This study examines medical payments, prices, and utilization in Texas and compares them with 16 other states (Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Virginia, and Wisconsin). The study also examines how these metrics of medical payments and care have changed following the Texas series of reforms focused on medical costs, particularly House Bill (HB) 7 in 2005. HB 7 impacted both prices and utilization of medical care as the various provisions were implemented beginning in late 2005. The data in this report likely reflect nearly all of the effects of HB 7 provisions, including certified medical networks and the required use of treatment guidelines and utilization review. The only exception is the pharmacy-closed formulary, which became applicable for all claims September 1, 2013. We analyzed claims with experience through 2014 for injuries up to and including 2013. In some cases, we used a longer time frame to supply historical context for key metrics.
CompScope™ Medical Benchmarks for Texas, 16th Edition. Carol A. Telles. October 2015. WC-15-43.
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