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Networks shift from cost tool to care driver in workers comp - Business Insurance Skip to content Register for free Search Search Log In Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Risk Management Cyber Risks Pricing Trends Mergers & Acquisitions Technology Sponsored Content WSIA RISKWORLD Workers Comp & Safety Workers Comp Cost Control Pain Management Workplace Safety International EMEA Asia-Pacific Latin America People Events BI Intelligence Top 100 Agents & Brokers Best Places to Work 2025 Lists Directories Insurance Pricing BI Stock Index Magazine Current Issue Past Issues Subscribe Women to Watch ALL INsurance Resources Risk Perspectives Sponsored Content Webinars White Papers Networks shift from cost tool to care driver in workers comp by Louise Esola Workers Comp Coverage , Workplace Safety Sedgwick , Zurich Apr 8, 2026 Medical provider networks are increasingly shaping how care is delivered, how disputes are avoided and how quickly injured employees recover in addition to reducing costs in workers compensation systems, according to industry experts. A study released this month by the Waltham, Massachusetts-based Workers Compensation Research Institute found that claims treated within networks had 26% lower total costs, faster access to care and shorter disability durations than out-of-network claims. The findings reinforce long-held views that networks can control medical spending but also point to deeper drivers behind those results. The research shows that differences in treatment patterns play a key role, said Sebastian Negrusa, the institute’s vice president of research in Washington. In-network care tends to rely more heavily on conservative services such as physical therapy and diagnostic imaging, while avoiding more invasive procedures like surgery and pain management injections, he said. Those choices not only reduce medical costs but also contribute to faster recoveries and shorter periods of disability, Mr. Negrusa said. The structure surrounding networks also matters, he said, noting that outcomes improve when networks operate alongside treatment guidelines, utilization review requirements and access to specialty care, which help ensure coordinated and consistent treatment. Network advocates say access to care is another critical component. Stephanie Leras, Sacramento, California-based director of program management at Enlyte, said certified networks are designed with specific access standards requiring providers to be available within defined geographic distances, helping injured workers obtain treatment quickly. However, access alone is not sufficient, she said. Networks must also ensure provider quality, Ms. Leras said, noting that networks increasingly rely on analytics to evaluate physician performance and guide participation. Networks are most effective when they are part of a broader strategy rather than a standalone solution, said Jesi Pabley, Schaumburg, Illinois-based vice president of managed care at Zurich North America. “I’m a big proponent of networks as part of our strategy, but it has to be multi-pronged,” she said, pointing to the need to balance access, cost management and provider relationships across jurisdictions and specialties. That broader approach includes integrating networks with bill review, pharmacy benefit management and other managed care tools, Ms. Pabley said. Network use can also help reduce disputes by improving communication and alignment with providers, she said. “Claims treated within networks are less likely to involve disputes or litigation, and we do see that,” she said, adding that education efforts with providers — including ensuring they understand network contracts — can further ease friction and prevent escalation. WCRI’s research supports that view, finding that network claims are less likely to involve litigation and incur significantly lower litigation costs. Still, challenges remain, particularly in rural areas where provider access is more limited. “That’s been a challenge for us and likely across the industry,” Ms. Pabley said, pointing to rural network adequacy as a key opportunity for improvement. The study similarly found that network effects are smaller in rural areas, where access constraints can limit gains in treatment speed and utilization. The evolving role of networks reflects a broader shift in how they are viewed across the industry, according to Josephine Copeland, New Castle, Delaware-based senior vice president of managed care product design and strategy at Sedgwick. Networks have historically been valued for generating discounts on medical bills, but that advantage has become less distinct, she said. “For so long, networks were really thought about around cost containment,” Ms. Copeland said. “I think that’s become commoditized.” Future network models are expected to focus more heavily on outcomes, including recovery time and return-to-work results, she said, requiring greater use of data to identify high-performing providers and steer care accordingly. The approach recognizes that not all physicians achieve the same outcomes. By directing injured workers to providers with better track records, networks can improve both clinical results and overall claim performance, she said. 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