March 23, 1998 MCOs cut injury reporting time in half (Article as it appeared in Crain's Cleveland Business)

By Tom Ford Crain's Cleveland Business

Workplace injuries are being reported to the state twice as quickly as they were before it turned over the handling of injury claims to managed care organizations last spring.

The Ohio Bureau of Workers' Compensation says the time between a workplace injury and the bureau's receipt of the critical first report about that injury had been reduced to an average of 20 days as of last December from 39 days before March 1, 1997, when managed care organizations began handling workers' comp claims. Officials cite the sharp reduction in reporting time as proof that revisions to the managed care system are working.

``We are still not where we want to be," said Jim Samuel, director of communications for the bureau. "But when you think that in 1995 the average time between an injury and it being reported to us was 60 days, there is a great deal of improvement. Ideally, we would like to know about the injury the day it happens, but that will probably never happen."

Today, March 23, the bureau will issue its first "report card" for the 52 managed care organizations, or MCOs, in the state that have handled injured workers' claims since last March. At the same time, it will allow employers unhappy with their current MCO to switch to another company.

Mr. Samuel said the bureau rated MCOs on how quickly they report injuries and return injured workers to their jobs. It also determined how satisfied both employers and employees were with the service an MCO provided.

The ratings are crucial in the bureau's calculation of bonus pay each MCO can receive for handling workers' compensation cases efficiently. Top-performing MCOs can boost their revenues from 3% to 6% of the total dollar value of the premiums paid by the companies whose claims they handle.

Mr. Samuel said these initial "customer service ratings" will be critical to MCOs that want to grab a larger share of the $60 million MCO market. Employers will be able to switch MCOs April 1 through May 29.

Overall, employers' satisfaction with how their workers' compensation cases were handled by the MCOs averaged 4.03 on a 1 to 5 scale, with 5 being the highest level of satisfaction.

Injured workers were somewhat less impressed with the service they received from the managed care groups, though their marks remained better than average. Worker satisfaction rated 3.83 on the same 1 to 5 scale.

William Pfeiffer, president and chief executive officer of Dublin, Ohio-based CareWorks, the largest workers' compensation MCO in the state, said his organization's average claims filing time was 19.6 days, slightly under the state average. He said the focus of CareWorks' first year of operations has been on more than reducing reporting time.

``There is no doubt now that the managed care system works and works better than the old system," Mr. Pfeiffer said. "This first year we have achieved some good reductions, but it really has been about educating everyone -- employers, workers and the care industry. We've created a new culture."

Mr. Pfeiffer said he expects MCOs to improve reporting times and cut costs even more now that all parties are more comfortable with the system.

``This is the first time it has been tried on this scale," he said. "We have had interest expressed from officials as far away as British Columbia. Everyone has more or less the same problem."

William Martz, president of Managed Health Care Services Inc./NaviSource, a Cleveland-based MCO, said his organization's average time for filing the first report of injury was about 17 days. The reduction of time is of benefit to both the worker and the employer.

``We feel that our workers' compensation MCO will be profitable in the first year," Mr. Martz said. "With the electronic filing system and the training and education we've been doing for workers and employers in the first year, we should be able to reduce the reporting time and the time a worker spends off the job even more."