It’s that time again. Between May 6 and May 31, Ohio employers dissatisfied with their managed care organization may select a new one.
But how to choose? Karen Conger, chief executive officer of Ohio Employee Health Partnership, a managed care organization with an office in Akron, says the prospect can be daunting for workers’ compensation administrators in small- and medium-sized businesses who wear many different hats. She suggests asking four questions to help determine if a managed care organization is performing up to par.
1. Does the managed care organization understand the concept of “timely and safe return to work” and work with medical providers to achieve that goal? “It’s not very often that somebody who is injured at work is completely disabled,” Conger says. “They have some ability. If they hurt their right arm, they still have a good left arm and two legs.”
One sign that managed care organizations may not be working closely enough with medical providers is that an employer’s light-duty programs aren’t being utilized.
2. Does the managed care organization understand what your company does? Conger says that knowledge is essential to safely returning employees to work as soon as possible. She cites a truck driver with a major knee injury. Someone who knows that the driver also unloads the truck, which is equipped with a standard transmission, could recommend to the doctor that person could return to work sooner by using a rig with an automatic transmission and limiting lifting to five pounds twice per hour.
3. When an injury occurs, does the managed care organization communicate with your company and provide timely information regarding the employee’s condition?
“The sooner the managed care organization can communicate with the employer, the better they both can manage that injured worker on return-to-work issues,” Conger says.
A managed care organization should contact the injured worker, the medical provider and the employer once an injury is reported so information can be verified. Accurate information, says Bob Carr, president of Ohio Comp Choice in Warren, not only reduces lapses in the injured worker’s treatment but speeds payments to providers. In many cases, it is the managed care organization that first notifies an employer of an employee injury.
“They don’t even know the injured worker went to the emergency room,” says Conger.
That communication should also come in a form and frequency the employer prefers. Conger says some of her clients like a weekly update faxed to their offices; others demand a daily phone call.
“If you’re not hearing from them as much as you feel you need to, then that’s a red flag.”
4. Is your company seeing a decrease in costs? Conger acknowledges that savings in medical management and return-to-work costs are often difficult to measure because of the rebates many managed-care organizations offer. But time spent dealing with workers’ compensation claims should definitely be cut.
The managed care organization — not one of your employees — should keep track of injured employees’ doctors appointments, progress during physical therapy, etc., and providing timely updates so staffing decisions can be made.
5. But Conger says the key indicator of whether a managed care organization is doing its job is employee satisfaction. “If they’re constantly in your office complaining about the managed care organization, that’s a red flag,” she says. “If you’re not hearing any bad news from your injured workers, you’re probably OK.”
When picking a new managed care organization, Conger recommends looking at the managed care organization report card compiled by the Ohio Bureau of Workers’ Compensation and mailed in April to every employer paying workers’ compensation premiums. She cautions that ratings are based on variables such as employer size and volume; therefore, they may not provide the most accurate assessment of a managed care organization’s performance.
“But it’s a place to start,” she says.
She also suggests checking out performance with other employers and medical providers.
“The providers deal with the managed care providers every single day — they probably deal with at least 10 in each region,” Conger says. “They’ll have a pretty good feel for what is going on.”
Don’t forget to ask about the staff, Carr says. Are they friendly and professional in addition to being knowledgeable and responsive? Is employee turnover low enough to provide a sense of continuity when discussing claims?
“We’ve heard complaints at some of the meetings we go to that the managed care organizations just hang up on you,” he says.
And what if you discover long before the next open enrollment period that your new managed care organization doesn’t meet expectations? Carr advises making your concerns known.
If they’re not addressed, report them to the Ohio Bureau of Workers’ Compensation’s managed care organization business unit and petition the managed care organization for a release. The request, he assures, is usually granted.
“Nobody wants a dissatisfied client,” he says.
How to reach: Ohio Employee Health Partnership, (330) 923-6320
