With open enrollment this month, you need to understand
what to look for when choosing a managed care organization
(MCO).
Because the Ohio Bureau of Workers’ Compensation’s Policy
and Procedure Guide is constantly updated, it is important to
stay up to date to save your company time and money.
“Workers’ compensation is so foreign to everybody because
most don’t look at it until it comes up,” says Karen Agnich,
president of Cleveland-based AdvoCare Inc. “Ninety percent of
the time we spend educating the employer on what we do and
how we can help.”
In 1997, the Ohio Legislature instituted the Health Partnership
Program, shifting workers’ compensation claims processing
from the BWC to MCOs, which has significantly reduced the
out-of-work time for injured workers. Today, the BWC and
certified, private-sector MCOs work together to provide comprehensive claims-management and medical-management
services to employers.
“MCOs act as a liaison between all parties involved in the
claim,” says Dan Neubert, executive director of Cleveland-based 1-888-OHIOCOMP, the fastest-growing MCO in Ohio,
with more than 10,000 employers on its client roster.
Once the BWC approves a claim, the MCO takes over, coordinating everything from treatment to bill processing to dispute-resolution services in order to return the injured employee to work as soon as possible. MCOs work with the injured
employee, the employer and the provider to develop a plan for
treatment, review treatment requests, monitor the cost and
quality of care, and establish return-to-work goals.
“[MCOs] work with the employee to get them better both
mentally and physically,” Agnich says. “Ninety-five percent of
workers want to go back to work, but the problem is they don’t
know what services they need or where to go get them.”
Because every company except those that are self-insured
must designate an MCO, it is important to understand what to
look for when choosing one. MCOs are very competitive,
Neubert says, and it all has to do with the level of service they
provide.
“If it was run as a monopoly, we wouldn’t have competition,
and we wouldn’t have good service,” he says.
When choosing an MCO, look for testimonials and get recommendations from other employers.
“Discuss the level of service [that the employer] is getting,”
says Neubert, who also advises employers to request public
information from the bureau on particular MCOs, as well as
researching which MCOs failed the BWC audit.
Ask how good the organization’s rate of return to work is,
how it communicates with all the parties involved, how it educates its employers on the services it provides, and what programs it offers.
But Agnich says the No. 1 thing to look for when choosing an
MCO is whether the organization has a nurse on staff. That
way, an employer knows who to call in case of an injury, and
the nurse emphasizes the importance of a call sheet, which
lists the contact for each particular service, including the person to speak with when reporting an injury.
“Companies can’t do [workers’ compensation] on their own
because they don’t have a nurse to talk to the doctor and make
sure they aren’t getting swindled,” she says.
And when it comes to keeping your premiums low, look at
the quality of programs the MCO provides, as good programs
can save a company hundreds of dollars.
“If an employer goes through these programs, it will reduce
their premiums significantly,” Neubert says.
Good programs can also help get an injured worker back to
work faster, which is to keeping costs down for employers
because the quicker an injured worker returns to work, the
lower the premium.
“Once you do have an injury, someone should be working
really hard for you,” Agnich says.
Ask MCOs about programs that help prevent injuries, such as
drug-free and safety programs, as well as those that provide
job retention, gradual return to work and job-search assistance, such as transitional and vocational programs. And offer
safety equipment, such as safety goggles, steel-toed boots and
fire-retardant clothing, which can help prevent injuries that
raise premiums.
“Safety is the best money an employer can spend in a workers’ comp program,” Neubert says. “It’s investing in their
employees and showing they care.”
But if all steps fail and an employee is injured, transitional
and vocational programs are crucial. In the case of major
injuries in which a worker may never be able to return to his or
her original job, an MCO can set up that employee with a vocational school to gain the necessary skills to possibly return the
worker to that same company but in another position. Or, a
vocational program can help that worker find another job or
career.
Transitional work programs bring back injured workers at a
lesser capacity than before to allow the employee to work,
within the injured worker’s medical restrictions, during the
recovery process and leading up to his or her return to full
duty.
“With transitional work programs, employees actually get
better quicker, and it saves the employer on premiums,”
Neubert says.
You can also keep premiums low by banding together with
other companies to achieve lower rates than you could on your
own. Last year, the highest group discount level issued by the
BWC was an 85 percent savings off a company’s premiums.
Companies are group eligible if they have an active BWC policy and a favorable claims ratio over a four-year period, meaning an employer’s claims should not exceed its expected losses, based on the type of risk it carries.
“The more safe a company, the more likely they’ll be group
eligible,” Neubert says.
The enrolled company’s amount of risk determines the discount offered. For example, an office-based company would
most likely receive the highest discount of 85 percent because
of its low-risk factor, but a labor company with much higher
risk may only receive a discount of 25 percent.
“A lot of companies could be group eligible, they just don’t
know it,” says Steve Millard, executive director of COSE
(Council of Smaller Enterprises), the small business arm of the
Greater Cleveland Partnership. “It’s not very hard to be group
eligible. I think, in the state, there are about 300,000 employers, and about 100,000 of them are in the (group-discount)
program.”
Employers should also consider joining an organization such
as COSE, which has been managing a group-rated program for
more than 15 years. COSE is a group sponsor that focuses on
helping employers become group eligible to keep their premiums low.
The small business council offers safety and drug-free programs and courses including PDP, a step-by-step performance-based safety program, as well as consultants who can design a
custom program to fit the needs of any company. COSE also
offers free legal services. Even if companies are not group eligible, depending on the type of programs they enroll in,
employers could get a premium discount of up to 20 percent.
“COSE is doing some of the things for small businesses that
large businesses are able to do for themselves,” Millard says.
“An MCO is a service that everyone needs, but you really need
to evaluate the services they provide. A good MCO can save
you a lot of money, but a bad MCO can actually cost you more
money.”
HOW TO REACH: 1-888-OHIOCOMP, www.1-888-ohiocomp.com, COSE, www.cose.org; AdvoCare Inc., www.advocare-inc.com
