Texas’ Model Offers Solutions for Growing Physician Access Challenges in Occupational Health ARAWC The challenge of ensuring injured workers have access to quality medical care is becoming increasingly complex across the United States. As populations grow and physician participation in workers’ compensation decreases, states are grappling with how to maintain high standards of care while improving access. Texas’s innovative approach to workers’ compensation offers valuable insights into potential solutions. Greg Gilbert, a senior executive at one of the nation’s largest occupational health providers, recently shared his perspective on these challenges in a recent conversation on the Forecasting Success Podcast: “The data shows from the AMA that there’s an access issue. They’re not graduating enough physicians. There’s not enough of them out there to treat,” Gilbert noted The President of the AMA recently sounded the alarm on this in a national address, and according to recent data from the Association of American Medical Colleges (AAMC), these shortages may be getting worse. According to the AAMC report, the U.S. faces a projected shortage of between 13,500 and 86,000 physicians within 12 years. This shortage may become particularly acute in workers’ compensation with the treatment of occupational injuries, where the system has traditionally been very physician-focused. The Texas Advantage Texas has proven particularly effective in addressing these challenges. Texas is unique in that it does not mandate employers to carry workers’ compensation insurance coverage. Instead, Texas employers have three options: Opt-in to Workers’ Compensation – Texas innovation and competition has created one of the best-performing workers’ compensation systems in America. Opt-in to QCARE – A responsible Texas injury benefit program that delivers better medical outcomes, improved benefits and cost savings, and meets 10 essential standards to earn the QCARE designation. Opt-Out – May not meet industry standards for the QCARE designation or provide any injury benefits. This freedom enables competitive innovation unique to Texas’ system, and has enabled it to become one of the most respected, high-performing programs in America. As Gilbert explains in his appearance on Forecasting Success, “We treat a ton of non-subscriber patients in Texas… We find our non-sub clients are really open to doing good things and allowing the doctor to practice medicine, but holding us accountable.” This balance of flexibility and accountability has enabled providers to maintain high standards, like those specified by the QCARE designation, while adapting to market realities. The Texas model offers several advantages in addressing these challenges: Treatment Flexibility: Injury benefit programs programs can adapt quickly to emerging solutions like telemedicine, particularly valuable for behavioral health services where access issues are acute. Market-Driven Innovation: Free market competition helps attract quality providers by removing unnecessary administrative burdens while maintaining high standards of care. Practical Solutions: The model allows for pragmatic approaches to using mid-level practitioners like nurse practitioners and physician assistants when appropriate, while ensuring physician oversight where needed. Gilbert notes that his company’s treatment model remains consistent whether treating patients covered under workers’ compensation or an injury benefit program, emphasizing that quality care is paramount in both systems. However the flexibility of Texas’ system can allow for more efficient delivery of that care. Looking Forward The solution to physician access challenges requires a multi-faceted approach. Texas’s model demonstrates how market-based solutions, regulatory flexibility, and innovative care delivery models can work together. As Gilbert notes, “Practically, what we’re seeing now in multiple states is that because of that, we’re getting delays in treatment… The discussion we had… was how do we open up our minds and thought process with the new world and the lack of access and our unique system in workers’ compensation?” Texas’s success in maintaining quality care while adapting to these challenges offers valuable lessons for other states. By allowing market competition based on reimbursement and removing unnecessary red tape, while maintaining appropriate oversight, Texas continues to lead the way in ensuring injured workers receive timely, quality care. As states continue to grapple with physician access challenges, Texas’s balanced approach offers a proven framework for maintaining quality while improving access to care. Through innovation, flexibility, and market-based solutions, Texas demonstrates that it’s possible to adapt to changing healthcare realities while ensuring injured workers receive the care they need.
Forecasting Success Podcast Episode 8: Greg Gilbert, Concentra Watch Now: Subscribe on the Following Platforms: Facebook Youtube Linkedin iTunes Spotify In this episode of Forecasting Success, host Ryan Brannan sits down with Greg Gilbert, Executive Vice President, Chief Reimbursement and Government Relations Officer with Concentra, a leader in occupational healthcare. Together, they discuss the complex world of healthcare operations, exploring Greg’s journey from health administration to overseeing reimbursement and contracting for over 500 centers across 43 states. Their conversation highlights the evolution of workers’ compensation systems, Texas’s unique framework, and the challenges of navigating multi-state regulations. Greg also shares insights into the role of AI in healthcare, particularly how Concentra uses predictive analytics to improve patient outcomes and operational efficiency. From navigating post-COVID advancements in machine learning to discussing the transition of Concentra into a standalone public entity, this episode is packed with valuable insights into the future of occupational healthcare. Latest episodes Episode 8: Transforming Healthcare with AI with Greg Gilbert, Concentra Watch Now » Episode 7: Recent SCOTUS Decisions & Texas Injury Benefit Programs: Unpacked w/ Richard Johnson, PartnerSource Watch Now » Episode 6: Brightening Futures for Children of Injured Workers with Hiawatha Franks, Kids’ Chance of Texas Watch Now » Episode 5: Transforming the TPA Industry: Insights from Michelle Villarreal Watch Now » Episode 4: Revolutionizing Workers’ Comp Education with Bob Wilson Watch Now » Episode 3: Navigating the Future of Non-Subscription Insurance with Joe Zopolsky Watch Now »
ERISA at 50: Revolutionizing Retirement Security and Texas Injury Benefit Programs ARAWC As the Employee Retirement Income Security Act of 1974 (ERISA) marks its 50th anniversary, the Association for Responsible Alternatives to Workers’ Compensation (ARAWC) celebrates this milestone by highlighting the act’s broad influence on both retirement security and injury benefit programs in Texas. Initially focused on improving retirement plan safeguards, ERISA now underpins a variety of benefit programs, including the innovative Texas injury benefit programs that provide a robust framework for protecting employees.Core Principles and the Evolution of Texas Injury Benefit ProgramsERISA was enacted to enhance transparency, ensure fiduciary responsibility, and uphold employer accountability across employee benefit plans. These principles have been crucial in guiding Texas injury benefit programs, which, while not falling under traditional workers’ compensation, benefit from the structured oversight that ERISA’s federal standards provide. These programs emphasize clear communication of benefits and responsibilities, ensuring that both employees and employers understand their rights and duties, akin to the disclosures required in retirement plans.Hybrid Regulation and the Role of QCARETexas injury benefit programs operate under a hybrid model that integrates state-specific laws with federal oversight, ensuring comprehensive protections that align with both local and national standards. The introduction of the QCARE (Qualified Compensation Alternative for Recovering Employees) designation enhances this framework. QCARE recognizes Texas employers who maintain high industry standards in their injury benefit programs, promoting transparency and care for employees. This designation not only boosts the credibility of employers, but also ensures that employee benefits are administered fairly and effectively under the umbrella of ERISA’s guidelines.Fiduciary Duties and Continuous ImprovementARAWC emphasizes the role of fiduciary duty in managing injury benefit programs, ensuring that administrators handle claims with diligence and transparency. This adherence to ERISA’s fiduciary rules has fostered trust and efficiency, crucial for the fair processing of injury claims. Enhancements in Texas injury benefit programs include improved fiduciary training and updated compliance measures with ERISA’s evolving standards, reflecting a commitment to continuous improvement and alignment with best practices.Forward-Looking: Innovation and Employee-Centric BenefitsAs ERISA continues to evolve, so too do the Texas injury benefit programs. Inspired by ERISA’s framework, these programs are progressively refining their practices to better serve both employers and employees. ARAWC’s dedication to leveraging ERISA principles aims to foster innovations that prioritize employee well-being and ensure that injury benefits remain effective and responsive to workers’ needs.Celebrating ERISA’s Legacy and Future ImpactCelebrating half a century of impact, ERISA remains a cornerstone of employee benefit protection, its principles shaping the landscape of both retirement and injury benefits. ARAWC remains committed to upholding these standards, ensuring that Texas injury benefit programs continue to offer robust protections that reflect the act’s enduring values of fairness, transparency, and accountability. Through designations like QCARE and the ongoing evolution of benefit structures, ERISA’s influence will undoubtedly continue to safeguard American workers’ rights and well-being in the years to come.
Forecasting Success Podcast Episode 7: Richard Johnson, PartnerSource Watch Now: Subscribe on the Following Platforms: Facebook Youtube Linkedin iTunes Spotify On this episode of Forecasting Success, host Ryan Brannan explores the changing landscape of administrative law and regulatory enforcement with guest Richard Johnson, Executive Vice President of PartnerSource.Richard draws on his extensive background in consumer protection and administrative law to unpack the recent Supreme Court ruling in Loper Bright Enterprises vs. Raimondo, which overturns the long-standing Chevron deference.This decision and other key rulings are reshaping how regulations are enforced, giving businesses more power to challenge federal guidelines. Join us for an insightful discussion on how these legal changes may affect American entrepreneurship and regulatory oversight moving forward. Latest episodes Episode 8: Transforming Healthcare with AI with Greg Gilbert, Concentra Watch Now » Episode 7: Recent SCOTUS Decisions & Texas Injury Benefit Programs: Unpacked w/ Richard Johnson, PartnerSource Watch Now » Episode 6: Brightening Futures for Children of Injured Workers with Hiawatha Franks, Kids’ Chance of Texas Watch Now » Episode 5: Transforming the TPA Industry: Insights from Michelle Villarreal Watch Now » Episode 4: Revolutionizing Workers’ Comp Education with Bob Wilson Watch Now » Episode 3: Navigating the Future of Non-Subscription Insurance with Joe Zopolsky Watch Now »
