ON Chiropractic Spring 2015 | Page 25

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