perform the direct contracting and credentialing of healthcare providers on behalf of its members (the pools.)
The Texas Department of Insurance (TDI) oversees certified networks, and the TDI Workers’ Compensation Research and Evaluation Group (REG) publishes an annual Network Report Card that evaluates workers’ compensation certified networks and Chapter 504 political subdivision networks. The criteria include:
• Healthcare Costs
• Satisfaction with care
• Access to care
• Return to work
• Health Outcomes
The Alliance remains one of the highest-ranked networks in the state. The REG uses data supplied by each network/provider panel for more than 100 data elements, denial codes, medical procedures and healthcare provider types. The REG also conducts a survey of injured workers by the Public Policy Research Institute at Texas A&M University. The time period for the 2018 network report card was for injuries occurring between June 1, 2016 and May 31, 2017 and evaluates 16 individual networks and groups. The data used included information for 219,000 injured employees, 5 million medical services, $400 million in medical payments to healthcare providers, and 3,200 completed injured employee surveys.
Among the more noteworthy findings of the report that compares the 15 networks, the Alliance had:
• the highest satisfaction of care of any of the networks in the survey
• the third highest rating for getting needed care and second highest rating for getting care quickly
• the second lowest average duration from date of injury to first non-emergency treatment
• the third highest return-to-work results
• the second highest physical and mental functioning scores
• the second lowest average medical cost increase between six months and 18 months among all networks
• the second lowest average professional costs
• the third lowest average hospital costs and pharmacy costs
• the lowest average number of prescriptions per injured employee
• 21 percent of all workers’ compensation claims, the second highest of any network in the report
The Alliance is a consistent top performer since the REG began publishing network report card results. As a result, the Alliance continues to ensure that the best quality doctors treat our injured workers and return them to work in a timely manner with a high level of satisfaction of care. The complete report can be viewed at https://www.tdi.texas.gov/reports/wcreg/documents/netrc2018.pdf.
This article was originally published in the December 2018 issue of Texas Town & Cities; it was written by the team at TMLIRP.
The Texas Municipal League Intergovernmental Risk Pool is the leading provider of workers’ compensation, liability, and property coverage for local governments in Texas. Founded in 1974, we are the oldest and largest pool of its type in the United States, serving over 2800 governments and political subdivisions. We are driven to continue the mission that began over 40 years ago, providing our members with a tailored risk financing system through reliable partnership, performance, and service.
If you are currently looking for coverage or have any questions, please contact our team.