Most employers say they are satisfied with the managed care organizations (MCO) they work with through the Ohio Bureau of Workers’ Compensation’s Health Partnership Program.
But for those who aren’t, the chance to change providers is coming up in May. Employers can switch their MCO with one simple phone call to the bureau between May 1 and May 31.
HPP, Ohio’s managed care program for workers’ comp, was mandated by the legislature in 1993, but didn’t go into effect until March 1, 1997.
“It took quite a bit of time to build the system,” says Jim Samuel, director of corporate affairs. “Ohio is unique, because the system was built with everyone at the table,” including big business, small business, organized labor, government entities and medical providers. “It wasn’t like some other states, where one particular interest group controls the creation of the managed care program.”
Before the HPP system was put into place, all of the work related to a workers’ comp claim was handled by the BWC. The change was made to “bring in some private sector theories to the workers’ comp area,” Samuel says. “MCOs are private sector. If they don’t get any business, they’ll go out of business. If they don’t perform, they’ll go out of business. We wanted to bring that to the managed care system.”
Every Ohio employer, both public and private, is required to choose an MCO to handle the medical management portion of injured workers’ claims. When the program began in 1997, those 30 percent of employers which failed to choose an MCO were randomly assigned one by a BWC computer.
Employers can choose among 38 BWC-approved MCOs. Three years ago, that number was 57, but it has decreased, due to both poor performing MCOs booted out of the program and, more often, consolidations and mergers in the industry.
To help employers make a choice, the BWC make available as much information as it can by issuing a report card on each MCO through its Web site, www.ohiobwc.com.
“We look at how many policies the MCO has, how many workers that covers, the number of claims handled, the size of the MCO — maybe someone prefers a smaller MCO, or one that just focuses on Summit County, as opposed to the entire state,” Samuel says. “We look at customer service ratings — how do other employers rate it, the rating from injured workers, and the first report of injury — how quickly they tell us about claims.”
The last time open enrollment was offered, in 1998, just 10,000 employers, involving 100,000 claims, switched MCOs. Samuel says that’s not many, considering there are about 225,000 employers in Ohio.
“Many businesses may not have had a claim for a long time,” Samuel says. “If they’re not dealing with the system a whole lot, they’re not so apt to make a change.”
Because of the relative lack of interest two years ago, the BWC decided to offer open enrollment only every other year.
“There’s not enough interest,” Samuel says. “Logistically, it’s a big thing to do,” with all the paperwork involved, and encouraging employers to stay with an MCO for at least two years gives them a chance to get to know how it operates before making a decision about changing.
However, “if a business is really having a hard time with an MCO and wants to switch, if the problem can’t be resolved, they can switch any time,” Samuel says.
Under the new system, a quicker reporting of claims has been a boon for everyone from the BWC to the injured worker to the employer, Samuel says. Before, it took more than 60 days, on average, for the BWC to hear about a claim.
“More than two months went by before we even knew an injury had occurred,” Samuel says.
Although the statute of limitations on filing claims remains two years, with HPP, the average reporting time has fallen to 13 days.
“That allows them to get treatment quicker and everything happens more quickly for them,” Samuel says.
Not only does the injured worker begin receiving payment of lost wages sooner, but the employer gets him or her back to work sooner, saving both money and time.
“An injury costs (an employer) more than just workers’ comp,” Samuel says. “It’s how the business deals with someone being out. You have to hire a temp, train someone, figure how much it costs to bring them up to speed. There are a lot of other costs involved.”
Getting the worker back on the job as quickly as possible is a priority for the BWC and has become a major feature of the state’s most recent contract with participating MCOs. An MCO is paid a flat fee by the state to handle claims, but also receives incentives based on first report of injury, customer service and getting people back to work, Samuel says.
“People say, ‘They’re just going to force that poor guy back to work even though he’s not ready,’ but if he goes back to work and reinjures the same thing within 90 days, it’s looked at as if they didn’t give them the right treatment,” Samuel says. “The goal is to get the right treatment as quickly as possible with proper healing and get them back to work.”
It seems to be working. Injured workers give the system a score of 4.02 out of five when rating the services they received; employers gave a rating of 4.25 when asked to rate overall service from their MCO.
The program is proving so successful that government entities from around the world are flocking to the state to find out how they might copy it.
“A lot of folks are coming to Ohio to see how it works,” Samuel says. That includes states such as California and Nevada, several Canadian provinces, and countries including Sweden, Germany, South Africa and Australia.
The HPP program is also helping the state recruit businesses to relocate here.
“The economic climate in Ohio is better because of this,” Samuel says. “Years ago, the one thing we really avoided (when talking to business owners thinking of relocating to Ohio) was workers’ comp. If it didn’t come up, we avoided it. It was the last thing you wanted to talk about it.
“Now, if they don’t ask, we bring it up and tell employers, ‘This is what it could do for you.’”
To check out the BWC’s report card of Ohio’s MCOs, see its Web site at www.ohiobwc.com. To change your MCO, call the bureau at (800) 644-6292 between May 1 and May 31.