University Hospitals CompCare News

What Makes a Workers' Compensation MCO Successful?

University Hospitals CompCare has identified three key factors that determine how successful a workers' compensation managed care organization (MCO) will be. They are:

• Creating a climate of trust and shared goals among employers, employees and health care providers.
• Being results-oriented, including facilitating the safe and timely return to productive work.
• Being process-focused so that documentation is correct and on time, and that all of the details of claims management are handled effectively.

MCOs focus on facilitating a safe, timely return to work. In fact, one of the key criteria that BWC uses to evaluate MCO performance is a measure called degree of disability management (DoDM). The DoDM scale was invented by Milliman & Robertson, a health care management consulting firm. For each type of injury and for activity levels ranging from light to heavy, the guidelines identify benchmarks for expected days off before return-to-work. For the state to consider a return-to-work successful, the worker must have no re-injury for at least 90 days.

MCOs are also evaluated by how well they manage the process, including how quickly they file electronic first reports of injury and other documentation, the level of employer and injured worker satisfaction, and the efficiency and accuracy of their provider billing processes.