A GUIDE TO OPEN ENROLLMENT
It happens every other year as the weather gets warmer and the summer months approach. But it doesn’t have anything to do with April showers or May flowers — it’s the Ohio Bureau of Workers’ Compensation’s MCO open-enrollment period. This is the biennial time in which employers can choose to change their managed care organization, and this year, it takes place from April 28 to May 23.
You may have seen this period come and go in previous years without taking action or even understanding what it means.
If you are satisfied with your current MCO, you do not need to take any action to continue your relationship, says Teresa Arms, director of the MCO Business and Reporting Unit of the Ohio BWC.
Time to consider options
If, however, you would like to switch, are on the fence or aren’t sure, now is the time to evaluate other options. You don’t need to provide a reason for changing MCOs, since selection is entirely an employer’s decision.
MCOs perform important duties in the unfortunate event that a worker is injured on the job.
They are responsible for reporting claims, providing a diverse panel of certified health care providers, managing medical cases (including reviewing treatment requests and making treatment reimbursement decisions), resolving disputes, reviewing and paying bills, and educating and assisting employers regarding safety and return-to-work initiatives.
Selecting an MCO is an important decision as it directly affects the health and safety of your company’s employees and your bottom line.
“MCOs work closely with the Ohio BWC to provide comprehensive claims management, medical management and utilization review services to ensure injured workers receive the timely, quality medical care they deserve,” Arms says. “A timely and effective response following a workplace injury is critical to facilitating a quick and safe return to work. This is one of the most influential factors in the overall cost of a claim because the longer someone is in the system, the greater the cost.”
All state-funded businesses — those who pay workers’ compensation premiums into the state insurance fund, i.e., not self-insured employers — are required to have an MCO. The Ohio BWC pays MCOs from a portion of the premiums that Ohio employers pay.
New businesses must choose an MCO within 30 days of receiving the Ohio BWC’s new employer kit. If the new employer does not choose by then, the Ohio BWC will assign an MCO to it.
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WHAT IS YOUR ROLE Your managed care organization will take responsibility for managing your workers’ compensation claims. However, your company has some responsibilities as well. They include the following:
SOURCE: Ohio Bureau of Workers’ Compensation |
Individual needs are important
There are a number of factors to consider when selecting an MCO.
“Because different factors may be important to different businesses, we encourage employers to carefully evaluate what their individual needs are because they may vary,” Arms says.
For example, some companies might be more comfortable with a smaller MCO that handles fewer employers and claims, while some might prefer a larger MCO that handles a larger number of employers and claims.
Employers can evaluate MCO data by viewing the Ohio BWC’s MCO Report Card at http://bit.ly/HhVEdM. Data includes number of employers, number of claims, first report of injury timing, first report of injury turnaround time and Quality Medical Management for each MCO. The Ohio BWC calculates the scores based on the information it receives regularly from the MCOs.
Although open enrollment happens every two years, it updates the information yearly. The Ohio BWC also publishes an MCO Selection Guide available at http://bit.ly/HdlJgO. It includes an alphabetical listing of Ohio MCOs and their five-digit identification codes.
If you have additional questions, the Ohio BWC recommends contacting MCOs directly. It’s a good idea to ask about an MCO’s experience: Does it work with similar businesses in your industry?
Choosing an MCO
Selecting an MCO that has managed similar claims will expedite your claims process — returning your injured employee to work sooner and helping you avoid costs associated with lost productivity. Also, ask whether you will be assigned a case manager and how often you will receive information from this person. You want to keep communication with your MCO open to ensure you and your employees are receiving the best service and seeing the best results.
In addition, Arms says to ask the MCO if it has negotiated payments less than the Ohio BWC’s fee schedules, resulting in additional savings. For example, some MCOs offer discounts for using providers within their network.
You will most likely begin receiving marketing materials, phone calls and possibly even visits from area MCOs as open enrollment is the only time they are allowed to market themselves to your company. The Ohio BWC reminds employers to keep in mind that these interactions are created with the intent to influence your MCO selection.
Arms says that an MCO cannot decline a specific employer. If an MCO has placed itself “at capacity” for a specific county, however, no employer within that county will be able to select that MCO. Also, there is a possibility that an employer’s MCO selection may be rejected.
“The Ohio BWC may place an MCO at capacity because it is not in compliance with BWC requirements or is waiting on a pending merger or decertification,” she says. “If the employer’s selection is rejected, the employer can either make another selection or contact the MCO to discuss the matter.” •
For more information on MCO Open Enrollment, contact the Ohio Bureau of Workers’ Compensation at (800) 644-6292 or visit www.bwc.ohio.gov
| WANT TO SELECT A NEW MCO? |
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Employers who decide to select a new MCO can complete the MCO Selection Form found at www.bwc.ohio.gov/employer/forms/MCOSelection or in the MCO Selection Guide. An online form is available, or you can download a blank form and mail or fax it to the Ohio Bureau of Workers’ Compensation. The mailing address is: Ohio Bureau of Workers’ Compensation Policy Processing 30 W. Spring St., 22nd floor, Columbus, OH 43215-2256 The fax number is (614) 719-5313. The effective date of the change is June 30. |
HOW TRANSITIONAL WORK PROGRAMS
CAN BENEFIT YOUR COMPANY
When an employee is out of work because of an illness or injury, there are both direct and indirect costs to your company. These include lost time, decreased production, hiring, training, overtime, workers’ compensation and disability, says Tina Elliott, manager of the medical services division at the Ohio Bureau of Workers’ Compensation.
Illnesses and injuries also affect the employee in terms of lost training, wages, relationships and time spent integrating back into the workforce.
To minimize these losses, the Ohio BWC encourages companies to adopt transitional work programs that allow injured employees to voluntarily return to work as soon as safely possible before the worker is 100 percent recovered. These employees are given job-related tasks to accommodate medical restrictions until they can return to their original duties.
“The most important goal is to promote the employee’s recovery and return to work,” Elliott says. “But the transitional work program also is intended to reduce costs associated with work-related injuries and illnesses by decreasing the lost time of the injured worker.”
Besides these cost reductions, by implementing a transitional work program, employers can potentially reduce their workers’ compensation premiums because they will be reducing both their payments of lost-time compensation and the medical costs on claims.
These factors will have a positive impact on the employer’s premiums and experience rating, possibly qualifying the employer for group programs where it may realize additional premium savings.
There are five components to a transitional work plan:
1. Corporate/company analysis: An on-site review of your company’s demographics, accident-reporting process and return-to-work policy and identification of any barriers by the Ohio BWC’s staff, your MCO and a third-party administrator.
2. Employer/employee relations: An assessment of the union/nonunion relationships with management and creation of a joint labor-management team.
3. Written operational guidelines: An identification of community resources that will channel injured workers to their area medical providers and provide quality, comprehensive medical care tailored to industrial injuries. It also includes training to inform workers and supervisors of stay-at-work and early return-to-work processes.
4. Job analysis: You must accurately describe your workers’ jobs using worker input, observation and measurements. This document also provides guidelines to identify appropriate tasks that a worker can perform based on his or her capabilities.
5. Program evaluation: A policy for your company to review the plan on a regular basis.
Besides the internal benefits, your company may also be able to receive Ohio BWC discounts for implementing or continuing a transitional work program. Employers who received a BWC transitional work program between 2001 and 2006 or those that have a program they created may have their program reviewed by the bureau.
An employer with an approved program is then eligible to apply for the Destination: Excellence Transitional Work Bonus program.
Elliott says this program provides a back-end bonus of up to 10 percent of the employer’s pure premium based on successful use of transitional work in eligible claims with dates of injury within the program year.
The Ohio BWC has awarded 185 stated-funded employers a Destination: Excellence Transitional Work Grant program to assist them in developing and paying their customized transitional work plan. In the first bonus period, which began in July 2012, 330 employers earned a total of $3.09 million in bonus rebates and 61.8 percent of those employers received a bonus rebate of more than $5,000. •
For more information on transitional work programs, discounts and grants, contact the Ohio Bureau of Workers’ Compensation’s Transitional Work Grant Department at [email protected] or call (800) 644-6292.
WHAT DOES AN EMPLOYER NEED TO KNOW ABOUT AN MCO? |
| An MCO plays a vital role in the Ohio workers’ compensation system. When a job-related injury occurs, the MCO is responsible for the medical case management of that injury. Because it is job-related, that injury becomes a workers’ compensation claim and treatment is covered under the employer’s Bureau of Workers’ Compensation policy. MCOs act as an agent of the BWC to ensure injured workers get the care they need, that providers are paid promptly for service and that the injured worker can return to work safely.
All Ohio employers who pay into the state fund are required to have an MCO. If they do not choose one when they receive their BWC policy, the BWC will assign an MCO to them. MCO services are included in company’s premium payment to the BWC, so the BWC pays the appropriate MCO. While all MCOs have to meet certain criteria set by the BWC, the way services are provided and the ancillary services MCOs provide can vary greatly. These differences are important to review when selecting an MCO because medical claims management can have a direct impact on the premiums an employer pays for workers’ compensation coverage. Specifically, effective utilization management to keep medical costs low, and strategies to safely return an injured employee to work quickly can keep BWC premiums lower. Therefore, it is important for the MCOs to do more than simply make sure the injured employee gets treatment. MCOs need to work with all parties to the claim to develop strategies for quicker return to work options (i.e., modified duty, transitional work or other return to work opportunities), review and negotiate treatment requests from the physician of record and look for trends that could help identify areas of concern to find possible solutions to prevent claims. Each claim is different, so employers should work with an MCO they trust will give them the personal attention to address their specific situation. • Shari Herper is senior vice president of Sheakley. For more information, visit www.sheakley.com. |
HOW IMPLEMENTING A HAZARD-AVOIDANCE
CULTURE REDUCES COSTS
One of the best ways to prevent workers’ compensation costs is to avoid accidents in the first place. Businesses spend $170 billion a year on costs associated with occupational injuries and illnesses, according to the Occupational Safety and Health Administration. OSHA, however, also reports that a business can reduce its illness and injury costs by 20 to 40 percent by implementing a safety and health culture.
And while implementing this culture may seem like a daunting task, it is really quite simple — if you have the right tools.
Evaluate dollars and sense
Setting up a safety culture in your workplace keeps employees informed and protected while on the job, says Ibraheem Al-Tarawneh, superintendent of the Division of Safety & Hygiene at the Ohio Bureau of Workers’ Compensation.
“Statistics show that for every dollar of investment a business makes in safety, the return on investment is between $1 and $3,” he says. “It is also a cost-saving module. Safety tends to improve productivity and morale and protects the most valuable asset of a workplace, which is the employees.”
And if your workplace is found to be in violation of any OSHA violations, such as improper use of respiratory protection, your company could face big fines, says Kevin Roegner, assistant vice president at Concentra, the largest provider of employer-based health care services in the United States. Roegner works in the Environmental Health and Safety Services division, which focuses on helping its clients meet OSHA regulations and prevent injuries and illnesses in the workplace.
“If OSHA believes you have a standard violation that you did not know about, it could cost less than $7,000,” he says. “However, if it is a violation you were aware of or should have been aware of, like if you have documentation of it or an employee was injured and you haven’t corrected the problem, those are willful violations and could cost tens of thousands of dollars.
“What we try to communicate to clients is a safety culture may not seem like something you need now, but eliminating those citations and the costs associated with them saves you much more than the cost of implementing such a program.”
In addition to the in-house savings, implementing a safety culture also translates to decreased workers’ compensation costs because having a strong commitment to safety and accident and injury prevention in the workplace helps companies prevent claims, Al-Tarawneh says. Preventing claims reflects positively on your company’s experience rating, which translates to decreased workers’ compensation premiums. Enhanced experienced ratings also qualify companies for other Ohio BWC programs that can provide them with additional discounts.
There are several discount programs tied to safety. The Ohio BWC’s Division of Safety & Hygiene sponsors more than 81 safety councils across the state; employers can earn a 2 percent rebate by actively participating in one of these councils. In addition, they can earn an additional 2 percent performance bonus rebate for reducing the severity or frequency of injury in their workplace by 10 percent or maintaining both at zero.
The Ohio BWC sponsors the Safety Intervention Grants program, which was expanded as part of Gov. John Kasich’s Billion Back rebate last summer. Employers can receive a 3-to-1 matching grant up to $40,000 per eligibility cycle to purchase equipment that will substantially reduce inquiries and illnesses associated with a particular task or operation. In exchange for the grant money, employers give the Ohio BWC follow up data showing whether or not the intervention did reduce risks. The Ohio BWC then shares the data with Ohio employers to learn from. The program is open to all private and public Ohio employers that pay into the State Insurance Fund. Eligibility cycles differ depending on a business’s payroll; this scale can be found at www.bwc.ohio.gov or by asking your Ohio BWC representative.
Create a plan
Al-Tarawneh says implementing a safety culture is simple. First, companies should make safety part of the company’s mission. There then needs to be a commitment by the leadership of the company.
These leaders should show an example by adhering to the specific company’s safety policies — for example, wearing protective eyewear when applicable or conducting regular training sessions.
These policies should be available to all workers and communicated regularly. Depending on your company, you may also have certain OSHA regulations. For example, if your company uses certain chemicals, you will need to have a hazardous item identification process in place.
To determine other safety policies, your company can conduct safety audits on a frequent basis.
“Depending on your company, if you have the experience, you can conduct this audit in-house,” Al-Tarawneh says. “However, you can also use an outside private consulting firm that will be able to provide you with the expertise you need. And any employer in Ohio can use our services, which are generally provided for free, as well.”
Roegner says one of the most overlooked parts of setting up a safety culture is lack of enforcement. While one part of enforcement is the responsibility of leadership (and will be part of your company’s leadership commitment), the other part is the responsibility of the employees.
“You might have a great policy and training but no consequences for those who don’t abide by those,” he says. “Having those consequences, like getting written up, drives a safety program tremendously.”
To foster employee accountability, get employees involved in the development and implementation of safety policies. Ask for employee feedback on what policies they would like to see, form a safety committee that will implement the policies and encourage employees to hold one another accountable. Some of the best ideas for solving and mitigating hazards come from the employees who are exposed to them daily. Enforcing a safety culture also translates to instilling behaviors in employees that encourage safe practices.
“Changing behaviors is not easy,” Al-Tarawneh says. “People are always occupied with getting the work done. We sometimes overlook the fact that the U.S. worker is the most productive worker in the world. But sometimes that means finding ways to get things done quicker, sacrificing safety.”
To change these unsafe behaviors, stress the importance of safety over speed and provide thorough training for each job duty. Over time, these safety measures will become part of your employees’ thinking process as they perform work tasks and enforcement will become less of a problem.
Your company can also consider an incentive or recognition program to reward employees who practice safe behavior. Employees observed practicing safe behaviors could receive verbal recognition at a company meeting or a reward such as a certificate or a gift card.
“An incentive or recognition program promotes the safety culture throughout the organization and reinforces the behavior,” Roegner says.
Find help
Concentra offers OSHA compliance assistance and safety audits to both its clients and other interested companies. It also offers safety training through on-site and online classes.
In addition, the Ohio BWC offers several services to help employers implement safety cultures and create safety policies in their workplaces. It provides more than 80 different safety classes in 11 locations around the state and also offers online classes. In addition, it has a video library of safety DVDs that employers can rent for free.
“We want business leaders to know we are here to help them,” Al-Tarawneh says. “We are their partners in safety. We invest in these aids because we believe the best thing we can do to reduce workers’ compensation costs is prevent claims from happening in the first place.” •
For more information on creating a safety culture in the workplace, visit http://1.usa.gov/1fXs6ov or call the Division of Safety & Hygiene at (800) 644-6292. You can also visit www.concentra.com or call (866) 944-6046.
OSHA VIOLATIONS RANGE FROM FALLS TO MACHINERY |
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THE 10 MOST FREQUENTLY CITED OSHA VIOLATIONS The following were the top 10 most frequently cited standards in fiscal year 2013 (Oct. 1, 2012 through Sept. 30, 2013): 1. Fall protection, construction (29 CFR 1926.501) |
DRUG-FREE SAFETY PROGRAMS PROVIDE DISCOUNTS AND PREVENT ACCIDENTS
Drug abuse in your workplace may be more prevalent than you think — 15 to 17 percent of employees in an average U.S. company are substance abusers, according to the Bureau of Labor Statistics.
That’s why the Ohio Bureau of Workers’ Compensation and organizations like Working Partners are working to make workplaces drug-free.
“A drug-free workplace program is an important safety tool to help control an employer’s workers’ compensation costs and operating costs associated with drug use such as theft, lost productivity, etc.,” says Ron Suttles, director of employer services for the Ohio BWC’s Drug-Free Safety Program. “By deterring drug and alcohol use in the workplace, an employer may prevent an accident from ever happening.”
In addition, your company can participate in the Ohio BWC’s Drug-Free Safety Program, which offers a premium discount to eligible employers that implement a drug-free workplace strategy.
The program is open to state fund employers who pay worker’s compensation into the state insurance fund, and includes private employers and public employer taxing districts. Self-insured employers may participate, but are not eligible for the program bonus.
The program offers up to a 4 or 7 percent bonus depending upon the level of program participation and compatibility with other Ohio BWC safety programs. Employers are required to submit an annual report to verify they are meeting program requirements.
Implementing a drug-free program in your workplace is simple, says Dee Mason, founder and CEO of Working Partners, which provides drug-free workplace consulting and training. While Working Partners is not directly affiliated with the Ohio BWC, it does provide technical assistance.
There are five elements of a comprehensive drug-free workplace program:
- A written substance abuse policy — This should summarize the program, include the responsibilities of employers and employees, outline prohibited conduct and consequences, explain the circumstances of testing and reference available help.
- Employee awareness and education — Employees need to be aware of the policy and its provisions.
- Supervisor training — Supervisors should learn the impact of drugs and alcohol in the workplace, how to recognize, document and confront a possible substance abuse problem, the company policy, how to refer an employee to resources/testing and how to support a recovering employee.
- An employee assistance plan of action — Employers need to identify a plan of action and resources for employees who seek their own help, are referred by management for a possible alcohol/drug problem or have a positive alcohol/drug test.
- Drug and alcohol testing (as appropriate) — Your company must decide when it will test, who will be tested, what drugs will be tested for, what the appropriate cut-off levels are and what protocols and laboratory will be used.
Many businesses may think the cost to implement such a program outweighs the benefits, but that is not the case.
“The discount is intended to incent employers to do the right thing,” Suttles says. “The benefit of the program is long term and difficult at times to quantify since claim preventions benefits are nebulous but are much greater than the discount in terms of lost productivity and pilferage.”
Mason says the program this year has been expanded to include more employers. Previously, some employers were unable to receive an Ohio BWC Drug-Free Safety Program discount if they were already receiving other discounts, but now they can.
For example, state-funded group-rated employers were previously unable to receive the discount but now qualify. •
To learn more about the Ohio BWC Drug-Free Safety Program and how to implement a program at your workplace, visit http://bit.ly/aw8xeb or call (800) 644-6292. To learn more about Working Partners, visit www.workingpartners.com or call (614) 337-8200.
WHAT DOES AN EMPLOYER NEED TO KNOW ABOUT AN MCO? |
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The winning message in Ohio’s workers’ compensation is savings — discounts, rebates and more. To have as many favorable options as possible, employers must choose trusted partners to help them secure savings, and the MCO is a crucial part of that equation. MCOs are evaluated primarily on achieving return-to-work in claims. An employer’s number of “lost days” is a powerful cost-driver, impacting rating options and premiums for the long term. Selecting an MCO that excels in achieving return-to-work for injured workers and minimizing this exposure is a must for an employer that is focused on maintaining competitive workers’ compensation costs. Depth of resources should also be considered. Our workers’ compensation system has many moving parts, and an MCO can help employers on several fronts. Medical management and return-to-work are the fundamental objectives of an MCO, but there is a larger context of employee health care resources, HR policies concerning injury reporting, OSHA and PERRP compliance, medical provider networking and general infrastructure for handling a workplace injury. A well-equipped MCO can help an employer address these areas. Often, the most important work an MCO does for an employer takes place before there is an injury — facilitating a sound post-injury management practice is an enormous value. •
Quinn Guist is president of CompManagement Health Systems Inc. For more information, visit www.chsmco.com. |
