Today, begins Managed Care Organization Open Enrollment. It is the period of time where state fund workers’ compensation employers have the opportunity to choose a MCO that will medically manage their claims for the next two years. With the financial health of the company on the line, it’s one of the most important decisions that an employer can make. Open Enrollment runs from May 2nd until the close of business on May 27th. Miss this window and the next opportunity to change your MCO will be in 2018. Employers happy with their current MCO do not have to do anything and will be automatically re-enrolled.
Why are MCOs important?
All MCOs are tasked with the same basic function of medically managing the recovery process when an employee is injured. The MCO assigns each employer a team whose primary goal is to ensure sound medical treatment and plans for the injured worker to return safely to duty. The medical management of the claim and return to work of the injured worker both have significant financial impact on an employer’s workers’ compensation premium.
Where to find an MCO
During the next few weeks, employers will be receiving information from many different resources. It’s important to understand the motivation behind each piece of communication and endorsement received. High premium employers can expect to receive a high volume of marketing material and direct calls from most MCOs. Third Party Administrators, business associations and many chambers of commerce often endorse a preferred MCO, as well.
Third Party Administrators are a great resource for a recommendation but should be cautiously explored. Some TPAs share a parent company with an MCO and clarifying the relationship between the two is important. If a shared parent company exists, the employer should ask for a second recommendation and meet with both before making a decision.
Business associations and chambers of commerce also endorse a preferred MCO. Employers should ask how often the association or chamber evaluates their endorsement and the information used in making that decision. Again, interviewing at least two MCOs is always a good idea.
Employers may have accountants, consultants and other business providers that can also make recommendations. Clarifying the business relationship between the MCO and the provider is important. And certainly, nothing compares to an endorsement coming from another employer, especially one in the same line of work.
Numbers Matter - Sometimes
“Bigger doesn’t always mean better and smaller doesn’t mean more responsive” is what we preach to our clients during open enrollment. So what numbers really matter? The overall size of the MCO should have no bearing on your decision, but the average number of open claims handled by the MCO team assigned to your company should. The open claims number is indicative of the attention a claim will receive. Too many claims on the team’s desk means important information could get missed and cause a claim to linger for longer than necessary.
The most important statistical information comes directly from the MCO Report Card provided directly by the BWC. The Report Card shows important information like First Report of Injury Turn Around Time and the number of claims handled by each MCO. Some clarification on two of the Report Card scores is needed:
Meeting with the prospective MCO
If you’re in the market for a new MCO, narrow your choices to two or three and schedule an in person meeting. It is never a good idea to blindly trust an endorsement, no matter how reliable the source because what works for one employer may not fit well with another. This partnership is too important of a decision to make on the golf course with friends. (and, yes, believe it or not, that happens every year!).
When meeting with the MCO:
Remember, the deadline to file your selection for a new MCO is the close of business on May 27th. Selection forms are available on the BWC website.