Ohio Employee Health Partnership on MCOs

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.