Fund and Alliance Top Ranked by Texas Department of Insurance

By Herman Wilks

The Texas Department of Insurance (TDI), Division of Workers’ Compensation (DWC) is mandated to monitor the performance of both carriers and medical providers in the workers’ compensation system.  Compliance is monitored through a process referred to as Performance Based Oversight (PBO).  Since PBO’s inception in 2007, DWC has monitored system participants on several key compliance objectives, including accuracy and timeliness of data submitted, medical payments, and temporary income benefit payments.  DWC then ranks system participants biannually at minimum into three tiers:  poor performers, average performers, and high performers. 

The Fund has consistently ranked in the high tier and the 2010 PBO results were no exception.  Not only did the Fund maintain its high tier status, its overall performance statistics improved from 96.7 percent in 2009 to 97.97 percent in 2010.  A minimum performance standard of 95 percent or greater is required to be ranked as a high tier performer, a designation earned by roughly the top 22 percent of the carriers rated system-wide. 

"The Fund has consistently ranked in the high tier and the 2010 PBO results were no exception."

Performance of workers’ compensation certified networks is also monitored by TDI, specifically the Workers’ Compensation Research and Evaluation Group (REG).  The REG is charged with evaluating networks in the system on several key regulatory indicators including health care costs, utilization of care, satisfaction with care, access to care, return to work, and health outcomes.  They achieve this by requiring data submissions from the networks and by surveying injured workers to gauge their satisfaction with the health care received.  Networks are then compared to care received by those who did not receive care through a network.  Dubbed “non-network” treatment, this segment of the WC system still represents largest number of injured workers.  The REG then issues a “Network Report Card,” which grades the networks based on their regulatory performance.

Although not considered a certified network, the Fund is a member of the Political Subdivision Workers’ Compensation Alliance (Alliance).  The Alliance is a joint partnership though an interlocal agreement of five risk pools that contract directly with health care providers.  Governed under chapter 504 of the Labor Code, the Alliance was also graded in the 2010 Network Report Card. 

"Injured workers from the Alliance had higher return to work rates than non-network injured workers."

Overall, the Alliance scored better than any other network reviewed.  When compared to non-network claims, the Alliance’s performance was also stellar.  For example, when compared to non-networks, the Alliance’s average medical costs were lower in 11 of 19 categories.  Regarding overall utilization of health care or the average number of visits, the Alliance had lower utilization in 12 of 18 categories.  When injured workers were surveyed by the REG about the Alliance, they reported higher levels of satisfaction with their care and with access to that care when compared to non-networks.  Most importantly, injured workers from the Alliance had higher return to work rates than non-network injured workers.

The Fund is dedicated to providing quality workers’ compensation and other risk management solutions to school districts and other public school entities in the state of Texas.  As evidenced by the outstanding record of achievement both in the PBO ratings and with the Network Report Cards, the Fund has leveraged its position as a leader in the workers’ compensation area by continuing to be a pioneer in the industry. For more information about PBO or Report Cards, please visit the TDI Web Site at www.tdi.state.tx.us. For more information about this article, please contact Herman Wilks, Department Director of WC Claims Administration, at 800.482.7276, ext. 7272 or .