Linkia: What Does It Mean for O&P?

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Linkia, a wholly owned subsidiary of Hanger Orthopedic Group, has recently ignited controversy as its contract with the insurance giant CIGNA rolls out, sending shockwaves through the O&P industry.

The contract was signed in September 2005 but its effects have not strongly impacted independent O&P companies until relatively recently. Linkia recently has signed a contract with Great-West Healthcare, as has the POINT O&P network. CIGNA's contract with Linkia will cover about nine million people; the Great-West Healthcare contracts with Linkia and POINT provide O&P coverage for about two million people.

Where is Linkia going? How much of an impact will it likely have on independent facilities and the O&P industry as a whole? How can independent facilities keep market share?The O&P EDGE takes a look at these issues as we explore this arm of the O&P field's largest company.

Hanger Orthopedic Group announced the formation of Linkia in March 2004, billing the new company as "the first managed care organization [MCO] dedicated solely to serving the orthotic and prosthetic market."

Linkia is "positioned to partner with healthcare insurance companies by securing national and regional contracts," Hanger said at that time. "It will fulfill its mission by establishing a customized network of O&P patient care providers delivering accountable healthcare services, through dedication to clinical outcomes, science-based guidelines, and sound medical reasoning." Linkia also will reduce administrative expenses by providing simplified electronic billing and eligibility verification, prior authorization, and professional relations connections between MCO clients and the O&P provider, the company said.

Heading the company is Rebecca Hast, president. The senior management team also includes LaVerne Smith-Boykin, vice president of operations; Karyn Kessler, vice president of clinical operations, and Richard Lentz, vice president of national accounts.

Linkia custom-designs orthotic and prosthetic networks to meet the individual needs of each payer customer, including national healthcare companies and insurers in other lines of business, Hast explained in an interview with The O&P EDGE. Thus, there is no single Linkia "network" per se, but rather Linkia draws from its potential pool of O&P facilities to tailor a network to meet the individual requirements of each payer customer. "We don't go to the customer and say, Here's our readymade network,'" she explained. "We examine their membership data, make a recommendation, then sit down with them and determine together what that network is going to look like regarding providers. Our networks are designed both in size and scope in concert with our customers. They actually determine how big the network is going to be, what area it will cover, etc."

National, not Local, Solution

Linkia is a solution for large national and regional insurers doing business over a wide geographic area, Hast said, rather than a solution for local needs. "Linkia is not a solution that a small PPA [Preferred Provider Access] doing business locally would select." Linkia does not require exclusivity of its providers; they can service other contracts independently of Linkia, Hast said.

Linkia contracted providers will be required to have facility accreditation according to the pending CMS (Centers for Medicare & Medicaid Services) regulations. "From a national perspective, payers are interested in working with an entity that can help them standardize that process for credentialing," Hast noted. "Large health plans are NCQA [National Committee for Quality Assurance]-reviewed, so for them to be able to certify that their vendors, providers, and other participants in their business have the appropriate credentials is an important part of doing business with them."

Follows Other Ancillary Models

Linkia is following other ancillary healthcare models, Hast noted. "What we are doing here is similar to what other ancillary healthcare products are doingórecognizing that there are different products needed to meet requirements of national employers and payer groups."

"Network strategy in healthcare is nothing new," commented Hanger Chairman and CEO Ivan R. Sabel, CPO, in discussing Linkia. "Network strategy is in large part being dictated by the individual payers. They know where their constituents reside; they know what kind of access they want in those geographic areas. What Linkia does is provide the network that will provide that access of both Hanger-owned and independent facilities.

"Network strategy is general in healthcare in everything from physicians to hospitals to pharmacies to surgery centers," Sabel continued. "Patients can choose to go to a provider in their insurer's panel, or they can go outside of itóit's their choice. I know this is controversial, but it is nothing new to the field of medicine, and O&P is part of the field of medicine."

Clearing up what could be an area of confusion, Hast said that OPNET, a Hanger network of its facilities and independents, is totally separate from Linkia. However, OPNET relationships, arrangements, and functions are being transitioned to Linkia, with OPNET being phased out. This does not mean that OPNET's arrangements and agreements will be terminated; they will simply be transitioned, she explained.

Other Questions For Hast

Q: Would independent facilities participating in a Linkia network have the same purchasing discounts with SPS that Hanger facilities have?

A: "We have not yet set up a specific buying program, but we have been discussing it, relative to benefits of membership in Linkia."

Q: Is Linkia contemplating adding other allied healthcare professionals to its networks to provide its payers with a rehab care continuum?

A: "That's an interesting idea, but we don't have anything like that in the works right now."

Q: Does Linkia have any outcomes research underway?

A: "We are very interested in that and see it as a benefit that Linkia brings to the O&P profession overall. Certainly, our customers have expressed interest in that. One recent project involves deformational plagiocephaly. As you're probably aware, there has been increased awareness and concern about this condition in the press and public, generally based on the Back to Sleep campaign to help prevent SIDS. Our research has been underway and is ongoing. What that involved was using industry research and developing a protocol for treating this condition." Linkia has collected baseline data, Hast said. The next step is to take measurements in points of time to ascertain treatment results, "and we will be glad to share this."

She explained that Linkia has a quality program, which among other aspects, includes patient and referring physician satisfaction measurements. "We want this data to be totally objective, so we are using tested survey instruments," Hast said, adding, "We're also working on basic metrics for the quality program."

Q: What do you foresee in the future for Linkia?

A: "We are working to grow our customer base and networks. As part of the original plan for Linkia, we want the opportunity to make a difference for the O&P profession."

She added, "We strive to be a fair company. We respect independent providers. Independent providers are really a key for us; we could not be the company we are without them."

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