As of June 1, 2022, 30 networks covered 254 counties certified to provide workers’ compensation health care services.
As of May 31, 2021, 24 certified networks actively treated injured employees.
Since 2006, 1.3 million injured employees have been treated in workers' compensation networks.
As of 2022, almost half of all new claims are treated in networks (47%). The overall percentage of new claims treated in networks has not changed significantly since 2015.
Medical Costs
2022 average medical costs, six months post-injury: $2,897 (non-network); $2,886 (network).
- Since 2017, non-network average medical costs per claim at six months post-injury had been approximately 4% higher on average than network claims. The difference narrowed in 2022 as networks’ average medical costs increased by 14%.
- The medical cost gap widened between network and non-network claims 18 months post-injury: Network medical costs were about 12% lower per claim than non-network claims.
- Nationwide, in 2022, the change in the Consumer Price Index (CPI) for medical care was 4.1%; the change in medical cost per lost-time claim was 5%.
Health Care Costs (Overall)
Average Overall Medical Cost per Claim, Six Months Post-Injury
Health Care Costs (Professional)
Average Professional Cost per Claim, Six Months Post-Injury
Health Care Costs (Hospital)
Average Hospital Cost per Claim, Six Months Post-Injury
Health Care Costs (Pharmacy)
Average Pharmacy Cost per Claim, Six Months Post-Injury
Success of Pharmacy Closed Formulary
A major component of the 2005 legislative reforms was DWC’s adoption of a pharmacy closed formulary for injured employees in the Texas workers’ compensation system. DWC first implemented a pharmacy closed formulary in 2011 to manage drug prescriptions to injured employees. The formulary significantly reduced drug costs and improved injured employee outcomes and return-to-work rates. Between 2009-2022:
- Pharmacy costs decreased 73% (from $163.7M to $44.1M)
- Overall opioid prescription costs decreased- Opioid N status drug costs decreased 97% (from about $18.1 million in service year 2009 to about $603,000 in 2022), opioid non-N status drug costs declined 88% (from about $30.8 million to $3.6 million)
- Total number of prescriptions decreased 73% (from 1.7M to 442,000)
- Total number of opioid prescriptions decreased 86% (from 555,000 to 78,000)
- Total number of generic prescriptions increased 21% (from 74% to 95%)
Return to Work
- Since 2012, network claims consistently report higher return-to-work rates than non-network claims.
- Overall, network claims had higher return-to-work rates than non-network claims.
- Ninety-four percent of injured employees in the network returned to work compared to 89% non-network. The non-network was up slightly from 84% in 2021.
- The average number of weeks employees reported being off work because of a work-related injury is five weeks in network, compared to eight weeks non-network.
Claims
- Most networks had a higher percentage of injured employees who reported no problems getting needed medical care after their injury than non-network claims.
Overall, networks provided non-emergency care sooner after an injury 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. 2022 network claims reported higher physical and mental functioning scores than non-network claims. This generally means injured employees who received network medical care reported better physical functioning and quality of life outcomes than non-network injured employees.
