For Ohio employers, the phrase "workers' compensation insurance" is something you pencil in at the end of your "to d' list. Add insider terms such as "the BWC open enrollment period for MCOs under the HPP," and the reaction may understandably be: "Do I have to pay attention to this?"

Now think of being the one who reports to the boss or the board that you just saved your company thousands of dollars. Does that widen your attention span?

This May, for less than the entire month, employers in the state will have the chance to change their managed care organizations (MCO), the entities that handle the medical management and bill-paying chores on their workers compensation claims.

Every employer is required by the Ohio Bureau of Workers Compensation (that's the BWC) to be enrolled with an MCO. This is law, under what's called the Health Partnership Program (HPP). When an employer doesn't choose one, the BWC chooses one for them. The service MCOs provide is paid for by the BWC, partly through employers' premium payments. In May, employers will get their opportunity to choose a new MCO for themselves. 

But the opportunity is fleeting. MCO open enrollment periods come around only once every two years, for one month at a time"”but employers would be wise to take advantage of the short window of time while they can, according to experts.

"It's an opportunity that is periodic in nature, (but worth investigating) for the benefit of both the bottom line and the employees," remarks Jeremy Jackson, chief of marketing for the BWC.

The reason for the short window"”also the only time during which employers can be blitzed by marketing pitches from MCOs"”is that it gives MCOs a chunk of time between enrollment periods to prove themselves, Jackson explains.

"The way we structure open enrollment gives a certain level of continuity to the MCOs and employers," Jackson says. "By only having a small window (for changing MCOs) every two years, it gives a chance for relationships to develop (between MCOs and employers)."

Employers do change MCOs, but not in droves. In the last open enrollment, 19,000 of the state's 270,000 employers made MCO switches, Jackson reports. Whether this reflects complacency or contentedness on the part of employers is hard to say for sure, but many experts suspect complacency is the cause.

"Most (employers) do nothing, but they should be as aggressive in finding an MCO as they are in finding health insurance," comments Cyndi Britton, vice president at Health Management Solutions, an MCO in Columbus. "They don't realize that with workers' comp, they do have control over lowering their premiums, and their MCO should be one of the biggest factors in lowering their premiums."


MCOs affect premiums because they're charged with the medical management of the claims, and the timely return to work of injured workers. The latter is one of the key measurements included in the BWC's evaluation, or report card, of MCOs. The BWC sends its report card to employers in advance of the open enrollment period as a way to objectively evaluate the performance of the state's 28 MCOs.

The report card lists all of the MCOs, their number of policies (employers) and the number of claims assigned to each.

Another component of the report card, the DoDM (degree of disability management) is a bar scale that indicates how well MCOs manage the return-to-work objective for their injured workers. The BWC measures this according to its classification of injuries and their expected recovery time frames, coupled with a consideration of the worker's occupation.

For example, a construction worker with a broken leg is expected to be off work longer than an office worker with the same injury, because of the way the injury relates to the worker's job.

The report also reflects an MC'™s efficiency in reporting injuries and submitting claims. As the report states, the sooner a claim is filed, the sooner medical treatment and benefits can begin, and the sooner the injured worker can safely return to work. The FROI component measures the first report, meaning how long it takes for the BWC to be notified of a workplace injury.

"It is the responsibility of the MCO to work in conjunction with the BWC to educate employers on the significance of prompt reporting, early notification, and proactive interventions," says Joe Mercurio, director of operations for the MCO Avatar Comp.

A related component measured in the report card is the FROI turnaround, which is the average number of days it takes the MCO to submit the claim to the BWC. From the date the MCO receives the first report of injury, the MCO must gather and validate all the required information before it can electronically file the claim with the BWC.


Why is early notification important?

"The BWC defines "The Big 3" as frequency, severity and lag time," Mercurio explains. "These are three components that have the potential to substantially impact an employers' out-of- pocket premium. In the state of Ohio, time is money."

Frequency, Mercurio adds, is the total number of claims filed against an employer's risk in a given measurement period. Severity is the total number of days lost for all claims filed against an employer's risk in a given measurement period, and lag time is the time between the date of injury and BWC receipt of the claim. It includes both the time from date of injury to MCO receipt and the MCO turnaround time (notification to BWC that the injury has occurred).

Employers' and injured workers' satisfaction with MCOs also are included in the report card. Both parties respond to survey questions by rating their satisfaction on a scale of 1 to 5, with 5 being the highest score an MCO can get.

While the report card offers a snapshot of MCO performance, and some have questioned its ability to really differentiate between MCOs, it should neither be dismissed nor taken as the only source for employers in making an MCO selection, according to those in the field.


"Employers need to look at the merit of the companies (MCOs) and really put some value on the report card," notes Martha Folchi, vice president of sales and marketing for 3-HAB, an MCO in Blue Ash. "It's their money, so they need to evaluate (the MCO options)."

Folchi recommends contacting the MCO to learn more about it and determine the likely level of service. Employers who need more hands-on attention might consider a smaller MCO that services fewer companies, she adds.

Since MCOs approve or deny care, employers might also want to ask about the MC'™s decision-makers, or case management staff. 3-HAB's case managers are physicians who can talk to the doctor assigned to the patient in determining what care to certify in the orthopedic, chiropractic and occupational therapy categories.

Britton also recommends an employer gets in touch with a potential MCO by phone for what she calls a phone test, or sneak peek at how business would be conducted if the employer were a client of the MCO.

"See how easy it is to get to a live person and get your question answered," Britton says.

Employers should also call all provided references for the MCO and ask specific questions about its service as it pertains to their industry, Britton adds. For instance, employers could ask how the MCO handles certain injuries or if they do workplace assessments.

Not all MCOs do workplace assessments, Britton notes. Workplace assessments entail a visit by a clinician who analyzes a business' most common type of injury and works with the business to help set up safety and ergonomic programming, as well as identify light duty job options for injured workers who are unable to resume their regular duties.

Employers should ask about what other return-to-work options the MCO provides in order to cut down on lost time at work, says Shari Herper, senior vice president of the Sheakley Group in Cincinnati. For instance, Sheakley partners with a transitional work therapy provider to foster a successful back-to-work transition for injured workers.


But beyond calling potential MCOs and just digesting delivered reports about them, employers can easily do more research and access more information by lesser known ways.

"Employers should be aware that there are multiple ways to evaluate an MCO aside from the annual report card," Mercurio points out, citing the BWC's weekly MCO summary report that captures a snapshot of that MC'™s performance for the previous week.

"From an employer's perspective, this would be more relevant to evaluating the current status of a MC'™s performance within the Health Partnership Program than any data captured months ago, he explains. "The weekly summary is current to-date information on a particular MCO and in several key measurements it will compare that MCOs performance to that of the statewide average of all MC'™s.

"The MCO Summary provides information on the current measurement period along with the previous four weeks," Mercurio says. "This is information that could be available to employers, if they asked."

Every MCO also has an annual yearly on-site audit by the state of Ohio, he adds. The minimum score to consider a passing grade is 85%.

"I would encourage employers to complete a public inquiry to the state of Ohio and find out how well their current MCO performed," Mercurio recommends. "The annual audit looks at administrative, financial, and case management processes and can provide some key insight into how well a MCO is performing."

Mercurio suggests other questions employers should pose to their MCOs:

Is the current MCO able to stand alone? Specifically, what aspects of their services are vendored (subcontracted) to another MCO? Who is really managing your claims?

How well did your current MCO score on its most recent URAC accreditation survey (American Accreditation HealthCare Commission) This information can be obtained by contacting the MCO directly and requesting a copy of their survey results.

The URAC survey measures the quality of case management services. URAC scores 43 core standards and 24 case management standards. Each individual core or case management standard is weighted from 1 to 5. There can be a wide variation in MCO scores based upon how that MCO handles the quality improvement and quality management standards. This is significant to an employer because it reflects their company or organization's performance relative to the highest standards of care in this particular industry.

"It would not be in an employers' best interest to consider selecting an MCO that did not achieve a minimum (URAC) compliance level of 95% or greater," Mercurio remarks.