State of New Jersey Managed Care Organization Evaluation
On November 19, 2009 the State of New Jersey completed their analysis of the Managed Care Organization proposals for the State employee’s worker’s compensation program. The following are excerpts from their final report which ranks our network size and discounts as clearly the best in New Jersey:
“QualCare’s proposed provider network is comparable to Horizon’s in the area of orthopedic care, the specialty that is considered by the Committee to be the most utilized in the New Jersey workers’ compensation program. The Milliman report clearly indicates that while Horizon and QualCare have a significantly lower amount of orthopedic specialists in their respective provider networks than CorVel, Coventry and First MCO, if the State uses Horizon as a measuring stick, QualCare has only 84 orthopedic care specialists fewer than Horizon (929 vs 845), an amount determined to be acceptable by the Committee. ”
“As indicated earlier, the State is not only concerned with the technical attributes of the proposal but also the overall cost. With that in mind, the committee looked very closely at the Facility and Physician Discount Analysis provided by Milliman on Page 4 of the Milliman Report (Attachment B). The bidders were required to submit confidential information directly to Milliman in an effort to determine overall discount rates and ultimately, cost to the State. The bidders completed an excel spreadsheet requiring current discounts for inpatient hospitals, outpatient hospitals and provider fees for physicians under specific Current Procedural Terminology (CPT) diagnostic codes. Milliman received this information, compiled it, analyzed it and provided the State with a final analysis ranking overall discount rates. The results of the analysis demonstrated that First MCO was clearly the bidder with the best overall discount; however, given that First MCO was determined to be non-responsive by the Committee, the Committee looked to the second best overall discount rate…”
We emphasize that even though “clearly the bidder with the best overall discount” is important, it is combined with the top ranking we received in network size and penetration.
For more information please contact our team of specialists.