Top Ten Benefits of the Prospice Group Corporation Network





  1. An HCO that takes less
    The #1 benefit is that as a Health Care Organization (HCO), Prospice Group Corporation makes less on every transaction than other HCO's.  What does that mean for YOU?  It means lower costs for employers. Higher returns for doctors.   How does our new paradigm save dollars ... here's how:

    Traditional Model   Prospice Group Corp  
    Patient medical bill submitted to Insurance $1,000 Patient medical bill submitted to Insurance $1,000
    Doctor is paid by insurance company ($1,000 less 20% fee that doctor must pay) $800 Doctor is paid by insurance company ($1,000 less 20% fee that doctor must pay) $950
    Insurance keeps 20% fee that doctors must pay to network $200 Insurance keeps 5% fee that doctors must pay to network $50
    Insurance pays 50% to HCO $100 Insurance pays 50% to CHN
    		 $25
    Insurance keeps 50% $100 Insurance keeps 50% $25
    Cost to Insurance Carrier $900 Cost to Insurance Carrier $975
  2. Unique efficiencies
    Efficiencies exist within our system that don't exist with other HCO's

    Traditional Workers' Comp Model
    		 Prospice Group Corp New Paradigm
    Inefficient System:  Limited communications between parties; Limited use of technology to track or transfer information
    		 More Efficient System:  Integrated network between doctors and California Healthcare Network (CHN); Technology utilized to efficiently process claims
    Issues:  Difficult to identify fraud; Processing claims is very slow; Workers unable to return to work for long period of time
    		 Improvements with Prospice Group Corp Paradigm:  Claims processed quickly; Workers return to work in shorter time period

  3. Cost containment
    We offer cost containment measures to employers and doctors

  4. Back to work faster
    Employees are back to work faster
    Savings for the employer
    Better healthcare for the employee
    More opportunity for the doctors

  5. Remove the adversarial nature of the system
    Healthcare traditionally has been adversarial by nature and dysfunctional by habit.  The left-hand never knows what the right-hand is doing.  Prospice Group Corporation is shifting the paradigm to a model that is collaborative, effective and efficient.

  6. The integration of technology that enables seamless, integrated communications between parties
    Prospice Group Corporation is a leader in integrating technology into a system that works.  Almost everyone has experienced the frustration of a healthcare provider not communicating with another healthcare provider, or the billing department, or the insurance carrier.  Claims are filled out on paper forms.  Just reaching an adjustor can take weeks.  Employers and employees waste hours of their own time being an intermediary between these different entities -- all because we operate in a "broken" system!  The process is slow, laborious and inefficient.  The reason?  Within the industry, there is no communication between the many players that touch the claims process.  Their  communication is typically limited to internal correspondence and some email or digital documents exchanged between the parties.  The Prospice Group Corporation family of companies are tied together with ONE technology system that enables the left-hand to always know what the right-hand is doing.  Our technology creates full integration and information exchange - instantly - between all parties.  The result?  Reduced costs, fewer delays and a more efficient system.

  7. Doctors won't be squeezed any longer
    When it comes to injured workers, providers have chosen to just get out of a broken system that requires mountains of paperwork and wasted time filling out forms.  Their attitude is that they don't need the aggravation.  The result?  They are "talking with their feet" and leaving practices in California for communities that are friendlier to doctor-patient relations and where equitable reimbursement is provided.  The Prospice Group Corporation paradigm specifically addresses this issue -- and has created a fair solution that rewards instead of punishes the doctors that want to help injured and ill workers return to work.

  8. An MPN built from the ground up
    Healthcare management organizations have existed for dozens of years.  These organizations have appeared with a variety of nomenclatures including: IPA, PPO, MPO, HMO, HCO and, more recently, MPN.  In April 2004, Governor Schwarzenegger signed Senate Bill 899, which instituted significant reforms for California's workers' compensation system. One of  the reforms was the creation of MPNs.

    According to the Division of Workers' Compensation for the state of California, an MPN "is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine.  MPNs are required to meet access to care standards for common occupational injuries and work-related illnesses."

    Once it became evident that MPNs would be mandated, the large HCO groups scrambled to "create" their MNP network  With extensive PPO provider networks already in place, these HCOs began the "PPO to MPN shift".  In other words, instead of building a credentialed network trained in handling workers' compensation claims, they essentially "re-labeled" their network using their current provider network list along with any other provider lists they were able to access.  Subsequently, when SB 899 was passed, these lists were "grandfathered" and established as their MPNs.  From a cost standpoint for these HCOs, this was a significant advantage because they weren't required to adhere to credentialing and training requirements.  However, from a patient standpoint, this meant inferior service and sub-par care.  In a significant number of cases, the providers on these lists did not take injured workers claims or, in some cases, just "refused" care by scheduling patients 6-12 weeks out.

    Prospice Group Corporation is proud of the MPN provider network we have built.  100% of our doctors must meet minimum requirements and all are credentialed.  For further information on the advantages of our MPN network, read "Doctors: Why Join Our MPN".

  9. Put a stop to the losses.  "Cracks are starting to show once again in California's workers' comp system based on the latest report issued by the Workers' Compensation Insurance Rating Bureau. Costs on a per-claim basis are climbing, loss ratios are rising as are combined ratios, based on data collected by the bureau through March 31 of this year.  Aggregate insured losses grew 6.7 percent last year to $6.3B from $5.9B in 2005."  (Read more about this report: "Loss Ratios, Claims Costs Rise in 2006"!) While workers' comp reforms seemed to "fix" many of the problems that existed within the system, the recent deterioration indicates that these reforms are not enough as a long-term solution.  Prospice Group Corporation is proud to be the first to introduce a viable, long-term solution to California's workers' comp problems.

  10. It starts with trust!  The current system doesn't operate within a spirit of trust.  "A class action lawsuit has been filed against California's State Compensation Insurance Fund and some of its former top executives, accusing them of "self-dealing" and for "improperly diverting" funds." (Read more about this story: "Class Action Suit Against SCIF Seeks $75M")  With few checks and balances and a system dictated by the insurance carriers, it is no wonder that employers - and employees - are distrustful.  Even worse, the State Compensation Insurance Fund, operates behind a veil of secrecy since the commissioner does not require administrative fees to be made public.  (Read more about this story: "SCIF Plans 20% Commission Hike for Group Business".) Prospice Group Corporation has now built a paradigm that allows and encourages competition - thereby enabling checks and balances - while giving employers a choice.  We are committed to changing the perception of workers' compensation  .... it starts with trust!