Quality improvements Featured

6:24am EDT March 9, 2010
Managed care organizations have done a lot of work over the last several years to speed up processes in the workers’ compensation system.

Stakeholders from several groups, including the Bureau of Workers’ Compensation, The Kilbourne Co. and the MCO League of Ohio studied 10 years of data from previous health organizations to develop areas of improvement. Twelve major objectives were developed from this, but five were seen as the most important for MCOs to focus on.

These objectives include providing injured workers with more timely and efficient access to quality care, reducing disability days, returning injured employees to work more efficiently and effectively, reducing overall claims costs, speeding up the payment process for providers, and increasing the satisfaction of services for employers and injured workers.

“These items all focus on timing, efficiency and quality care for injured workers,” says Karen Conger, CEO of Ohio Employee Health Partnership. “This will result in reduced missed days and indemnity payments, because that’s where your costs lie. You’re not only treating the injury, but also managing the time away from work, or time an injured worker is on modified duty. This all adds to your premium cost.”

Smart Business spoke with Conger about how MCOs have made improvements under these objectives.

How have MCOs provided injured workers with timely access to quality care?

MCOs have reduced the filing time between when an injury happens and when it’s reported. This was an average of 62.1 days before the study and was down to an average of 19.3 days in 2006. This means injuries are being reported and adjudicated sooner. Treatment is then authorized sooner, so injured workers have more timely access to medical services.

One of the most important goals is to have fewer disability days for injured workers. It’s all about looking at those lost time days and reducing that number so injured workers are back to work. Injured workers have returned to employment in 8.9 days, as opposed to 19 days before 1998. Ninety-two percent of injured workers have gone back to work safely within 60 days of filing a claim.

How have MCOs reduced overall claim costs and the number of claims being filed?

MCOs have been able to reduce claim costs by 73 percent through effective return-to-work strategies and requesting appropriate treatment options. An average claim was $8,188 in 1995 and down to $2,183 in 2003.

The number of claims has gone down over the years in the U.S., but it’s hard to say if the managed care process has helped weed out any questionable claims. This reduction could come from a variety of areas, including less manufacturing or healthier workers. But one of the ways MCOs can help keep claims down is by promoting a safe workplace and working with employers on safety to make sure injuries never happen.

How have MCOs helped speed up the payment process for providers?

This happened in two ways. The first was by reducing the lag time, or time between the date of injury and reported date. This gives you more time to pay the bill because you know you have an allowed claim. If you didn’t know about a claim for 60 days, that’s lost time when you could have paid it and sped up the process.

Strict benchmarks were also set to speed up this process. The lag time has been reduced by 51 percent, and 98 percent of bills today are now paid by MCOs within 30 days of receipt. Knowing about the injury quicker, getting the treatment approved quicker and getting the claim allowed quicker can allow a company to pay the bill quicker. It all wraps together.

How have MCOs increased overall satisfaction, and how can this success be measured?

A 2007 report card showed satisfaction levels at 4.28 for employers and 3.93 for injured workers on a scale of 1 to 5. By using an MCO, employers have someone to talk to and employees have medical experts to work with. MCOs also give employers another partner in return-to-work programs and a liaison between providers. Satisfaction increases as you see claim costs and premiums decrease.

Injured workers are getting treatment sooner because claims are being reported and filed sooner. So they’re not sitting around for days or weeks, waiting for treatments to be approved. This can lead to a better quality of life for them, reduce their lost time wages and get them back on the job safely, so they can continue taking care of their families.

These improvements have offered a net savings in excess of $1.78 billion from 1997 to 2006. This lowers reserves for employers, which is a big calculation of the premium.

Do you foresee any future improvements to the system?

We are constantly looking for ways to improve. Future improvements may deal with decreasing provider payment time as the health care industry moves from paper to electronic systems. These electronic systems may help improve filing times and other issues in the workers’ comp area. It also may help in the cost savings. But as things become more and more electronic, and more health care providers are using electronic systems, these will lead to more improvements for MCOs.

Karen Conger is the CEO of Ohio Employee Health Partnership.