There are essentially three types of intermediaries that perform that function between healthcare providers and insurance carriers or plaintiff attorneys. None are exclusive to workers’ compensation claims or independent medical evaluations, as IME’s are useful for and frequently used to gauge personal injury claims, among other things. Additionally, there are several complementary services that can be and often are offered, such as medical file reviews and medical-legal strategic consultation, that take little extra effort to put together. The range of services offered tends to be the same, regardless of what type of intermediary the business is.

      Stand-alone (independent) intermediaries
      These intermediaries are independent businesses that solicit
      business directly from insurers and attorneys, and then locate 
      and schedule an appointment with an appropriate health care 
      provider. They add value by providing a specialized service in 
      finding appropriate, qualified, and willing independent health
      care providers to perform IMEs, file reviews, medical-legal 
      strategic consultation, and other services for their clients. 

The revenue model for this type of intermediary is transaction—to hire the physician or health care provider, usually at a discounted or intermediary-set rate, and to bill the insurance company a rate higher than the health care provider is being paid. The insurance companies are willing to pay for this value added because finding qualified and willing health care providers can be an onerous and time-consuming task, especially given the historical contentions between the two parties.

 

To note, although some intermediaries are profitable, as the three mentioned below, no intermediary of this type has reached a true critical mass on a national level, although some are better known regionally. Additionally, there are undoubtedly a number of much smaller, regional intermediaries, but since they are so small and have no Web presence, their relevance is not highly significant (and they’re very hard to find).

Key people in these types of firms tend to have category expertise as health care providers themselves, or in practice management, or by having worked in the insurance industry as claims adjusters, etc. However, this is not always the case. As these tend to be privately held companies, it is unclear where their financial backers derive, although since most started out very small and are still privately owned, it is likely that big start-up money from investors is limited.

 

This intermediary model is the base upon which our B2B model has been developed. 

 

 

Independent Medical Evaluations, Inc (http://www.imei.com/ )

 

Independent Medical Evaluations, Inc., known as IME, Inc. in the industry, was founded in 1989. Starting out with a strong regional presence in the northeast, it now bills itself as a national service-oriented organization offering a comprehensive range of medical-legal services to attorneys, insurance companies, employers, and others. They claim consistent quality and an established reputation for reliability. Their long-term presence in the market suggests this is likely true; they also likely have an extensive, pre-qualified and tested network of providers into which they can tap.

 

IME, Inc.’s is a bricks-and-mortar business, and their web presence mostly consists of a store-front, although clients and potential clients may print their intake form off the web and fax it over. Most of their work is still done via phone and fax, both with the clients and the providers.

 

 

Medical Consultants Network, Inc. (http://www.mcn.com/)

Medical Consultants Network, Inc. (MCN), headquartered in Seattle, was founded in 1985 as a private medical practice by a medical doctor, focusing on providing occupational and non-occupational healthcare. It has evolved into an independent intermediary with a network of health care providers that provides the same services as IME, Inc. MCN also claims a national presence, but like IME, Inc., has not reached critical mass.

 

MCN has the most significant web presence of the three here, although it is unclear how integrated their system is as a B2B. It appears that most of their work is also still done by phone, although their online form can be sent directly to their office via the Internet. They do offer peripheral networking benefits to their health care network members, including an online chat room.

 

 

Alternatives in Health Care and Management, Inc. (http://www.althcm.com/)

 

Alternatives in Health Care and Management (AHCM) was founded in 1992 by a registered nurse and former director of a regional rehabilitation center. AHCM provides the same types of services as IME, Inc. and MCN, but also works directly with employers, as well. They appear to have a strong regional presence in the Pennsylvania and surrounding areas.

 

AHCM’s web presence is also limited to a store-front, although some information may be gleaned from their site. No forms are available for submission, although clients and potential clients may email the company for assistance on specific cases.

 

 

Healthcare consultants and on-site occupational clinic management

These intermediaries offer IMEs and related services as a value-added to their primary function, which is often as finite-timeframe consultants or as managers of on-site occupational health clinics at employers. Thus, their clients tend to be large, industrial employers who are seeking to either staff their on-site clinics, or are seeking assistance in implementing standards to limit workers’ compensation claims. These intermediaries tend to work with large, established companies on long-term contracts.

 

The revenue model for this type of intermediary is retainer, monthly, or service fees to manage clinics or provide consulting expertise. Employers are willing to pay for these services because they don’t usually have the expertise to staff and run a clinic, and they are looking for ways to lower their workers’ compensation liabilities. In either case, IMEs and like services are not their primary business, thus they do not reach critical mass in this industry; nonetheless, these intermediaries can be quite profitable and may be publicly or privately owned. 

 

Web presence may be significant, however more as a source for information and less as a B2B, thus relevant financial backing for Internet B2B is limited. Key people in these types of firms tend to have category expertise as health care providers themselves or in practice management. 

 

Sample firms include:

 

Medical Consultancy BV (http://medcons.nl/mission/)

Continuum (http://continuumhc.com/HealthManagement/background.htm )

 

 

 

Healthcare providers/group practice networks

These are not true intermediaries, but often look like it at first glance. Instead, they are physicians or health care providers in private practice, or group practices or clinics that actively court the insurers as a means getting business directly from the insurers. The revenue model is service fee. Few have any critical mass, and if they do, it’s regional presence only. 

 

The positive side of using these providers directly is that they do offer the same services as the other intermediaries, but usually at a lower cost. The downside is that they are not pre-qualified, they are limited in their scope and region, and they require more time in direct management. These intermediaries are worth noting mostly because they are a player in this market, and many have visions of grandeur of becoming the next HealthSouth.

 

Web presence is usually limited to storefront information, and key people have category expertise as health care providers themselves.

 

Occupational Medicine Services http://www.occumedservices.com/default.htm

Prestige Network http://www.frontiernet.net/~perino/ 

Charles H. Morefield, MD, PA  http://www.occdoc.com/medevals.htm

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