By Julie Bethlenfalvy
Quinn Guist has had nearly three decades of experience in the workers’ compensation industry. His first job after he graduated from The Ohio State University was with the Ohio Bureau of Workers’ Compensation, and since
then has worked for various workers’ compensation organizations, picking up the ins and outs of industry. As the current president CompManagement Health Systems (CHS), a Managed Care Organization (MCO), Guist provides answers to important work comp and MCO-related questions.
Q: Why should an employer use an MCO?
A: All 225,000 state-funded employers have an MCO. By fully utilizing and collaborating with their MCOs, employers can limit the negative impact of cost-driving injuries while returning their employees to productive and healthy lifestyles.
Q: What services, including value-added products or services, do MCOs provide that help employers? What’s their return on investment (ROI)?
A: MCOs have many responsibilities, including initial claim setup, medical case management focusing on return to work, medical bill payment and employer education.
While it’s difficult to place an exact financial figure on the ROI for MCO services, a study was conducted several years ago that estimated a net real-cost savings of $443 million over a 10-year period.
This same study also concluded that there had been significant improvements in claim filing (77 percent improvement), claim determination (61 percent improvement) and bill payment turnaround time (53 percent improvement), when compared to the workers’ comp setting prior to MCOs coming into existence.
Q: What is the most important goal for an MCO in helping a company and its injured employee?
A: Achieving return to work for injured workers. An MCO will work with the injured worker, employer and medical provider to coordinate effective medical treatment to expedite the injured worker’s safe return to work.
Q: MCOs employ registered health care professionals, how does this benefit employers?
A: All MCOs employ health care professionals to deliver the contracted services required by the BWC; however, MCOs utilize different mixes of health care professionals within their operations. At CHS, our medical management model drives high-quality, efficient care for injured employees and removes barriers to recovery. Our clinical team routinely contacts physicians to negotiate more reasonably related treatments to enhance recovery and reduce delays. Our full-time, on-site medical director provides insight on clinical matters and assists with complex cases. Our team’s interaction with physicians ensures they have a greater awareness of each employer’s return-to-work capabilities and keeps them focused on the recovery process.
Q: What differentiates one MCO from another?
A: Every employer must evaluate their MCO in terms of confidence in the MCOs ability to engineer return to work for injured workers. The financial stake employers have in their MCO is mainly found in moving claims to a cost-effective resolution. This truly depends on the MCO, as strengths vary. The strength of CHS is our investment in our clients’ overall experience while helping them control all aspects of their workers’ compensation program. We have more than 200 employees in four regional offices where we can better understand our customers’ needs since we live within their communities.