Privately owned MCOs, or Managed Care Organizations, play a critical role in the Ohio Bureau of Worker’s Compensation (BWC) system, which provides workplace injury insurance to quarter million Ohio employers for their employees.
The state’s 15 MCOs are selected by employers to manage their injured workers’ compensation claims. That includes filing first injury reports with the BWC, managing claims, coordinating medical bill payments and coordinating recovery and return-to-work programs.
Cleveland-based 1-888-OhioComp was one of the original MCOs in the BWC’s managed care program when it was launched in 1997; and over the last two decades it’s grown from one of the smallest to the fourth largest in terms of premiums, number of employers and claim volume, says COO Dan Neubert.
“The secret to the success of 1-888-OhioComp is very simple,” he says. “We partner with our employers and provide very aggressive claims management.”
1-888-OhioComp recorded 24,184 claims in 2015, according to the BWC’s MCO report card. The state’s MCOs currently manage more than 130,000 active lost-time claims, the most expensive and those that have the biggest impact on employers’ premiums. 1-888-OhioComp manages more than 12,000 of these claims.
“We’re very proud that the active lost-time claims managed by 1-888-OhioComp have the lowest claims cost of any MCO,” he says.
Working with its employers 1-888-OhioComp also has the best return-to-work rate for lost time claims of any MCO, based on recent BWC data,” Neubert says.
“First and most important, we partner with our employers to coordinate our efforts in managing these claims to effect a safe and early return to work. Implementation of transitional work programs and other strategies has reduced the length of time many injured workers are off from work,” Neubert says. “Second, we provide an exceptional team to each employer to aggressively medically manage claims from date of injury.”
With 147 employees, including 68 nurses on staff, 1-888-OhioComp has one of the best ratios of nurses to active clients, he says.
“The differentiator is really our staffing. Our staffing is different from other MCOs because we have a high ratio of nurses to claims than most MCOs,” he says.
Neubert says other keys to 1-888-OhioComp’s claims management include:
- Utilization management is conducted on every treatment request to ensure only treatment for the allowed condition is authorized.
- Discounts are negotiated with medical providers.
- Drug utilization reviews are done to stop excessive opioid usage and prescriptions for unrelated conditions. 1-888-OhioComp has the highest percentage of drug utilization reviews of any MCO, he says.
- Bill utilization review is conducted on every medical bill. The review confirms that the medical procedures and/or treatment were appropriate and that the invoices are correct and accurate. Neubert says that they get a copy of what’s been paid after it’s been and challenge the bills that shouldn’t be paid.
“Each year we reduce or deny thousands of medical bills that are for unallowed conditions, incorrectly billed, improperly coded or are duplicates,” he says.
The bottom line for employers, he says, is that aggressive claims management equals lower claim costs, resulting
in lower worker’s comp premiums.