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.
