One thing that differentiates R3 Continuum is the breadth of our services – the continuum of our name. It also provides us a unique perspective into optimizing networks, as each service that requires a network has different needs. Some of the needs and providers cross over, but they are, essentially, networks customized specifically to each service.
This experience has led us to one conclusion across all our networks: the best network for any given service is the smallest network that meets the needs of our customers.
This seems counterintuitive. Isn’t a larger network always better? Isn’t it always better to have more providers so you’re never without a provider? We frequently are asked in requests for proposal about the size of our network, with the implied assumption that larger is better.
Before we explore our conclusion, let me state this: in some cases, a large network is required. For example, the network associated with our disruptive event management (DEM) service has to be pretty large and geographically dispersed in order to be effective. These providers have to be on our clients’ sites, frequently on very short notice. We also respond to a large number of DEM cases daily, so we need both breadth and depth within that network to be able to respond to all of our customers’ requests.
With that stated, there’s even a limit to the size of that network. It needs to be large enough to meet our customers’ needs, but not so large that providers are getting cases infrequently. It’s like learning a foreign language – the less you use it, the more likely you are to get rusty. Too large of a network can create quality issues, because no matter how much training you provide, experience is still the best teacher, and repeated use of a skill hones that skill. Further, if a provider gets cases too infrequently, they’re likely to exit the network, creating network turnover. This creates a situation where you must continually train new providers, who have a ramp-up time. Of course, we provide in-depth training and mentoring to ensure that providers meet our standards, but once again, refining those skills requires experience.
Applying the same logic to our peer review network reveals a need for a much smaller network. It’s geographically agnostic – the provider doesn’t have to be in the same place as the medical records originate. We can fill the needs of our customers with far fewer providers. Those providers turn over less frequently because we provide them with enough cases to keep them engaged. Their experience should also result in a higher quality review, because they’re doing them regularly, and that experience maintains and hones their skills. They’re also likely to do them more quickly, since they know what to look for.
To our customers, this smaller network provides a higher-quality review from a more-qualified provider more quickly.
About the Author: Dr. Les Kertay, Ph.D., ABPP, LP, a licensed and board certified clinical psychologist, provides clinical direction and perspective to all areas of R3 Continuum as chief medical officer. He brings extensive experience and expertise in the arena of mind-body health including disability medicine, chronic pain, health behaviors, and managing workplace absence. With over 15 years in executive leadership positions in the medical and vocational areas of the disability insurance industry, Dr. Kertay has presented at national and international conferences on topics related to the psychological aspects of work and disability, practical approaches to managing psychosocial issues in medical practice, pain management, somatoform and personality disorders, and professional ethics. Also, in addition to other publications, he is a contributor to three books on psychosocial aspects of complex disability claims and is lead editor for the AMA Guides to Navigating Disability Benefit Systems. Dr. Kertay is also a practicing clinician and industry consultant.
