ON Chiropractic
psychological services. This trend was
driven by growing societal awareness
of mental health challenges and plan
member expectations in recent years.
This can work in both ways. Vision and
orthodontic coverage are becoming
less common than in the past, perhaps
because plan members are no longer
demanding the coverage the way they
once did.
Fraud & Abuse:
According to the Insurance Bureau
of Canada, 10 to 15% of insurance
premiums go to paying fraudulent claims.
KPMG tallies that up at approximately
$1.6 billion dollars in fraud from auto
insurance alone. Common types of fraud
include claims for services not actually
rendered, providers performing services
outside of their scope of practice
or licensing and kickbacks or illegal
referral payments. All told, fraud has a
major impact on premiums and on the
availability of funds to pay out legitimate
claims. Fraud is also factored into the
pricing models of insurance plans.
These economic drivers clarify
in some ways the opportunities for
chiropractic to cement its place within
EHB plans. Direct advocacy to plan
sponsors and managers is crucial.
This has been a focus of the OCA for
some time and that effort will continue.
Cracking down on fraud is critical
too. Individual chiropractors can play
an important role as advocates for
the profession by clearly articulating
the value and benefits of their care to
patients and encouraging them to speak
to their EHB plan manager. While that is
underway, the OCA and the Canadian
Chiropractic Association will continue to
advocate to key stakeholders about the
role chiropractors can play in helping
employers cultivate a healthy workplace
and a productive team of employees.
Developments in Health Care
Delivery
P
referred Provider Networks
(PPNs) are becoming increasingly
prevalent in both the EHB and auto
insurance realms in Ontario. Just last
fall the OCA entered into a partnership
with Quindell Health Services North
America (Quindell), the operator of a
PPN in Canada that serves both auto
and extended health insurers. Quindell,
a company with a long history in
Europe, entered this market through the
acquisition of a Canadian firm, PT Health,
which is now operating and expanding
under the Quindell banner.
The Chief Executive Officer of
Quindell Health Services North America
is Glen Piller. Mr. Piller has worked in
the insurance industry for over two
decades and has a clear, first-hand
perspective on the value that PPNs bring
to the insurance industry. This includes
benefits for patients, practitioners and
stakeholders.
The landscape of the auto insurance
market in Ontario has changed
dramatically in recent years. Resulting
from many factors, the increase in the
number of private, for-profit health care
clinics has been particularly striking.
According to the Health Claims for Auto
Insurance (HCAI) database, there are
currently at least 9,500 clinics and over
31,000 individual health care providers
practicing in the province.
At the same time, motor vehicle
accident (MVA) related health care costs
have shot up, contributing to Ontario
having the highest auto insurance
premiums in the country. The average
motorist in Ontario was paying about
$1,500 per year as of 2013, prompting
the Ontario government to take further
steps to try to tamp down premiums.
Enter PPNs.
“Preferred Provider Networks will
become a significant percentage of the
health care market,” said Mr. Piller. “These
networks reduce operational costs
through the use of advanced systems
in customer relationship management,
billing, scheduling, charting, practice
management and contact centre
telephony,” he added. Mr. Piller went on
to point out that systems and automation
provide transparency in patient care and
play a role in reducing abuse and fraud.
The bottom line, though, is that
PPNs can be beneficial to all of their
relevant stakeholders. “Patients enjoy
an excellent, efficient care experience
focused on recovery, while practitioners
can focus on the patient rather than
administrative tasks. Insurance carriers
realize cost savings along with happy
customers and pass their savings into
premium reductions,” Mr. Piller said.
Of course, not all PPNs are created
the same. That is why the OCA chose to
partner with Quindell, a company with
a very strong team and focus on patient
care. Learn more at www.chiropractic.
on.ca/quindell.
T
hese and other trends are quietly
but significantly shifting the
nature of the insurance industry
in Ontario. While the news is not always
purely positive, chiropractors are well
positioned to play an increasingly
important role in the provision of EHB
services in the years to come. What
is most essential now is focusing on
providing exceptional patient experiences
a