MPNs Done Right: EK Health’s Recipe for Success

Medical Provider Networks (MPNs) have recently received negative publicity for leaving a bad taste in the mouths of employers and employees, often being seen as mere provider discounting mechanisms or profit centers. However, EK Health, a leading managed care company, firmly believes that a properly formulated MPN goes far beyond cost-saving measures. Their “secret sauce,” outcomes-based approach hinges on high-quality providers who are carefully vetted and credentialed and proper management of guidelines. By ensuring understanding and adherence to the expectations of the MPN and the employers, trust is built and accuracy is promoted across the board – providing value for all, most importantly, for the injured worker.

Prepping the Essentials
“The basic recipe for success is that MPNs should not be your typical large, unmanned, discounted networks; they should be hand-crafted, custom-built networks that prioritize value and quality,” stated Dr. Douglas Benner, EK Health’s Chief Medical Officer. “For instance, the providers in our network are specifically nominated by EK Health’s trusted clients who have first-hand experience with their expertise in workers’ compensation and receive positive feedback. This ensures that the right providers are in the right areas, offering the right care to injured workers at the right time.”

EK Health’s MPNs are developed over several years with providers that agree to the specific performance metrics and expectations. EK Health regularly evaluates providers’ performance and ensures appropriate payment for performing providers. This helps strike the ideal balance between access to care and the quality of services provided. “We manage providers via back-end data, reporting, and metrics from utilization review and bill review, as well as through issues/complaints raised by patients and claims adjusters. With this information, we can identify potential problems and opportunities to engage and counsel providers. We remove providers from the MPN for repeated offenses, including when they do not uphold our standards. Continuous monitoring of providers for any state or federal license actions, malpractice payments, or adverse clinical privilege action keeps information accurate with accountabilities and verification,” stated Robyn Calvetti, Provider Network and Provider Relations Manager for EK Health.