September 21, 2001 CareWorks MCO secures important accreditation (Article as it appeared in the September 21, 2001 issue of Business First of Columbus)

That Dublin-based CareWorks recently met national accreditation standards for managed care organization (MCO) doesn’t surprise its chief executive, William Pfeiffer.

"We’ve been successful from day one by focusing every entity on customer service and exceeding customer expectations," he said. "We’re in a service industry and are all about providing service for people."

CareWorks has been granted a two-year accreditation for case management from the American Accreditation HealthCare Commission/ Utilization Review Accreditation Commission (URAC). The company is one of the first workers’ compensation MCOs in Ohio to earn the accreditation, Pfeiffer said.

"It shows we are raising the bar and our quality is improving," he said.

All of the state’s 35 MCOs must meet URAC case management accrediting standards by Dec. 31, 2002, said Jim Samuel, spokesman for the Ohio Bureau of Workers’ Compensation.

"As we continue to improve our system, we want to up the qualifications for our MCOs," he said. "URAC is one of the organizations that has the high standards we want to see."

Based in Washington, D.C., URAC offers 12 accreditation programs for the managed care industry. The nonprofit group’s membership includes employers, consumers, care providers, government regulators, and MCO and workers’ comp professionals.

Since 1997, the state has outsourced medical case management for injured workers to private-sector MCOs like CareWorks. MCOs report new injuries to the workers’ comp bureau, medically manage the injuries with doctors and care providers, process medical bills and educate employers on new developments in managed care.

Samuel said the bureau’s Health Partnership Program (HPP), which includes the MCOs, has become a national model for lowering workers’ comp costs and improving services for injured workers.

Workers’ comp premium rates paid by Ohio employers have fallen more than 40 percent since 1995, he said. At the same time, HPP is credited with reducing delays in care for injured workers by more than 70 percent and improving customer service satisfaction rates among them and their employers.

Tough Standards

MCOs are measured against 33 URAC standards during the case management accreditation process, said Lori Yetter, CareWorks’ vice president of quality assurance. They include staff qualifications, ethics standards, information systems and case management policies and procedures.

"We’re always focused on continuing process improvement," she said. "We always want to be the best at what we do as an MCO – get the person back to work and recovered from a work injury."

Since it was founded in 1996, CareWorks has become one of the largest players among Ohio workers’ comp MCOs. It provides medical management for more than 52,000 employers in Ohio and four other states and manages $542 million in workers’ comp premiums annually.

The privately held company is owned by a group of investors headed by two Dublin firms, Compensation Consultants and Frank Gates Cos. It has 600 employees.

CareWorks has come a long way since Pfeiffer and a handful of employees launched the firm. After the state’s first managed care organization open enrollment in 1997, CareWorks had 32,000 employers under its medical management wing.

"It was like a whole new industry was created overnight," said Pfeiffer, an attorney who was acting director of the Bureau of Workers’ Compensation in 1995.

Growing Business

CareWorks’ customer list now includes Ohio State and Ohio Universities, Ohio Department of Transportation, Akron City Schools, Cheryl’s Cookies and the cities of Columbus, Westerville and Akron.

Pfeiffer said CareWorks’ growth has been aided by its partnership with Cleveland-based Medical Mutual of Ohio and access to that insurer’s large network of care providers allowing it to offer aggressive fee schedule discounts to employers.

"It’s all based on service," Pfeiffer said. "People want to work with us because they like what we do on the workers’ comp side. There is energy here. We want to keep the entrepreneurial spirit alive."