How to select the MCO that’s right for your company

The Ohio Bureau of Workers’ Compensation (BWC) allows a biennial open enrollment period for Managed Care Organizations (MCO). This year open enrollment falls between May 2 and May 27. Open enrollment is very short and companies have many factors to consider. The decision employers make now to stay with their current MCO or change to a new MCO will impact them for the next two years.

“Companies must recognize that when they’re making this decision, to stay with their current MCO or change to a new MCO, it’s crucial to choose wisely,” says Joe Spooner, vice president at Spooner Medical Administrators, Inc.

Smart Business spoke with Spooner about open enrollment and the factors to consider when choosing an MCO.

What is an MCO and what is the difference between it and a Third-Party Administrator?

MCOs and Third-Party Administrators (TPA) are both private employers. MCOs are contracted through the BWC to manage the medical aspect of employee on-the-job injury claims. They facilitate communication between employers, injured workers and the BWC.

TPAs represent employers’ interests when an employee files a claim through the BWC, managing the claim and employers’ risks. Whether a company works with a TPA is entirely up to the employer. Every employer in Ohio that applies to the BWC for workers’ compensation insurance can select an MCO or the BWC assigns an MCO.

Company’s can also select an MCO during open enrollment, which occurs every other year in the month of May.

What should an employer look for when selecting an MCO?

There are several factors to consider when choosing an MCO:

  • A utilization review department that is separate from the case management department. This helps an MCO maintain impartiality and make objective decisions when responding to treatment requests by doctors to determine their appropriateness in the context of a claim.
  • An MCO needs a thorough fee-auditing department to determine what claims are appropriate to pay. A company should feel confident that its MCO’s process is thorough to avoid unnecessary charges.
  • Companies benefit from MCOs that have a relationship with a provider network. This enables it to take advantage of discounts below the BWC’s fee schedule. Lower medical costs equate to lower workers’ compensation premium payments.
  • Customized reporting is an added perk as such reports contain exactly the data a company finds most valuable.
  • A company should have one point of contact at its MCO. Having multiple contacts is confusing. One point of contact means he or she can learn the employer’s preferences, and most importantly its return-to-work philosophy.
  • MCOs should help with an employee’s return to work. It should offer flexible return to work strategies that are specific to the employee’s company.

When should employers meet with MCOs and how should they prepare for the meeting?

Employers cannot interview prospective MCOs before the open enrollment period, so it’s advisable to do research beforehand. Then, when employers are free to interview MCOs, they can ask carefully considered questions because there is limited time. A hasty choice or choosing not to look at other MCOs during open enrollment can prove costly.

Meeting with an MCO during the BWC approved open enrollment period from May 2 to May 27 is free. But the vendor the employer chooses could save or cost them thousands.

Insights Workplace Health & Safety is brought to you by Spooner Inc.