The open enrollment period for workers’ compensation will be the only time during the next two years that Managed Care Organizations approved by the Bureau of Workers’ Compensation will be able to market themselves to employers as the ideal conduit to provide medical case management, and as the perfect organization to provide support and guidance in the wake of workers’ compensation claims.
“Even if an employer believes they’re satisfied or is comfortable with what their MCO has been doing, it still is important that they objectively evaluate how their MCO compares to other MCOs in terms of performance,” says Richard J. Poach, president and COO of CareWorks. “They may be perfectly happy, but they may be able to get something better at no additional cost.
To make sure you are getting the most cost-effective and efficient services, you need to better understand what an MCO is. There are no direct costs for an MCO, as fees are included in your BWC premium. Considering that all MCOs are priced the same, you have to look at intangibles. If you do your research, your choice will become clear.
“Not all MCOs offer the same reports, the same services, the same medical discounts. So it’s important if an employer’s not happy that they talk to other employers or they do their homework in looking at the BWC report card and previous BWC report cards to get a feel for overall MCO performance.”
In today’s challenging economy, consistent return to work can help employers lower their costs and control their future premiums. That may be why 175,000 Ohio employers have selected CareWorks.
“If somebody gets injured and the MCO is able to get that injured worker back to work quickly and safely, it’s going to help the employer control future premium increases,” Poach says. “And by getting injured workers back to work quickly and safely, the MCOs can help employers control their lost productivity, as well.”
To help control costs, CareWorks uses an exclusive Medical Mutual provider network, which continues to offer substantial medical cost savings, with fees for most professional services 20 percent below the BWC’s fee schedule.
“It’s important that employers understand whether or not their MCOs offer those discounts, and to what extent or degree those discounts fall below the Bureau fee schedule,” says Poach.
Because the open enrollment period ends May 28, you should start researching MCOs now, if you haven’t already started.
“Employers are allowed at any time to contact an MCO, even if it’s not their own MCO, to request information, to request a face-to-face meeting, and they can do that even outside of an open enrollment period,” Poach says. “The more MCOs companies interview and seek information from, the more informed they’ll be in making their MCO selection.”
CareWorks is an Ohio BWC-certified MCO and manages nearly 30 percent of all new claims filed in Ohio, and its customers represent more than $700 million in workers’ compensation premiums. Its focus is to help injured workers throughout Ohio recover from workplace injuries and return to work as quickly and safely as possible.
“Often an injured employee can be limited in what tasks they can perform when they attempt to return to work, based on work restrictions prescribed by their healthcare provider,” says Poach. “However, today’s occupational health providers are receptive to working with employers and focusing on an injured employee’s abilities as opposed to their disabilities. The MCO can be instrumental in working with employer, employee and health care providers to facilitate a safe return to work within an employee’s physical abilities. All parties can work together with a common goal of returning injured employees to productive employment, realizing the positive impact work can have on achieving long-term recovery while effectively minimizing claim costs.”
Creating structured early-return-to-work duties for employees to perform during their recovery is key, as it allows them to remain active and productive, helping prevent loss of physical fitness and minimizing disruption to their life.
“The longer an injured employee spends away from their career and peers, the harder it can be for them to safely return to gainful employment,” says Poach. “Early return to work is designed to give employers tools to eliminate the occurrence of costly lost time claims and provide the healthiest recovery option for their valuable employees.”
Effective medical management helps CareWorks’ customers develop strategic return-to-work programs that reduce lost time, promote healthy and timely recoveries for their injured employees and help control workers’ compensation costs.
“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 they are more challenged to achieve the financial margins 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.”
To sign up for CareWorks during this year’s MCO Open Enrollment, go to www.careworks.com, click on “Get the Info” and follow the on-screen instructions. If you have questions, call CareWorks Open Enrollment Unit, toll free at 1-888-627-7586. Ohio employers have until May 28 to change their MCO.
