The MCO "Spin Game"

Spin #1: Medical Cost Savings: An MCO claims to be able to save the Employer (through their ‘exclusive’ provider network) a larger percentage of savings on fee bills, below the BWC fee schedule, thus reducing the premium you pay.

Logic to Consider:

a You get what you pay for. Many employers are already struggling to find providers in their areas that will even accept workers’ compensation claims because they do not want to accept the current fee schedule for their services. If an MCO is again undercutting that fee schedule, what service/treatment are your injured workers really receiving?

a Most provider networks have a very limited number of providers who have agreed to accept a reduced fee schedule which reduces or eliminates the probability that they will be chosen to provide treatment to your injured workers in your community.

a Employers are not directly charged for medical claim costs. You pay a premium to the BWC that is based on your industry type, payroll size, and Workers’ Compensation experience.

a Employees in Ohio have a freedom of choice to select any BWC certified medical provider to treat their Workers’ Compensation claim.

a Medical costs make up only a portion of your Workers’ Compensation experience which includes the last four years of claim activity.

a To achieve the savings offered by an MCO that claims they could have reduced your Workers’ Compensation medical costs by 10% thus saving you $$$ in BWC premium, you must assume that every injured worker will seek treatment from a provider who accepts reduced fees over the next four years to receive a premium savings in 2016.

a Are discounted providers willing to work with you on objective return to work and treatment durations?


Spin #2: Our MCO is better than your MCO because our BWC Report Card statistics are better.

Logic to Consider:

aBWC Report Card statistics are based on averages and claim volumes. The majority of all Workers’ Compensation claims are medical only (no lost time) reported immediately and turned around in less than one business day.

a An MCO with a large claim volume will have more medical only immediate report claims to offset the few lost time and delayed reporting claims which will produce a better average.

a A small volume MCO has the same types of claims and can provide the same service but has a higher average only because of a reduced volume discrepancy.

Remember, Bigger is Not Better. Vantage Occupational Health Plan (VOHP) offers hands-on personalized service for all of our employers. Vantage can guarantee a more efficient claims management process that will achieve a more cost effective outcome.

We invite you to visit our website to see how our clients define our quality of service at http://www.ohpinc.com/.

Evaluating Ohio Managed Care Services

Every two years the Ohio BWC produces an MCO Report Card that is available to every Ohio employer. This report has a lot of statistics related to Workers’ Compensation “claims processing” and comparisons between all MCO’s.

This information is interesting, however, it does not include the basic customer service quality values an employer should be concerned about. We have outlined some MCO quality questions for an employer to consider:

1. Do you receive timely and informative notification of a reported claim from your MCO claims representative?

2. Do you work with a consistent claim representative that manages all of your active claims and is aware of your work environment and return to work policies?

3. Is your claim representative “pro-active” in managing your claims and persistent in achieving an objective return to work outcome?

4. Does your MCO assist you in understanding the Ohio BWC system?

5. Is your MCO assisting you in managing claims in a objective and cost effective manner?

These are the issues that directly relate to satisfaction with your Workers’ Compensation managed care service. The BWC report card will show you how one MCO compares in size and volume to other MCO’s in addition to claims processing statistics. A lot of the statistical averages are skewed based on the variance of claims processed between large and small MCO’s.