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Health Care Network Report Cards
Requirements in Other State Workers' Compensation Systems Amy Lee Research and Oversight Council on Workers' Compensation August 2002 Acknowledgements The Research and Oversight Council on Workers' Compensation (ROC) would like to thank the state administrators who participated in the survey. Their insights into the day-to-day operations of the managed care organizations in their states were an invaluable source of information. We would also like to thank the Workers Compensation Research Institute (WCRI) for providing valuable background information on state workers' compensation managed care structures.
This report was made possible by the collaborative efforts of several ROC staff members. Amy Lee drafted the report and served as project manager. Dana Baroni collected the various multi-state survey findings and provided valuable direction and support. D.C. Campbell, Jon Schnautz and Joseph Shields reviewed the final draft and provided many useful comments. Diana San Miguel and Jerry Hagins helped collect information on states that have HMO report cards. Jerry Hagins also edited and formatted the final document. Material produced by the Research and Oversight Council on Workers' Compensation may be copied, reproduced, or republished with proper acknowledgment.
9800 North Lamar Blvd. · Suite 260 · Austin, Texas 78753 (512) 469-7811 · Fax: (512) 469-7481 · E-mail: info@roc.state.tx.us Internet: http://www.tdi.state.tx.us CONTENTS
Introduction ............................................................................................................... 1
Section I:
Section II:
Lessons Learned from Other State Workers' Compensation
Conclusion .............................................................................................................. 18 List of Tables Table 1 States with HMO or PPO Report Cards .................................................................... 6
Table 2 Description of URAC Workers' Compensation Performance Measures ...................... 7
Table 3 Workers' Compensation Managed Care Arrangements in Other States .................... 10
Table 4 Types of MCO Performance Information Collected by State Workers' Introduction
In response to concerns from Texas workers' compensation system stakeholders about the rising costs of medical care provided to injured workers in the state, the 76 th Legislature in 1999 passed House Bill (HB) 3697, which directed the Research and Oversight Council on Workers' Compensation (ROC) to conduct a series of studies to examine medical cost and quality issues. Specifically, these studies were designed to compare the amount and cost of medical care, return-to-work outcomes, functional outcomes (i.e., whether the worker physically recovered from the injury), and patient satisfaction outcomes for injured workers in Texas with those in other state workers' compensation systems and other health care delivery systems in Texas . 1 These study results, along with findings from Workers Compensation Research Institute (WCRI) and the National Council on Compensation Insurance (NCCI) studies, confirmed that Texas' medical costs were higher than those in other state systems and other health care delivery systems, but that these high costs did not result in better return-to-work, functional or patient satisfaction outcomes for injured workers in Texas . 2 Results from these research studies, compounded by increasing pressure from system stakeholders about rising medical costs, led to the passage of HB 2600 (77 th Texas Legislature, 2001), an omnibus workers' compensation bill that resulted in the most significant legislative reforms since the system overhaul in 1989 . 3 One important and much-debated component of HB 2600 was Article 2, which introduced an alternative health care delivery model for the Texas workers' compensation system, namely regional, fee-for-service, health care delivery networks administered by the Texas Workers' Compensation Commission (TWCC) on behalf of a Governor-appointed Health Care Network Advisory Committee (HNAC) . 4 When constructing Article 2 of HB 2600, policymakers envisioned a health care delivery network that would address the deficiencies identified in the HB 3697 research studies, specifically the overutilization of physical medicine services, diagnostic testing, and surgery; poor return-to-work outcomes and communication among doctors, workers, and employers; and dissatisfaction on the part of injured workers with their access to quality health care. In order to successfully pilot this network model, policymakers called for it to be initiated on a regional basis. Furthermore it was stipulated that a feasibility study be conducted to determine whether the statutory structure of these proposed networks (i.e., state-run rather than state-certified networks, participation voluntary for both insurance carriers and injured workers) would meet the goals of higher quality medical care while reducing overall costs. The HNAC initiated this feasibility study in June 2002 and plans to complete it prior to the beginning of the 78 th Legislative session in January 2003. As part of the feasibility determination, HB 2600 requires the HNAC, along with the ROC, to develop the evaluation standards and specifications necessary to implement a regional network report card. At a minimum, this report card must include a "risk adjusted" evaluation of : 5
1) employee access to care; 2) coordination of care and return to work; 3) communication among system participants; 4) return-to-work outcomes; 5) health-related outcomes; 6) employee, health care provider, employer, and insurance carrier satisfaction; 7) disability and re-injury prevention; 8) appropriate clinical care; 9) health care costs; 10) utilization of health care; and 11) statistical outcomes of medical dispute resolution provided by independent review organizations. The statute also requires that a report card be provided to injured workers during the enrollment process for the regional networks, so they can make an informed decision as to whether they should participate in the network . 6 Although the format, frequency, data collection and distribution methods of the report card have not yet been determined by the HNAC, three potential types of report cards have been identified and proposed by the feasibility consultant: 1) A Network Performance Report Card (or NPRC) containing various quality of care and financial performance measures, which would allow system stakeholders, HNAC members, network administrators and policymakers to evaluate and compare the performance of individual networks. 2) An Injured Worker and Employer Report Card (or IWERC) , which would be a pared down version of the NPRC geared toward helping employees make decisions about network participation. 3) A Network Effectiveness Report Card (or NERC) , which would allow system stakeholders, HNAC members and policymakers to compare the cost and quality of medical care provided to injured workers who participate in the regional networks with that provided to injured workers who receive medical care outside of the regional networks (i.e., the current workers' compensation health care delivery system in Texas).
Proposed report card elements and data collection methods for each of these report cards are currently being developed by HNAC's feasibility consultant and ROC staff, and will be available for review by various stakeholder groups and existing health care delivery networks in late August or early September 2002.
Purpose of this Report
This report is the second of a two-part series designed to assist the HNAC and its consultant in gathering important information for the network feasibility study. Specifically, this report presents a brief summary of health care report card standards in other state workers' compensation systems and other health care delivery systems in an effort to assist the HNAC and its consultant to formulate report card recommendations as required by HB 2600. For more information about the network standards, certification requirements, and data reporting requirements used in other state workers' compensation managed care networks, see the first ROC report in this series, entitled An Analysis of Managed Care Network Standards in Other State Workers' Compensation Systems . Section I of this report discusses the use of report cards in other health care delivery systems, while Section II presents information about the use of report cards or other performance benchmarking initiatives used in other state workers' compensation systems. Section I: Use of Report Cards in Other Health Care Delivery Systems It has generally only been since the emergence of managed care arrangements that such factors as access to care and quality of care have begun to be systematically measured. . Many of these monitoring efforts began at the federal level to measure the quality of care being provided to Medicare and Medicaid patients during the early- to mid-1990s (primarily by organizations such as the Agency for Healthcare Research and Quality - also called the AHRQ - and the federal Centers for Medicare and Medicaid Services - formerly the Health Care Financing Administration or HCFA). 7 As managed care became more prevalent in the group health arena - either through Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs) - many states began to develop informational materials (i.e., "e;report cards") to help consumers make valid comparisons between available health plans. Currently nineteen states (including Texas) have HMO or PPO report cards aimed at providing health care consumers with objective and easily-understood information about the performance of participating HMO or PPO health care plans (see Table 1). Most of these state HMO report cards are based on the HEDIS® standardized data measures (developed and maintained by the National Committee for Quality Assurance, or NCQA) and CAHPS® survey results (developed and maintained by the AHRQ). 8 The majority of the states that produce HMO or PPO report cards, including Texas, require HMOs or PPOs to report these data measures to the state regulatory agency, which then compiles it and publishes the report card results on the Internet. The data reported by these HMO or PPO plans are subject to independent validation paid for by the HMO or PPO. Even with the widespread use of standardized quality of care measures, HMO and PPO rating systems vary considerably among states. Table 1 States with HMO or PPO Report Cards
Source: Research and Oversight Council on Workers' Compensation, Survey of State HMO and PPO Report Cards , 2002. In response to growing health care quality concerns from consumers and policymakers, several national non-profit organizations such as the NCQA, the American Accreditation Health Care Commission (also known as the Utilization Review Advisory Committee, or URAC), and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have created health care report cards or benchmarking initiatives to systematically measure access to care, patient satisfaction, and best practices . 9 Many of these organizations require - or strongly suggest - that participating health care plans adhere to their benchmarking initiatives as part of the accreditation process. All of these benchmarking initiatives were developed for use in the Medicare, Medicaid, and commercial health care markets (rather than in workers' compensation specifically); however, URAC, with a grant from the Robert Wood Johnson Foundation , 10 recently developed performance measures for workers' compensation (see Table 2).
Table 2 Description of URAC Workers' Compensation Performance Measures
Source: URAC, 2001, and the Research and Oversight Council on Workers' Compensation, 2002.
Most report card or benchmarking initiatives in Medicare, Medicaid and the commercial group health markets compare the quality of care among different health plans by measuring the percentage of eligible patients that receive different types of preventative tests, the timing of certain diagnostic tests, and the extent of pre and post-natal care allowed by each health plan. By contrast, URAC's performance measures address workers' compensation issues, including the measurement of return-to-work outcomes, communication among system participants, case management, and prevention of re-injury. 11 Although URAC's performance measures have undergone some validation, they have not been widely tested and have not yet been implemented by any other state workers' compensation system. Section II: Use of Report Cards and/or Performance Benchmarking
According to the Workers Compensation Research Institute (WCRI), there are five general categories of state workers' compensation managed care arrangements : 12
Approximately 16 states (including Texas) currently use the "e;allowed model"e; with employee-directed choice and change of doctor making it the most prevalent type of managed care arrangement (see Table 3). If deemed feasible by the HNAC, the alternative Texas model, as outlined in Article 2 of HB 2600, represents a regulated managed care arrangement, although participation under the proposed Texas model will be optional for insurance carriers and injured workers. While HB 2600 places Texas in both the "e;allowed/employee directs doctor choice"e; category and "e;regulated/employee may opt out"e; category, Texas is unique in that it is the only state (specifically TWCC under the direction of the HNAC) that will contract with and manage the regional health care delivery networks, rather than the networks simply seeking state certification to operate (as required in other regulated managed care states).
Table 3 Workers' Compensation Managed Care Arrangements in Other States
Source: Workers Compensation Research Institute (WCRI), Managed Care and Medical Cost Containment in Workers' Compensation: A National Inventory, 2001-2002.
Although health care report cards and standardized benchmarking initiatives are prevalent in other health care delivery systems, few state workers' compensation systems currently publish similar health care plan information for injured workers. One notable example is the managed care organization (MCO) report card published by Ohio's Bureau of Workers' Compensation (BWC), which includes aspects such as degree of disability management per health plan (i.e., actual return-to-work outcomes for each MCO as compared to BWC return-to-work benchmarks) and overall employer and employee satisfaction with each health plan . 13 Examples of the survey questions BWC uses to measure employer and injured worker satisfaction include: 1) How satisfied are you with the service that you received from your MCO? 2) How satisfied are you with the medical management provided to your employees by your MCO? 3) How satisfied are you with your ability to contact your MCO when needed? 4) How satisfied are you with the quality and quantity of the educational, training, and other materials received from your MCO? 5) How satisfied are you with your MCO's effort to provide appropriate early return-to-work and rehabilitation strategies? 1) How satisfied are you with the information you have received about how BWC's managed-care plan works? 2) After you were injured, how satisfied were you with the choice of doctors available to you? 3) How satisfied are you with the service you received such as medical treatment, medication, quick response to requests, and other issues? 4) How satisfied are you with your ability to communicate with the organization that managed your claim? 5) How satisfied are you with medical bill payment? 6) Are you currently back at work? If yes , how satisfied were you with efforts to help you return to work or to receive rehabilitation services? If no , how satisfied are you with efforts under way to help you return to work or to receive rehabilitation services?
Ohio's BWC establishes minimum benchmarks for each of these general report card measures and monitors individual health plans for compliance with these minimum benchmarks. To get a better understanding of the types of information collected by state MCO programs, ROC staff conducted telephone interviews with personnel in the states identified by WCRI as having a regulated workers' compensation managed care arrangement. The workers' compensation certifying agencies in each of these states were asked to explain the types of information they collect to monitor the managed care plans they certify and to provide information on whether they produce a report card for consumers. After information was gathered via telephone, states were e-mailed or faxed a copy of their responses for verification. A total of fifteen states participated in the survey . 13 Although none of the fifteen states surveyed for this report produce an injured worker report card, many of these states collect a variety of data to monitor and evaluate the effectiveness of the MCOs they certify. (Ohio, mentioned above, is a mandated managed care state and not a regulated state, so it was not included in the survey.) Data collection mechanisms vary among states, but many states require reporting of aggregate level information either monthly, quarterly or annually by each MCO, which may then be validated by the state agency in charge of certifying workers' compensation MCOs through periodic audits. Table 4 presents a brief summary of the types of MCO performance information currently collected by state MCO programs. Table 4 Types of MCO Performance Information Collected by State Workers' Compensation Systems with Regulated Managed Care Arrangements
Source: Research and Oversight Council on Workers' Compensation, Survey of State MCO Certification Requirements , 2002. Most states collect basic information about the amount and cost of medical care as well as patient or injured worker satisfaction with the medical care received from the MCO. However, significantly fewer states collect information regarding return-to-work outcomes or injured worker physical functioning outcomes. Those states that do collect return-to-work data tend to monitor the average number of lost work days per claim. Generally, medical cost data is collected by states using various methods to determine whether the implementation of MCOs has resulted in overall cost savings. For example, Kentucky requires MCOs to provide aggregate, per-claim medical cost data and estimated network savings by ICD-9 code, while Georgia collects aggregate data on all claims and then analyzes the differences between patients receiving treatment through MCOs and from non-MCO health care providers.
Ten of the states surveyed reported that they collect patient or injured worker satisfaction data, and this data is collected in a variety of ways. Montana, Oklahoma and Florida require certified MCOs to collect and report patient satisfaction data to the state (although these three states use different methodologies for collecting the data). States such as Oregon (which conducted injured worker surveys in 1995 and 1997), New York (which conducts an injured worker survey every two years), and Georgia (which sends out an injured worker, employer, and provider survey with each reported injury requiring medical care) rely on state-sponsored injured worker survey information for reporting of patient or injured worker satisfaction outcomes. Information about access to care is generally collected through reports of MCO compliance with the state's network standards regarding the minimum numbers and types of health care providers required for each MCO network. These reports are usually submitted annually to the certifying state agency. It is important to note, however, that states vary widely on how they define data elements (such as what constitutes "e;return-to-work"e; for an injured worker), and how they collect and analyze data reported by MCOs. 14 Virtually no state uses similar measures or methods for comparing their workers' compensation MCOs with HMO or PPO plans in their own states .
Lessons Learned from Other State Workers' Compensation
Results from recent research studies suggest that introducing managed care into workers' compensation can save as much as 20 to 30 percent in total claims costs, mainly through the use of discounted fee schedules, decreased utilization of medical services, and a lower incidence and duration of income benefit claims. 15
While some state managed care arrangements have reportedly cut costs, many states that have implemented managed care have not fully examined the impact of MCO arrangements on the quality of medical care provided to injured workers. Those states that have examined quality of care issues, however, found a trade-off between cost and quality in terms of customer satisfaction. For example, Washington found that while medical costs were reduced by approximately 27 percent in its MCOs (based on an analysis from April 1995 to April 1996) , injured workers who received medical care in these MCOs were less satisfied with their care (particularly with their access to care) compared to injured workers who received medical care outside of the MCO networks. 16 Florida, New Hampshire and Oregon have also observed cost reductions as a result of the introduction of managed care (primarily due to decreases in premium rates, lost-time cases, medical authorization appeals, and income benefits), as well as lower levels of patient satisfaction. 17
Quality health care, however, is not solely defined by patient or injured worker satisfaction outcomes. To fully understand whether managed care arrangements provide quality health care to injured workers, it is important to look at medical and functional outcomes (i.e., whether the workers physically got better and went back to work in a sustainable fashion). Unfortunately, few studies have analyzed quality of care issues from this perspective. Interestingly, recent studies on the use of health care provider incentives in non-occupational managed care health plans illustrate that certain types of health care provider compensation arrangements can - but do not always - have an impact on patient satisfaction ratings. One recent study using Texas commercial health care plan data collected by the Texas Health Care Information Council found that health plans with a relatively high percentage of board-certified health care providers did not receive higher satisfaction ratings than other health plans. This study also found that "e;health plans that offered bonuses to a large percentage of their participating practitioners who meet certain goals (were) not rated any more highly than health plans that offer bonuses to a few practitioners."e; However, health plans that threatened to withhold payments from their participating practitioners when they did not meet certain goals were rated higher in patient satisfaction than other health plans. 18 Managed care pilots in other states have also yielded some important lessons that the HNAC and its feasibility consultant should consider when formulating the structure for the Texas regional health care delivery networks:
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· Specifically, they recommended identifying a control group of non-network injured workers that would be comparable to the injured workers receiving care within the MCO and tracking the experience of these control group workers for several years, reporting on their progress at different intervals in their claim history and allowing comparisons between network and non-network participation. States remarked that they had often under funded or had difficulty staffing these evaluations unless a clear evaluation design was in place (essentially a project plan) at the beginning of the network implementation.
· For example, recent changes in the Texas professional services fee guideline will likely impact the negotiated rates for medical services within the proposed regional health care delivery networks. Typically managed care networks are able to provide some type of volume discount on services provided within the network. Generally, this would mean a discount off the current fee guideline. However, if providers perceive the new fee schedule to be lower than they are willing to accept for workers' compensation patients, the networks may not be able to offer any more of a discount on the price of medical services performed within the network. The HNAC may need to consider what types of incentives would be useful to system participants (not just health care providers but workers and carriers as well) to encourage them to be part of the network.
Since most of the cost savings enjoyed by other state workers' compensation MCO programs primarily came from a lower utilization of services and lower income benefit costs rather than discounts on fees, it is reasonable to believe that even with no volume discounts in Texas, a well-managed regional network could still produce significant cost savings. However, proposed network fees and other health care provider financial incentives need to be examined to ensure that networks are able to attract the right mix of quality health care providers who are experienced with occupational injuries and disability management.
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· Initial evaluations of the impact of managed care on claim costs or quality of care outcomes should not be relied on as the sole measure of the success or failure of MCOs. True evaluations of these MCO arrangements may take several years.
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Conclusion Concerns regarding the quality of health care by consumers and policymakers in Texas have spurred an increase in the systematic monitoring, benchmarking and reporting of health care quality and patient satisfaction information. Unfortunately, consumer-focused "e;report cards"e; do not yet exist in most workers' compensation systems, primarily because there are no widely accepted report card standards for workers' compensation MCOs. However, since HB 2600 requires the creation of report card standards for Texas MCOs and outlines the statutory minimum requirements for these report cards, the HNAC may want to examine the performance measures developed by URAC (which are based on the general structure of HEDIS® and the CAHPS® survey) as a starting point. The HNAC and its feasibility consultant should also confer with members of the Texas Health Care Information Council and the Office of Public Insurance Counsel to examine whether it may be possible to use some of the same measures, data collections requirements, report formats and/or dissemination methods as the Texas HMO report card for the proposed workers' compensation network - since the comparisons between the quality of health care for injured workers in certain health care plans and the quality of care in Texas HMOs may be of some interest to both consumers and policymakers. The HNAC and its feasibility consultant will also want to discuss with TWCC how a workers' compensation report card will be published and ultimately distributed to injured workers. Although the statute specifically prescribes the minimum standards for a network report card, it is likely that it will take years for the data collection requirements for all of these measures to be completely implemented by regional MCOs, due to the complicated nature of building these data collection systems and the analysis capability needed to translate the data into meaningful reports. Therefore, the HNAC and its feasibility consultant may want to consider prioritizing these measures (or aspects of these measures) and phasing in the data reporting requirements over several years. As the first report in this series ( An Analysis of Network Standards in Other State Workers' Compensation Systems , ROC, 2002) indicated, several states are currently experiencing difficulties with MCO data reporting requirements. These states have suggested that obtaining "e;buy in"e; from the MCOs on what types of data will be captured, how it will be captured, and how often it will be captured is key to ensuring adequate data reporting compliance. These states also recommend periodic data quality checks and adequate penalties or incentives to encourage continued compliance.
Information from previous managed care pilots in other state workers' compensation systems show that the introduction of managed care arrangements resulted in significant cost savings (upwards of 20-30 percent), primarily due to reductions in unnecessary medical care and better disability management. However, patient/injured worker satisfaction ratings were lower because of perceived problems with access to care. The impact of managed care on other quality of care measures (such as medical and functional outcomes) is currently unclear and should be examined as part of any Texas network initiative. Recent research also highlights the impact that some network provider compensation agreements can have on patient satisfaction. Considering that patient satisfaction is generally a weak point in state workers' compensation MCO arrangements, the HNAC should take into account these and other research findings when developing network standards. Other valuable lessons learned include the importance of implementing new managed care concepts in a pilot mode rather than simply adopting a full-scale MCO arrangement across the state, and designing an evaluation component prior to the implementation of regional networks. With the adoption and ultimate implementation of the report card elements outlined in HB 2600 (using the three different types of proposed report cards mentioned earlier in this report), Texas has a unique opportunity to help establish quality of care outcome measures that will not only allow injured workers to make informed choices about their health plans and their health care providers, but also allow policymakers and system administrators to compare the quality and efficiency of health care received by workers in and outside of regional networks.
1 See Research and Oversight Council on Workers' Compensation (ROC), Striking the Balance: An Analysis of the Cost and Quality of Medical Care in the Texas Workers' Compensation System , 2001; Returning to Work: An Examination of Existing Disability Duration Guidelines and Their Application to the Texas Workers' Compensation System , 2001; and Recommendations for Improvements in Texas Workers' Compensation Safety and Return-to-Work Programs , 2001. Summaries and ordering information are available at pubform.htm. 2 See National Council on Compensation Insurance, Annual Statistical Bulletin, 1999 & 2000; Fox, Sharon, et al, Benchmarking the Performance of Workers' Compensation Systems: Compscope Multistate Comparisons , Workers Compensation Research Institute, July 2000; and Gotz, Glenn A., et al, Area Variations in Texas: Benefit Payments and Claim Expenses , Workers Compensation Research Institute, May 2000. 3 For a detailed description of all of the various components of HB 2600, see the special legislative edition of the ROC's Texas Monitor , vol. 6, no. 2, Summer 2001, available on the ROC's website at txmon6-2.htm. 4 See Section 408.0221 (c), Texas Labor Code . The HNAC consists of three voting members representing labor, three voting members representing employers, three non-voting health care provider representatives, three non-voting insurance carrier representatives, an actuary, and TWCC's Medical Advisor, who also serves as the committee chair. 5 Although many researchers include risk adjustments such as the type or severity of injury when comparing medical outcomes for different populations of injured workers, the statute did not specify the type of risk adjustment methodology that should be used. Determining the appropriate risk adjustment factors to use is part of HNAC's statutory scope and mission. See Section 408.0221 (h), Texas Labor Code . 6 Section 408.0221 (h), Texas Labor Code requires the Texas Workers' Compensation Commission (TWCC) to distribute these report cards to the public. Section 408.0222 (g), Texas Labor Code requires participating insurance carriers to distribute basic information about these regional networks (including a list of network providers and a copy of the most recent network report card) to its policyholders. In addition, employers are required to share this information with their employees during the network enrollment process. 7 For more information about the monitoring efforts and benchmarking initiatives maintained by the AHRQ, see www.ahrq.org. 8 For a copy of the HEDIS® data reporting requirements for Texas HMOs and a copy of the Texas Healthcare Information Council's rules governing these requirements see http://www.thcic.state.tx.us . 9 For more information about these organizations or their accreditation process, see Research and Oversight Council on Workers' Compensation, An Analysis of Managed Care Network Standards in Other Workers' Compensation Systems , 2002 or visit these organizations on the internet at PRIVATE HREF="http://www.ncqa.org;/" MACROBUTTON HtmlResAnchor www.ncqa.org; PRIVATE HREF="http://www.urac.org;/" MACROBUTTON HtmlResAnchor www.urac.org; PRIVATE HREF="http://www.jcaho.org/" MACROBUTTON HtmlResAnchor www.jcaho.org 10 The Robert Wood Johnson Foundation is a non-profit philanthropic organization devoted to improving the health and health care of Americans through various research grants and sponsored research studies. For more information, see http://www.rwjf.org. 11 URAC also has two separate accreditation programs specifically designed for workers' compensation programs including a network accreditation program and a utilization management accreditation program. 12 See Workers Compensation Research Institute, Managed Care and Medical Cost Containment in Workers' Compensation: A National Inventory, 2001-2002 . 13 For more information, see http://www.ohiobwc.com/downloads/blankpdf/2Kreport.pdf. 13 Although New York's managed care pilot program was not renewed, the state does have a PPO program that requires a similar certification process, and was therefore included in the survey. 14 For example, Ohio defines a worker as having returned to work if the worker has been back to work for at least 90 days, while other states define a worker as having returned to work if the worker ever went back to work for any amount of time after the injury. 15 One recent study by the Workers Compensation Research Institute (WCRI) found that restricting care to designated networks of medical providers can decrease medical costs by 15 to 40 percent. See W. G. Johnson, M. L. Baldwin, and S. C. Marcus, The Impact of Workers' Compensation Networks on Medical Costs and Disability Payments , Cambridge, Mass.: Workers Compensation Research Institute, 1999. 16 Approximately 11 percent fewer injured workers who received medical care within MCO arrangements reported that they were satisfied with their care compared to workers who received care outside of MCOs. See K.B. Kyes, T.M. Wickizer, G. Franklin, et al. "e;Evaluation of the Washington State Workers' Compensation Managed Care Pilot Program I: Medical Outcomes and Patient Satisfaction,"e; Medical Care , 1999, 37, 972-981; A. Cheadle, T.M. Wickizer, Gr. Franklin, et al. "e;Evaluation of the Washington State Workers' Compensation Managed Care Pilot Program II: Medical and Disability Costs."e; Medical Care , 1999, 37, 982-993. 17 See A. E. Dembe. "e;Evaluating the Impact of Managed Health Care in Workers' Compensation,"e; Managed Care , Philadelphia: Hanley & Belfus, 1998, pp. 799-821. 18 Scoggins, J.F. "e;The Effect of Practitioner Compensation on HMO Consumer Satisfaction."e; Managed Care , Philadelphia: Hanley & Belfus, 2002, pp. 49-52. Any suggestions or questions? Please send an email to us at: |
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