Snapshot: 2021 Network Report Card

Workers’ Compensation Research and Evaluation Group

In 2005, the 79th Texas Legislature passed House Bill 7, authorizing the use of workers’ compensation health care networks certified by the Texas Department of Insurance. This legislation also directed the Workers’ Compensation Research and Evaluation Group to publish this annual report card comparing the performance of these networks with each other, as well as with non-network claims, on a variety of measures.

1.1 million employees treated in networks since 2006; New claims 52% network, 48% non-network; medical costs are 9% lower in networks; average weeks off work in network - 5, out of network - 10; employee satisfaction in network 87%, out of network 69%.

Key findings

% of new claims treated in networks is stable

Almost half of all new claims are treated in networks, and the percentage of new claims treated in networks has not changed significantly since 2015.

Percentage of New Claims in Workers’ Compensation Networks 2010-2021

Network medical costs lower than non-network at 6- and 18-months post-injury

From 2010 to 2016, networks had higher average medical costs per claim for initial care, compared to non-network claims. Since 2017, non-network average medical costs per claim at six-months post-injury had been approximately 4 percent higher on average than network claims. The difference expanded to 7.5 percent in 2021.

Average Medical Costs (6-months maturity)

The medical cost gap widened between network and non-network claims at 18-months post-injury (using claims from the previous report card). Network medical costs were about 11 percent lower per claim at 18-months post-injury compared with non-network claims.

Average Medical Costs (18-months maturity)

Return to work rates better among networks

Since 2012, network claims consistently report higher return-to-work rates than non-network claims.

Percentage of Injured Employees Who Reported That They Went Back to Work

Network claims report better mental and physical health outcomes than non-network claims

Physical functioning measures a person’s ability to do everyday tasks. Mental functioning measures a person’s ability to think and reason.

In 2021, network claims mostly reported higher physical and mental functioning scores than non-network claims. This generally means that injured employees who received network medical care reported better physical functioning and quality of life outcomes than non-network injured employees.

Network claims get medical care sooner than non-network claims

The “Access to Care” portion of this report looks at injured employees’ opinions about whether they were able to get timely access to the medical care they needed compared to the care they normally get when injured or sick.