How a better relationship with your MCO contributes to financial success

Every state-funded employer in Ohio utilizes the services of a managed care organization (MCO), whose central purpose is to manage the medical aspects of workers’ compensation claims.

“What that actually means in practical application can seem mysterious,” says Lance Watkins, vice president of client services at CompManagement Health Systems. “By clearing up confusion about the MCO’s impact, employers may find new opportunities to leverage their MCO to help control costs, and also more confidently evaluate the effectiveness of their services.

Smart Business spoke with Watkins about what MCOs can do for companies.

Why is an MCO important?

The resolution of any claim — in a way that limits its future impact on your rates, premium and discount options — depends on injured employees recovering quickly and safely. Your MCO works closely with employees and their physicians to facilitate timely and appropriate medical treatment. MCO case managers keep all parties focused on the return-to-work goal. Your connection to your MCO ensures that lost work days are kept to a minimum.

How does an MCO help reduce lost time?

Depending on the type of injury and your company’s ability to adapt job requirements, your MCO may be able to help develop modified duty options that can drive a quicker return to work and lower claim costs.

Employees are sometimes taken off work due to the potential side effects of a prescribed drug. MCOs can discuss over-the-counter or alternative options to lower medical costs and allow employees a wider range of activities without medication-related impairment concerns.

A physician may prescribe treatment programs that could require an employee to be off of work. Additionally, physicians commonly take patients off work until they can be re-evaluated after physical therapy. Thinking creatively, your MCO can consult with you, the doctor and the physical therapist on options to support recovery with less downtime. Work activities could be incorporated in a physical therapy program.

While every injury and patient is different, it is important to keep the treating physician informed of the extent of lost time anticipated for each specific injury. Official Disability Guidelines provide this data based on the history of similar diagnoses.

How do MCOs directly impact businesses?

  • Initiating new claims — Thoroughly documenting and quickly submitting new injury reports to your MCO reduces ambiguity and expedites allowance decisions by the Ohio Bureau of Workers’ Compensation. An accurate and efficient injury reporting process speeds medical treatment and resolution.
  • Reviewing and paying medical bills — When opportunities to pay for medical services at lower reimbursement rates arise, your MCO may be able to reduce the costs applied to your premium rates.
  • Exploring vocational rehabilitation options — ‘Voc rehab’ can support employees as they prepare to return to work. It can also help employers defer significant claim costs and limit the impact on premium costs. All parties must agree on the utilization of voc rehab services, and partnering with your MCO in this process is essential.
  • Facilitating treatment requests — A physician or attorney may appeal an MCO’s decision to deny a specific treatment request, typically leading to delays, a series of hearings with the Industrial Commission, and significant time, energy and emotion invested by all involved. Your MCO can sometimes help avoid these delays by engaging the treating physician, exploring alternative treatment options to keep the claim moving toward resolution, and helping the employee return to work sooner.

An MCO’s focus on safe, efficient recovery will help ensure not only the health and productivity of your employees, but also your workplace. Employers often focus on premium rates and options for discount and rebate programs, which is appropriate. But these options depend largely on controlling your claim costs. Working closely with your MCO to limit lost work days and control medical expenses will help you secure premium advantages in coming years.

Insights Workers’ Compensation is brought to you by CompManagement Health Systems