One Call Care Management – Q2 2022 Company Update & Growth Outlook

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  • Healthcare
  • North America
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Former senior executive at One Call Care Management Inc


  • Key trends and developments emerging in the worker compensation and managed care market over the past 12-18 months
  • One Call Care Management workflow and revenue model
  • Key buying influences and gaps that One Call has not addressed
  • One Call’s competitive positioning vs companies such as Optum, Coventry, MedRisk and Streamline
  • Growth outlook for FY22



What are some of the key trends you have been following within the workers’ compensation and managed care market over the past 1-2 years, especially after the pandemic slowdown?

Specialist (SP): From a delivery perspective, some of the biggest trends that you saw obviously was a switch, or opportunity, to offer telemedicine or telehealth. There was telerehab, and most providers with a network that were brick-and-mortar started offering remote or virtual sessions, as well as the networks expanding into telehealth offerings. There was also a trend to recognise and address and cover behavioural health aspects of healing, and that was starting even before the pandemic, but I believe that, through the pandemic, it’s become more prevalent and more accepted to recognise the behavioural health components of injury and cover that on the workers’ comp, which, previously, they’d been hesitant to do. Then, generally also another big trend that was happening, I don’t know that again it is part of COVID per se, but there’s a lot of consolidation in the physical therapy market. The providers, there have been already a lot of mergers and acquisitions and consolidations, so there are not as many smaller PT providers, you’re seeing larger regional or national groups that not only put some price compression on managed care networks like One Call, but also complete. Select PT is obviously one of the biggest, they acquired, prior to the pandemic had acquired physiotherapy. You have ATI and Athletico expanding and merging and acquiring smaller clinics. You’re seeing the prevalence of two or three big national PT providers that compete against the managed care network, particularly in the PT field.

Those are probably the biggest trends, and it’s happened a little bit in smaller ways in some of the other markets, not necessarily in diagnostics but home health was seeing some of that. Then, of course, the networks themselves, the managed care networks have merged and acquired, so you’ve got Paradigm picking up different smaller vendors and services and becoming more comprehensive in their offerings. Optum is obviously the biggest competitor for One Call, and had done some acquiring. Then you have some bill review companies acquiring some other direct services, like nurse case management and UR. I think there’s becoming more compression on larger offerings, larger broader offerings, from some of the other competitors of One Call.

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Could you go expand on price compression and how that’s affecting One Call?

SP: Price compression for physical therapy was more about the consolidation, and the pressure from those larger national PT provider groups that have the ability. One Call needs them in network. They’re the biggest provider, so you have to have them in network to compete, and so they have more leverage to require a higher price point or a lower discount. Home health was also an area that had significant price compression and continues to. That’s due more to the salary ranges and the pricing. That is impacted, I believe, by COVID more because that field has been hard to staff, so your healthcare givers in home health and long-term care facilities, skilled nursing that One Call also offers under part of their home health umbrella. The home health aides and nursing shortages have created higher salary requirements, which those providers then push back on One Call to either offer, again, a lower discount, higher price or they won’t accept. A lot of home health agencies just won’t accept workers’ comp, they’ll just only accept Medicare, so it’s either pay more or have a smaller network. Generally, One Call is known for their size of their network and their coverage, so it’s just created a bit of a price compression that you have to combat with efficiencies, operational efficiencies, and cost control.

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How are volumes in the workers’ compensation industry trending relative to pre-pandemic or during pandemic?

SP: I think that’s good news and positive news, particularly from an investment time and perspective, I would think. COVID was obviously much more extended than expected when it first hit in March 2020. The work comp industry, and generally healthcare and elective surgery-type or elective services-type things. employee care, which is the hallmark of One Call’s services, saw a pretty significant drop in volume. Probably at its peak and immediate drop, it was 40-50%, then levelled out. I saw this across the healthcare industry, about maybe 25% drop, and that has held pretty steady for a while, with a very slow, really, and not much (audio cuts 08.03) at that dropped reduce rate of about 20-25%, but just my industry experience, and my current work actually, we’ve been doing analysis, and it’s out there in the industry, you’re seeing a return of normalised elective surgery rates, so it’s one of the things I’ve been tracking.

As those elective surgeries occur back in the industry, they’re usually related to musculoskeletal types of injuries and services that One Call manages. Of course, the industry, as we know, we see the trends, the countries opening back up, and it’s been open but the healthcare world is more in the green, and there are less restrictions, so I think it is a time where we could see a return to better employment levels, the healthcare industry being open and an uptick back to that normal rate. That’s probably the biggest opportunity for recapture and regrowth. I don’t know if it’s going to get back to the full, full level, but probably a 10-15% opportunity of growth in the next year I think, assuming there’s not another outbreak. Knock on wood we don’t have another outbreak, but assuming that things stay stable, I think there’s some growth opportunity back to normal levels.

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There’s been a huge trend towards managing utilisation, UR [utilisation reviews], with states having different regulations in terms of cost, reimbursement and discounts. How has One Call incorporated utilisation with using increasing costs into its business model? How can it broaden that service offering in this market?

SP: One Call, that has been one of its, I think, hallmarks and differentiation, that it was able to apply a standardised utilisation management model, clinical management model, across all of the services and client base or state, incorporating UR rules. Even more importantly, in states that don’t have aggressive utilisation review rules, where you see over-utilisation and higher costs, One Call was really able to establish more controlled clinical cost utilisation management even in absence of strict state UR rules, which I think is, again, a hallmark because it helps provide a more standardised clinically based appropriateness of care model that helps control the overall cost, and really I think potentially under-recognised and under-advertised or leveraged in some of the sales at times, and in some of the RFPs, to note the overall impact on the cost of the claim, which I do believe that is something that customers or the payers are looking at more now. Obviously, I’ve been seeing that interest pop up a lot more, because it’s fine when you’re in California and Texas and some of the more strict UR rules, and you could see a really big difference in the utilisation, like PT costs in those states vs Illinois or Indiana, Wisconsin, where there was no UR and you’d see 50% more PT per claim, even case mix, case-adjusted or severity-adjusted. One Call is really good at applying, with their provider network, quality control, steerage and scoring of their providers that applied better clinical management and utilisation control regardless of the UR rules, which I think is really critical because there’s so much more variation across states.

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The behavioural health component has been trending, and there’s increasing recognition of socioeconomic healing and injuries associated with behavioural health. How has One Call managed to keep up with this telehealth trend and devise different health delivery models pertaining to physical therapy or mental health? If so, how?

SP: I think there’s still an opportunity for growth there. The initial foray into it was to use physical therapy, which is a really great way to flag cases, because a lot of these behavioural health cases or psychosocial components of healing are identified from PTs. There’s psychologically based physical therapy now, and physical therapists are becoming more versed in being able to screen patients for catastrophising, fear-avoidance, different factors that impact their healing. One Call was and have started to implement programmes, actually even OCR and (audio cuts out 13.24) red-flagging of cases that were showing trends or issues that might indicate early on psychosocial factors, and then being able to alert the nurse case managers and collaborate on maybe next steps, whereas I believe there hasn’t been full capitalising on that, are then the next steps, the implementation of behavioural health treatment. Working with a physical therapist, yes, to help improve it, but truly having a seamless option for behavioural health, addressing the behavioural health components themselves. I think that’s a trend, as I mentioned, an industry trend of having more easily accessible behavioural health solutions like virtual counselling, and even just the app-based-type models they have, BetterHelp and so forth. I think that that is an area that could be expanded on by One Call, is to then have that type of network, and I have not seen anyone in the industry yet form a really strong global behavioural health network. The management of the actual delivery of the care is a little fragmented still, and is probably a good opportunity for somebody to capitalise on.

Third Bridge (TB): Would you be able to follow up and explain what you meant by OCR, and just go into more detail about that?

SP: It’s optical character recognition. It’s using AI and tools to scan PT notes, doctor’s notes, to identify certain terms that would indicate potential psychosocial components. Through AI learning, you scan these notes and look retrospectively back at patients that have had poor healing or poor recovery and psychosocial components. You match up the certain terms that doctors or physical therapists use, like chronic pain or non-compliance, fear, there are different terms that you would use, and then the OCR, which is again the acronym for using a machine to scan the notes, even handwritten notes, looking for those terms, and if they find certain terms in a certain frequency it would alert to a potential case that would be trending toward for recovery or behavioural health issues, and then you could flag those. That’s something that the industry is really looking to do. How do we get ahead of cases that are moving in the wrong direction, and before they get there can we intervene to mitigate those complications in that chronicity that happens?

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NCMs [nurse care managers] have been high in demand. What are your expectations for One Call within the NCM space?

SP: It’s the one area that One Call has not pursued. I think that, from a growth and revenue expansion, that’s one of the opportunities. One Call themselves don’t do formal utilisation review, don’t have formal nurse case managers. They use teams of nurses to help manage the home health and various ancillary services, where nurses apply nurse case management. They are starting to use nurses in some of their clinical programmes, but not in the formalised way of nurse case management. With the trend in the industry to get out of the hospitals and the direct patient care, they call it the Great Resignation and so forth, but it’s really happening in nursing, is because they’re trying to get out of patient care. Formal nurses are looking for that type of opportunity, and One Call could expand on that and potentially offer that. I think you’d probably want to do it with an acquisition vs scratch, because there are a lot of regulations and requirements. Ideally, you’d have the right accreditations and so forth and build up, maybe look at a small company that’s been doing it. That would be my recommendation.

TB: You’re saying it would be better for One Call to pursue the NCM service through consolidation rather than in-house. How would you suggest that would go?

SP: I think that nurse case management, when and how you use it, it’s a pretty big cost. One Call, part of their client base is often the nurse case manager that can refer into or choosing ancillary services, helping to manage. A true nurse case management is a fairly complex or catastrophic case that is then assigned to a nurse more permanently to manage the whole claim, and they’re looking at the physicians, the pharmacy, the ancillary care, and that nurse case manager might then choose One Call to help with the selection and delivery of PT diagnostics and so forth. One Call, to acquire and offer true nurse case management, I think it would be better to do it with an acquisition. Finding a small company that’s already built that up. You could do it ground floor, but I think it’s a different market, not a different market, but it’s own service, to do nurse case management and to build up a team that knows the nuances of claim management. One Call is really strong at the clinical services and the ancillary care, the provider network in pricing and billing, but getting into the nuances of the physician, pharmacy, overall claim, disability management and overall cost of a claim I think is a competency that it might be best finding someone that has done some of the legwork, the pre-legwork, and has all of the core components, and then you could use that as an internal referral route as well as when you look at cost management for a company.

One other thing that One Call offers as well by having multiple services is transition of care. You could have a really effective nurse case management model, where they could send the referral for nurse case management, but One Call would screen it to see if they really needed a full nurse case manager or maybe they just needed a really effective physical therapy management, and you could cut out more, not do as much nurse case management and refer it to a lesser service. I think a company that is willing to look at the overall best-fit service including nurse case management vs just care management, episode of care management vs full claim nurse case management. You might be cutting cost or cutting revenue for a particular patient because you’re not doing the more expensive nurse case management, but you’re building trust and confidence from your client base or from the payers that you’re looking at the lowest level of need, or the least costly service that would meet the needs of a patient. I’ve been working in the healthcare industry for a long time, and I think when we have really accountable and responsible companies that are willing to use costs responsibly or incur costs responsibly, who’s going to win or who should win vs throwing a bunch of care and costs at a patient or payer that is not necessary, isn’t necessary.

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How has One Call tried to keep up with the demand for increased specialisation with nurses, especially with psychiatry or obstetrics?

SP: They’ve developed certain care programmes that are specialised, so categorised. The ones that need nurses, particularly in the nurse case management or the care management programme they do, they’ve identified specialised programmes in amputation, spinal cord, traumatic brain injury, and so all of those really complex high-cost and high-care cases, and then you recruit nurses that have certifications in specialisation and build teams. Not just nurses but then you add physical therapists, prosthetists and even ATP, assisted technology professionals, that create a core care team that specialises in those key specialities.

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Would you be able to assess One Call’s M&A strategy pertaining to bill reviews and UR?

SP: I would say that, due to, I think, a good competency in that clinical management I had mentioned earlier, I think the utilisation review or nurse case management would be a primary area of focus, as well as even a behavioural health network and expanding on a virtual platform, so those areas, I would say. Bill review, most of the payers and clients out there have relationships already pre-existing with a bill review, and One Call has connections and relationships, so have the appropriate necessary data fees and files set up to appropriately have bills flow through the multitude, and because of that I don’t think the bill review is as beneficial, because you might acquire or offer bill review, but it’s not necessarily going to supplant the client’s choice. It’s just as important to have connections with multiple bill reviews, whereas utilisation review or nurse case management is complementary to the delivery of the ancillary services you’re doing, and is also an internal feeder to the services that One Call offers. Through UR, One Call was already connecting to prior author utilisation review fees and determination, so it’s something that went through a different UR vendor. We’d have vendor partnerships where we would get CCed on a UR approval for PT or surgery or whatever, and then that would be a referral that One Call could follow up on.

It’s the same thing if you were acquired or had a full UR company that you could then sell to clients. You could have a seamless process of flagging certain types of UR determinations for follow up on other services, and, as I mentioned with the nurse case management, you could take those nurse case management referrals and incorporate and determine what services they need and get them to the right route within One Call. The only challenge there is the same that One Call has faced through the last five years or more, is that the more they consolidated and had all services, there are clients and payers out there that tend to think they don’t want to put all their eggs in one basket and get too big. That’s where you’ve got to build the trust on you’re going to control overall cost, and that would go to the next trend, or another trend is the value-based care. The way you’d get around that is, similar to Paradigm’s model, if you got nurse case management or UR, particularly nurse case management, if you had nurse case management bundled with managed care networks for PT, diagnostics, home health, instead of piecemeal billing by service, where a payer would think you might be over-utilising or overselling and just self-referring, you would take claims for your nurse case management model and offer a value-based case rate to get all of the care done and get the patient recovered at a set price, or you would then control what services and when, or help control what services and when, to maximise recovery and reduce cost.

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Given the capital structure and earnings cash flow profile with One Call, do you think M&A as an approach is feasible for One Call?

SP: Yes, I do. I think there’s enough potential in growth, and it’s just such a popular industry and area.

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Is there a chance of competitors acquiring certain segments of One Call? Do you think that’s possible?

SP: You’re talking about splitting up One Call and acquiring certain aspects of it?

TB: Yes.

SP: Early on, when Align Networks became a part of One Call and then they basically brought diagnostics, home health and then the PT, those are the three majors, and it didn’t necessarily grow as fast as they would like, I think there was some discussion or potential. I think the one area would be someone, or maybe MedRisk deciding and One Call deciding to divest into PT, and then MedRisk trying to acquire the Align Networks, the PT network. That would probably be the biggest risk, but I can’t imagine One Call… It’d have to be a pretty big offer because PT is one of the biggest aspects. In all of the areas that we’ve talked about as far as opportunity for growth and expansion, I think to have PT is a big foundation. Maybe the transportation or the smaller areas like DME, medical supplies, things that are a little bit more adjunct, but the core components of diagnostic, home health and PT, I don’t think so. I think that would be pretty detrimental to overall success.

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How effective has One Call been in building out its clinical quality programme over its product portfolio, including physical therapy, and how do you expect this service to expand?

SP: That’s been the biggest strength. Obviously, I know the most about that. I helped build the core of it. It came through Align Networks, the crux of the network was that it was prospectively a managed programme that didn’t just rely on happenstance patients getting into the network. There’s a robust clinical review programme and management of utilisation that then ties back into the provider network to score the network based on their utilisation and their clinical management and clinical outcomes.

Then, because One Call, through the Align Networks network, primarily focused on prospective cases, meaning they get their referrals from the adjusters or case managers directly before the patient chooses a provider, then One Call is able to steer it into providers that are performing better. It’s a really good feedback loop or programme, where you’re steering to better-performing providers but then you’re managing the outliers or the managed cases that are maybe going off track a little bit, and then you’re keeping those aligned. As I mentioned before, it’s consistent across the network in the country regardless of UR states, but then it’s complementary to the UR rules. I think that it’s only growing. There’s more focus, and as we talk about value-based care and having a more case rate model, I think there’s some opportunity there where a lot of payers are looking at that to see they could pay a lump sum for the case to recover vs per visit, and then adding the predictive analytics or the risk stratification, or using the tools I talked about, the AI, to help identify patients that are not improving with standard PT and maybe rally them to a different type of service, like behavioural health. There’s a lot of opportunity to expand on it with their clinical programmes.

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Could you expand on the reimbursement dynamics within physical therapy and One Call?

SP: It has not yet moved to true value-based care. One Call has always been a per-visit basis, and the way they would manage the cost would be to look at it as a multiplier, by how many visits were billed and the total cost of the claim by a per-visit, which is still a fee-for-service-type model but with a discount. The momentum in the industry with clinical management and the trend that One Call has been moving toward is building the programmes first, but then ultimately being able to have pricing around it, which are care path programmes and, based on the type of injury, offering a holistic approach to providing the diagnostics, home health equipment, PT needed for full recovery. Right now, again, it’s still each service being billed individually, but controlling those services and managing them from a clinical perspective, when you get a good control and handle on that and get a sense of the trend and average costs and the cost drivers, the next opportunity is to then offer to clients to bill a case rate. For a right upper-extremity amputation, the full course of treatment including all the service, the prosthesis and the therapy and medical supplies and adaptive equipment would be X. That’s the true nature of value-based care, is bill on a case rate, and then based on performance. They’re not there yet, it’s still per service. I think the opportunity is, as they’re building out the clinical programmes and understanding the full cost, you can start to offer this case rate type model that clients are really interested in, payers are really interested in, because, control-wise, it’s a known cost, predictive for them to set their reserves and understand their total risks.

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Home health has been witnessing a huge market at the moment. How would you assess One Call’s home health service again? What do you assess the growth segment to be like?

SP: If I had to rank it, I would put PT, diagnostics and then home health in the third position. It’s not bad, it’s just that home health is a hard industry, and, I mentioned before, the price compression of the age, it just has a lower margin. Some of the better home health direct providers aren’t that interested in taking workers’ comps, you’ve going to find the right market. There are regionalised, smaller home health networks that I believe have created more challenges on the home health front for One Call, HomeCare Connect, Homelink, and they’ve started to grow a little bit, but they’re focused on home health and they’ve partnered with home health agencies, and it’s been, I think, a little bit more challenging to be seen as a market leader in the home health arena.

One area that they do better at, though, than a standalone home health agency I think they’ve got to capitalise on is the transition of care. While a good amount of home health is chronic, catastrophic or severe injury cases that are going to stay in home health for a while, and you do have just permanent if not permanent home health aides and home health care, the other side of it is transition, where someone’s coming with a severe injury like an amputation, or traumatic back injury or musculoskeletal injury, that they’re not able to get PT, outpatient PT. They might come from a hospital, surgery, inpatient rehab, home health, and then eventually outpatient PT. The advantage One Call offers is a quicker transition through those, or even avoidance. By managing clinically the progress the patient is making in long-term care and the skilled nursing facility, you might determine they don’t even need home health, they’re ready for outpatient PT, so you avoid that extra and additional unnecessary cost, because you’re willing and able to get them into the PT because it’s all in your net-based, and best practice and evidence-based care vs a standalone home health agency, when they get a referral for home health, they’re not going to want to decline it, they’re going to keep it. They’re not necessarily going to have the same incentives to determine if the patient is actually needing home health or some other level of care. I think One Call could capitalise on that continuity of care and transition across different services that a standalone home health can’t do.

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How would you position One Call’s services and pricing structure in comparison to some of its big competitors such as Optum, Coventry and MedRisk? In which areas does it possess an advantage vs a disadvantage?

SP: I think MedRisk and One Call are pretty equal, and I don’t think either of them offer an advantage. Honestly, from a PT perspective they’re very similarly leveraged as far as clients and network size and pricing, and I think it has generally come down to relationships with those two. Optum, Coventry, the challenge there is they tend to price lower. They’re more passive networks, and are not actively managing clinically the programmes. For One Call to offer that type of clinical management and oversight and prospective scheduling and steerage, it is a little bit higher price point, so I think the disadvantage or the advantage Optum and Coventry and CorVel and so have is their pricing, because they’re just bulk pricing just to run bills, and they give a network discount but they’re not managing the actual utilisation other than applying UR rules.

One Call has the advantage of offering a more comprehensive care management, that overall clinical management that proves out to show lower overall claims cost, but unfortunately what they run into is oftentimes people look at claims costs, they look at a per-unit, a per-service basis and just look at the core discount. You’ve got to, in the RFPs and the sales process, leverage and look at the overall cost of claim, and get customers and clients to look at that. In that case, One Call would win out, but it depends on the buying influences and decision-makers. A TPA is often looking at just a per-unit discount, and Optum can beat One Call out of that often vs a direct insurer or an employer might be more interested looking at the overall claims cost and taking a deeper dive, and understanding that One Call’s overall cost to them is lower.

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You mentioned that One Call and Optum are all broad full-service companies as opposed to MedRisk and Streamline, which focus on single services. How would the dynamics between the bigger conglomerates vs these single service companies work out? Do either of them have a competitive advantage over each other, and could these smaller companies be a potential threat to One Call?

SP: Honestly, MedRisk is the only big, I think, single service, most significant competitor right now, because PT is so big that clients or payers are willing to carve out, often willing to have MedRisk separately for their PT and then use One Call for other things. You don’t see it as much in diagnostics, and even in home health a little bit, but some of the smaller ones that are happening, there are even some smaller PT ones, Bardavon and Streamline. Streamline started with diagnostics, and then they branched into PT. I know that it’s the previous owners of Align Networks who are great and have great relationships. The advantage One Call has over these smaller and newer entrants, particularly in PT but even in diagnostics, so probably just as much in diagnostics, is that price compression in costs for the network and the consolidation. Providers, they’ve already chosen and made their decisions on network involvement, being a part of MedRisk or One Call or Optum, and they’re not necessarily needing the volume or even getting the volume from a smaller new network like Streamline, so I feel like one of the biggest challenges Streamline will face is trying to get a network that will compete. There might be a few regional employers to do relationships, but I think the ship has sailed as far as new entrants into these networks like PT and diagnostics. I think the network size and scope of One Call, and then, of course, the providers’ consolidation and acquisitions, where there’s a large big one, Select. If you don’t have Select or Athletico in network, it’s really going to be hard to compete, and they’re not really interested in joining any new small networks. They don’t really have any incentive to do that.

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What are the current reimbursement trends and what is One Call doing in response to these trends? How effective is One Call at managing relationships between third-party administrators, providers, employers and self-insurers?

SP: As far as the reimbursement trends, I do think there were pretty sizeable network margins in the past, say 5-10 years ago in the PT and diagnostics, and then fee schedule changes and/or the network pricing compression, say, the cost of home health aides and PT salaries and so forth, has created a lower network margin. The fact that One Call is the size it has, and, to your point, the relationships with their providers has been pretty good. Again, because their primary focus was perspective, so steering, providers would join the network, take a discount because they would get referrals, and One Call has genuinely proven that, particularly in the PT and diagnostics side, they’ve been able to actually drive business to their provider network. That relationship has helped to overcome some of the price compressions from the provider network, but it has also affected the margin, so you would see that in the overall EBITDA. I think that One Call has worked on some automations and some operational efficiencies to help offset that. I think their overall margins have stayed pretty steady. I think their biggest challenge was just growth. With COVID and other growth restrictions, just having an almost saturated market is the biggest challenge they face vs margin.

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How are labour costs trending within the market? Has One Call been able to manage its costs effectively? Does it offer premiums to its workers after the pandemic?

SP: I think, for everybody, One Call fell somewhere in the middle in the addressing of it. There were furloughs and temporary lay-offs, but they capitalised or took advantage of the federal funds that were available and offered some of that relief, most of that back to the employees that were on furlough or laid off, and obviously that was early on. As it came back in, they had already started moving toward a little bit more of a remote workforce. Obviously, they had to pivot immediately when COVID hit, and I think it’s been that sustaining of a virtual or remote workforce, the ability to do that, and I think it’s probably mixed. I think it’s a pretty standard culture. I don’t think there are any major drawbacks or anything to One Call. It’s workers’ comp industry, it’s an in-between. People are in healthcare and want to help people, we are making a difference. It’s probably not seen quite as altruistic and helpful as non-work comps, just because it has a little bit of a different flavour. I think just the remote workforce, there’s a focus on culture, there’s been a highlighting of the speciality care and they’ve built a pretty good career ladder and opportunity. Most of Align Networks particularly, before it even became One Call but even before it continued forward, most promotions and most upper-level management are from internal promotion, so I think that has been proven to help retain staff. I think they were already pretty competitive. Especially in the region, because of their ability to remote workforce, and then they’re based in Jacksonville, Florida primarily, it’s not been the same salary push that you might see in some of the bigger cities and so forth. I think they’ve not seen that as a big hindrance, because they were already a pretty decent competitive payer or employer.

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What steps has One Call taken to integrate automation and data analytics into its operational activities and labour costs?

SP: A lot of the challenges in workers’ comp, and even just in managed care, are just patients management. Getting a hold of patients, scheduling. A lot of the automation has focused on automated communications and contacts within the adjuster, the case manager, the patient, connecting those. Having self-service scheduling and just autodiallers dialling the patient. Then, also just communication back and forth, getting notes. There have been connections. They’ve invested in connectivity with their big provider groups to be able to get notes quicker and then they get auto-sent. Probably a combination of communications across the different parties with automated e-mails and autodiallers and faxes, or not faxes but texts and so forth and then just process orientation. They actually did have a pretty big investment, a process excellence team in Six Sigma, so they just do a lot of process workflows and further automate things and simplifying workflows.

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Could you elaborate on One Call’s buying influences and provide an understanding of what clients are looking for? How strong is One Call’s sales force and marketing arm?

SP: It’s one area that I think they have a fairly stable, strong sales force. They’ve lost a good number of tenured people over time, just obviously through COVID, and when there wasn’t as much access to offices and much-needed field staff, you saw quite a bit of a disruption there, and loss of a couple of key people. I have seen, in the industry, LinkedIn and so forth, quite a few of those, as their non-competes came up, going to some of the smaller competitors. They still have a really core sales force that I think has well-established relationships with key decision-makers at the big TPAs and insurance carriers. Marketing, I know they’ve recently refreshed their brand, but overall it’s fine. I think that’s one thing they’re trying to do a little bit better job on is leverage. I saw a highlight on their prosthetics leadership and their prosthetics programme, so I think, overall, leveraging the clinical excellent and clinical management is what I’m seeing them trend toward, and is a good trend.

What was the first part of the question, the buying influences? The buying influences are twofold. If you’re a TPA, it’s price and discount per unit per service, because they get a percent of that savings. At this point, One Call has (audio cuts out 55.02) of the largest TPAs. I feel there’s a little bit of big and take between the big players like Optum, One Call, MedRisk or PTE. I think that’s pretty steady-state. It’s by employer, and it’s influencing the employers underneath those TPAs and then the direct insurers, it’s almost identifying and creating a compelling story about the clinical management. The challenge in the industry, the clinical management, is the overall claims cost, and often One Call doesn’t get that tail end to really fully prove it. They can show in reduced PT utilisation against industry averages posted by WCRI or your home health costs, but it’s really the carriers and the employers that know their claims cost, and so getting that buy in with a decision-maker… and they actually had done some pretty successful RFPs in this manner, or wins of business, by getting their customer, or the buyer, to give blinded claims cost data, and that then One Call could run in an algorithm and against our network and our claims management or average cost and what we know we average, and showing overall reductions in claims cost given the same volume.

For example, you would go through an RFP, and say, “Last year you spent USD 20m. We think that, through our network discount and clinical management on the same volume of claims, we can get you USD 15m.” Just committing and having those performance guarantees to a point, and with some clients, actually that was done, where it’s like, “We’re going to be able to guarantee this percentage of savings off your claims when you use our PT network or home health.” I think that is the key buying influence, again, some of the TPAs will just take one look at your discount and just say, “Hey,” and they state, “I can give you a 25% discount off fee schedule.” That’s not mattering as much now because, “You spent this much in PT last year on these many claims. If you gave it to One Call, we would be able to save you this much dollars on the same claims,” I think it’s going to be a bigger influencer for decision-makers in the future.

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What is the outlook for One Call over the next 12-18 months? What 2-3 risks could the company potentially face in the near future?

SP: I think in this next year, as it feels like the industry is normalising just in general, healthcare and, of course, post-COVID employment and just normal activity, will offer probably a 5-10% growth back to normal, just in the same store, just in volume of claims and more companies in their current book of business. I think the risk is that it’s a slow growth. That itself is not that bad, but PT is pretty saturated. You’ve got MedRisk and One Call, and they flip back and forth. You’ve got a couple of ankle-biters like Bardavon and Streamline that could take a couple of regionals. I think that the overall growth of new customers in PT and diagnostics, and even in home health, is pretty flat, because what happens is they’ll win one but then someone else will win something off, so it just seems to be a saturated switching-around market. Besides same-store growth, just by additional needs, back to normal from post-COVID, the other growth is going to come from expanding the services we’ve talked about, like behavioural health, utilisation review, something like that.

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Is there anything that you would like to highlight that we haven’t covered yet?

SP: I don’t think so. I think One Call is going to always be a pretty stable steady. What I saw historically was just tempered expectations on the amount of growth. At the peak, and when One Call became what it was back in 2012-13, when Apax bought Align Networks and One Call and some home health up together, all of those companies were at their peak of growth, and so it looked like there was just a really, really large growth trajectory. That flattened pretty quickly, but it’s because, again, tempered expectation of that market. As much as people talk about the white space, I think the amount of managed space is pretty well-captured by one group or another between Optum, Coventry, MedRisk. It just moves around. When people look at investments, it’s understanding, I think, they’re pretty stable, and there is room for small and incremental growth, maybe larger growth in a new market, but that’s probably the key thing. There’s probably low risk as far as the floor, but it’s not a very high ceiling within their current markets, again, unless some big acquisition happened, like if they bought MedRisk. That’s the biggest opportunity, or they go get Streamline or Bardavon. That’s probably the biggest option, which is what they were known for back in the day. They took a lot of the smaller ones. That’d be the other way for growth, is One Call to acquire those.

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