Open Enrollment for Managed Care Organizations in Ohio started today and we’ve already received a few calls with questions. Understandably, it’s a confusing time with a lot of information coming from many different sources. The window for an employer to change their MCO provider lasts 30 days and comes around only once every two years. The next opportunity to change will be in 2020. All employers – even those comfortable with their current MCO - should take this time to evaluate their workers’ compensation program and the costs associated with injured workers over the last two years.
The MCO is a critical partner and plays an important role in ensuring quality care for the injured worker and controlling the bottom line for employers. Workers’ compensation costs can be expensive. For that reason, evaluating the MCO’s performance is crucial to the financial stability of the company.
What Does an MCO Do?
In Ohio, all public and private employers in the state fund workers’ compensation system are required to have an MCO. The services of the MCO are paid for through the employer’s workers’ compensation premium so the decision to use one MCO over another should be based on performance rather than cost.
All MCOs are tasked with the medical management of the workers’ compensation claim. The team will focus on the injured worker’s well being, ensure quality medical care and return the injured worker to duty as soon as safely possible. While all MCOs have the same basic function, some perform much better than others.
While reviewing the claims for the last two years, the biggest question to ask is if the claims history looks better now than it did two years ago? Is the premium and experience modifier moving in the right direction (decreasing)? Has the current MCO been responsive? Take a look at the most difficult claim and ask if the MCO explored all options to move that injured worker’s recovery forward or was the handling of the claim frustrating and disappointing? If so, there may be a better provider.
Size Doesn’t Matter
During open enrollment, employers can expect to receive information from many sources. It’s important to understand the motivation of each endorsement, metric and marketing piece received. Remember: Bigger doesn’t always mean better and smaller doesn’t mean more responsive. What does matter is the MCO’s performance.
Marketing material may contain many metrics and statistical information. It’s important to read the fine print and establish if the information is current. Any date listed before 2018 or without current information should be immediately discarded. The BWC also provides the most up to date information on many benchmarks on the MCO Report Card.
Know What’s Important
Return To Work: Lost time claims have a significant impact on an employer’s workers’ compensation premium. Having an MCO that consistently performs well in returning an injured worker to the job should be an employer’s number one priority. Return To Work is one of the metrics listed on the MCO Report Card. On the MCO Report Card, the higher the number for Return To Work, the better the performance.
Medical Provider Networks – An MCO can also have substantial influence on the medical costs by utilizing a medical provider network with rates negotiated lower than the current BWC fee schedule. Lower costs mean less impact on the employer’s experience and, in turn, controlled premium dollars.
Drug Utilization Review (DUR) - Lastly, choose an MCO that makes DUR a standard piece of the claims management protocol. The DUR reviews the claim for inappropriate medications or excessive use. This process ensures the health and safety of the employee and workforce and, also, controls the cost of claims.
Who Can You Turn To for Help?
If, after evaluating the current provider, an employer decides to explore other options, there are many resources to help find a few MCOs to interview. Employers should always interview at least two candidates. First, start with your Third Party Administrator. The TPA knows the employer’s claims history and management style and will be a good resource for the employer. Reminder: Some TPAs and MCOs share a parent company. When such a relationship exists, it’s best to request two additional MCOs and interview all three. While this process may take a little more time, it’s best to ensure the decision is a proper fit for the company and not because of the TPAs responsibility to their parent company.
Chambers of commerce and business associations often endorse an MCO during open enrollment. Before following the recommendation in blind trust, ask questions. Why did the Chamber/Association choose the particular MCO? When was the MCO last evaluated and what information was the decision based upon? It’s a good idea to get multiple recommendations and interview two to three prospects.
And, don’t forget the best resource of all: other employers. Employers will be able to provide personal experience and can help to understand the claims management style of the MCO.
Lastly, First Connect has been helping employers choose Managed Care Organizations and Third Party Administrators for over 14 years. Our staff is an unbiased resource in that we aren’t paid by any MCO or TPA. We work only for employers.
Open Enrollment ends on Friday, May 25th and all enrollment forms must be received by the BWC before 5:30 pm. Enrollment can be completed online or by printing off an enrollment form and faxing it to the BWC. Forms can be found on the BWC website: Enrollment Forms
For more information or assistance in choosing an MCO that is right for your company, please call our offices.