Helping Hand(s): Employers turn to managed care organizations to help get their injured workers back on the job quickly. The window for choosing a new MCO just opened.
Columbus Business First May 7, 2010
Every two years, companies can analyze how well the managed care organizations they're using for their workers' compensation claims stack up against peers - and decide whether to stay or go.
That time is now through May 28. Although the Ohio Bureau of Workers' Compensation originated the managed care organization· system in the mid-1990s, the landscape of MCOs has changed, and there are a diminishing number of companies from which to choose.
Statewide, there are 18 MCOs - though not all are certified in every county - that provide services to help companies file workers' compensation claims and to help injured workers receive medical care so they can return to work.
Dave McCarty, chairman of the workers' compensation practice at Columbus law firm Kegler Brown Hill + Ritter LPA, said he remembers the days before MCOs.
What the MCOs have brought to the workers' comp picture, he said, is expedited claim filing, the imposition of deadlines so matters are processed more quickly, and a substantially more efficient system - though one not without its flaws.
"Things happen more quickly, and that's both on the managed care side and the bureau side as well," McCarty said.
PUBLISHING THE GRADES
An MCO report card available on the Bureau of Workers' Compensation's website is the place for employers to start.
Employers can compare how MCOs rate against others in. measures including the number of employer clients, the number of claims filed, and the average time between the date of injury and when a claim was filed.
The report card also includes what the bureau calls an "optimal return to work" measurement that does not include empirical data but that compares the MCOs against performance benchmarks established by the bureau.
McCarty said applying a numerical value to the optimal return to work measure wouldn't paint an accurate picture of an MCO's performance because of the breadth of injuries and occupations.
Instead, the bureau compares actual accrued time lost from work against benchmarks for the amount of time expected off work based on insurance and actuarial data.
How close an MCO is to these benchmarks is characterized on the report card as "loosely managed" or "well managed."
McCarty, who began his practice in 1992 before the onset of MCOs, said efficiency measures for the companies have improved over time, which benefits workers because their claims get filed in a more timely manner and medical treatments follow more quickly.
"What I would suggest with regard to evaluating the report card is those that have a significant deviation from the norm in terms of poorer performance are ones you might want to be leery about staying with or going to," McCarty said.
TIME TO WOO
Among the newer MCO players with a presence in the Central Ohio market is Cincinnati's Sheakley Group of Cos., whose UniComp subsidiary in March bought Gates McDonald's HealthPlus from Columbus-based Nationwide Mutual Insurance Co.
That transaction hasn't changed what services Sheakley offers here or how those services are rendered, said Andrea Kiener, director of client programs.
She said the Columbus office strengthened the company's already strong market presence.
"We differentiate ourselves by providing personalized service to our clients as well as many employer programs (and) solutions to assist with managing their workers' compensation;' she said.
"The world of workers' compensation is always changing, updating and evolving," Kiener said. "A business should have an MCO that is evolving with the system plus anticipating future changes. This will allow the MCO to not only stay ahead of the game but keep businesses ahead as well."
But that doesn't mean the choice is easy. From the start of the open enrollment period May 3, employers receive marketing materials from the MCOs, especially the larger ones, who are looking to woo clients.
McCarty said smart companies always compare the claims made in these marketing materials against the state agency's report card.
"It provides a comparison between the MCOs over an extended period of time, so you can see those that are managing their claims well and those that are not," he said.
And in the world of workers' comp, things often are changing, Kiener said, so it's vital to stay on top of the game by building a relationship with an MCO you trust.