Understand that costs are driven by performance
Unlike so many other business partners and services, MCOs cannot bid for your contracts or your money. Because the BWC pays each MCO – and because that payment structure is fixed and based on performance standards – the dynamics of your relationship with your MCO might be a little different than with other folks who show up at your offices for a meeting.
Once the BWC approves a claim, the MCO takes control and starts to coordinate every aspect of the claim and toward getting the employee back to work. MCOs work with the injured employee, the employer and the provider to develop a plan for treatment, review treatment requests, monitor the cost and quality of care, and establish those goals for the employee to return to work.
"It’s important for them to understand the MCO’s role is the medical management of the claim," Conger says. "We have nothing to do with the allowances or with adding to the allowances. That’s still the role of the bureau and, sometimes, I think they get confused, thinking we’re the ones who make the allowances or the ones who deny the allowances when it comes to the injured workers, and we’re not. We’re just the medical experts."
And they are still a business. The recession has not battered their industry, but it also hasn’t provided a very clear path for many MCOs.
"Most of the companies that we work with are still feeling the struggles and the challenges of the economy," Poach says. "Even though we’re getting a bit of a rebound here, most companies are operating leaner than they have in the past, and their financial margins are more challenged to achieve what they’ve achieved in the past.
"As we look forward, it’s more important than ever that companies be able to control their workers’ compensation costs."
