April 8, 1998 Report card helps businesses rate workers' comp carriers (Article as it appeared in Columbus Business First)

Employers have 2 months to pick provider

By Todd McCullough Business First of Columbus Correspondent

Ohio employers are in the first month of a two-month open enrollment period during which they may pick a new managed care organization to handle workers' comp cases.

Employers have been bound to their current MCOs since the March 1997 kick-off of the Bureau of Workers' Compensation's Health Partnership Program, which was developed by the BWC, businesses, organized labor and health-care providers.

At that time, the bureau handed off medical management of injured workers to MCOs in an effort to replace bureaucracy with private-sector principles and competition.

Employers have until May 29 to switch MCOs, a decision that will be made easier thanks to a BWC-issued state report card on how well the agencies have done handling workers' comp over the past year.

James Conrad, BWC Administrator/CEO, said that during the first week of April all Ohio employers received an MCO Selection Guide containing the report card, step-by-step selection instructions and a selection form.

Conrad said the report card evaluates the performance of 53 MCOs that the BWC has authorized to handle claims through participation in the Health Partnership Program's first year. If, after evaluating its current MCO and the report card rankings, an employer wants to make a change, the BWC's instructions walk it through the process. Employers who are satisfied with their MCO do nothing.

"The report card is based on what the whole system is about: getting the injured worker into the system, getting them treated and back to work, and providing good customer service in the process," Conrad said.

Overall, MCOs fared well in the BWC's report card, which contains four components: first report of injury timing, employer satisfaction, injured worker satisfaction, and return-to-work ratio. Based on a 1-to-5 scale, the average score among all MCOs for employer satisfaction was 4.03, and the average score for injured worker satisfaction was 3.83.

The average first report of injury timing ñ the number of days between when an injury occurred and when a claim was filed with the BWC ñ was 19.8 days. The average return-to-work ratio ñ the percentage of injured workers who returned to work within 90 days ñ was 73.65 percent.

Several Central Ohio-based MCOs scored above average in the rankings. For example, CareWorks of Ohio Ltd., which handled about 52,000 workers' comp claims for the year ñ by far the most of any participating MCO ñ received an employer satisfaction rating of 4.09, and an injured worker satisfaction rating of 3.80. Its first report of injury timing was 19.6 days, and its return-to-work ratio was 74.93 percent.

Other area MCOs that received higher-than-average scores include: CompManagement Health Systems Inc., CRA Managed Care, Gates McDonald HealthPlus Inc., Health Management Solutions and Premier Managed Care Services Inc.

William W. Pfeiffer is president/CEO of CareWorks, which is the state's largest MCO with about 44,000 employer groups. He is pleased with the outcome of the BWC's report card, and expects his company's quality performance to continue.

"We're pleased with our rankings," said Pfeiffer. "But, it's going to take about three or four years to get truly meaningful data."

Pfeiffer said CareWorks, along with other MCOs, is aggressively pursuing new clients during this open enrollment period.

"Our first priority is to retain 95 percent of our client base, and our surveys show that nine out of 10 employers are satisfied with us," he said. "We feel very good about that, and if we keep them satisfied, they will bring new clients to us. To gain new business, we'll be marketing customers all over the state through direct mail, telemarketing, advertising and direct contact."

One of CareWorks' current clients who apparently won't be dropping the company is Ohio State University's Workers' Compensation office. Madeline O'Connor, director of the office, said CareWorks helps Ohio State obtain and analyze information essential to medically managing claims.

"We've been able to put more emphasis on the return-to-work and job retention (with the employee) never going off work, never having a claim to begin with," O'Connor said.

BWC's Conrad went on to say that he is proud of the first-year success of the Health Partnership Program, but admits it needs some fine tuning.

"The program is beginning to produce the results we said it would," said Conrad. "It is speeding up the claims process for the injured workers and it is improving customer service. I will be the first to point out that there are still problems we need to overcome, but we have come a long way in one year in building a better workers' compensation system for everyone."

In an effort to improve the program, Conrad is asking Ohio doctors, billing personnel, office managers and record administrators to attend a free Provider Training Seminar. The training is offered in two identical sessions on April 30 at the Aladdin Shriner's Complex from 8 to 11:30 a.m., or 1 to 4:30 p.m. To register, visit the BWC's Web site at HYPERLINK http://www.ohiobwc.com (under Medical Community Section); e-mail provider-training @ohiobwc.com; or call 800-466-6292.