Meeting_Body
FINANCE, BUDGET AND AUDIT COMMITTEE
JUNE 17, 2020
Subject
SUBJECT: WORKERS' COMPENSATION MANAGED CARE SERVICES
Action
ACTION: APPROVE CONTRACT AWARD
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to award a four-year base term, with three, two-year options, incentive-based contract, Contract No. PS161339000, to Anthem Workers' Compensation, LLC to establish, maintain and provide a workers' compensation managed care service program, including access to the Anthem network, effective July 1, 2020.
Issue
ISSUE
The current workers' compensation Preferred Provider Organization (PPO) and Medical Provider Network (MPN) services contract with Anthem Workers' Compensation, LLC (AWC) will expire on July 31, 2020. To ensure workers' compensation claims are properly reviewed and to control costs of workers' compensation medical bills, a new contract is required effective July 1, 2020. The commencement of this new contract is aligned with the start date of Metro's new workers' compensation medical bill review contract to effectively administer workers' compensation claims.
Discussion
DISCUSSION
PPO vendors give clients a network of contracted doctors, hospitals and other medical service providers at rates below California's approved fee schedules for their services. The highest quality PPO vendors have deeper discounts, broader networks and better-quality assurance by constantly reviewing their panel of physicians, and terminating contracts when physicians fail to meet specific clinical or legal criteria. PPO vendors have extensive networks (Southern California has tens of thousands of medical providers) with many medical specialties and locations represented, allowing a greater degree of access and penetration than smaller networks can provide. PPO vendors must also be able to support the creation of a customized MPN consistent with the regulations in the California Labor Code.
AWC has the most comprehensive Workers'...
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