Texas WC Networks Medical Costs are lower than Non-Networks

The Texas Department of Insurance has published its 2020 Workers’ Compensation Network

Report Card Results Showing networks outperform non-networks on various measures including medical costs per claim for injured workers.

“Overall, the 2020 network report card continues to show that networks tend to be more cost-efficient than non-network claims, and these cost differences appear to be partially driven by lower hospital utilization and lower prices per service. Despite lower costs, network claims generally have better return-to-work and functional outcomes, compared with non-network claims,” the report concludes.

Network claims also tend to receive initial non-emergency medical care sooner than non-network claims, which may help in controlling medical costs and reducing unnecessary disability among injured employees. Since 2012, network claims consistently report higher return-to-work rates than non-network claims.

Other findings include:

• Medical Utilization - A higher percentage of network injured employees received evaluation and management, physical medicine, and pharmacy services than non-network claims (a higher percentage of non-network injured employees received hospital services).

• Health Outcomes- Most network claims had higher physical and mental functioning scores than non-network claims.

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