Embed Size (px)
Citation preview
Workers’ Comp and Wellness Programs
•Proven and tested Workers’ Comp programs
•Integrating Health and Wellness into your program
State of Wisconsin
Loss Control / Prevention Programs
Kell Holland
Senior Vice President
Willis
Loss Control / Prevention Programs
Return to Work
Job Safety Analysis
Cost Allocation
Fleet Safety Program
Managing Claims that occur
Return to Work
Purpose
Coordinator
Job Safety Analysis
Communication with all parties
Coordinate with claims department
Job Safety Analysis
Identify physical demands
Environmental conditions
Observe job steps
Higher productivity
Cost Allocation
Management Commitment
Accountability
Options
Caps
% of Total Incurred
Lost time/Medical Only/Notice Only
Fleet Safety Program
Driver Hiring and Selection
Training and Orientation
Accident Investigation
Vehicle Maintenance / Pre-Trip… Post Trip Inspections
MVR Guidelines and Evaluations
Hours of Service
Managing the claims that occur
Reporting claims
Adjustor’s role
Nurse involvement
Attorney involvement
THE COMPONENTS OF MANAGED CARE
Diane J. Blaha, RN
Vice President National Sales
CorVel Corporation
The Facts• 3% of Injuries Create 50% of Medical Costs
• Only 50% of Employees Off 6 MO, Ever RTW
• Greater Than 12 Months, Only 5% Ever RTW
• Physical Therapy Accounts for 30% Medical
• Diagnostics Account for 7-10% of Medical
• Aging Work Force – Average Median Age is 40
• Shortage of New Workers• 14% Less Since the 1990’s• 37% Less Since the 1980’s for Age Group 25-34
Managed Care 101
• Medical Bill Review• PPO Networks• Utilization Management• Pharmacy• Directed Care Networks• Case Management• RTW Programs
Medical Bill Review
• State Fee Schedules• Usual and Customary Review• Creative Billing Practices• Related• Appropriate• Clearinghouse• State Reporting and EDI
Medical Bill Review Savings
• The Reality of Savings• Medical vs. Indemnity
Considerations• Savings vs. Accuracy• Creeping Body Parts
Preferred Provider Organization
• Contracted Providers• Credentialed• Non Directed States• Managed Care States• Directed Care Networks• Quality vs. Quantity
Utilization Review
• Types• Prospective• Concurrent• Retrospective
• Components• Care Setting• Frequency• Duration
• State Supported• URAC
Pharmacy
• 5-10% of WC Dollar• Quick Fix Mentality• Interactions• Overuse• Safe RTW
Case Management
• Types• Triage• Early Intervention/TCM• Medical• Vocational
• Appropriate Provider• Treatment Plan• Early RTW• Medical Relatedness and Necessity
Managed Care A Necessity
• Quality Care• Appropriate Payment• Patient Advocate• Early RTW• Secondary Gain• Inflation
True ExamplesOxygen
- Hospital Charge $72.00/hr (4 day stay)
- 36 hrs in each 24 hr period $3400 Overcharges
- Orthopedic Mitek Anchor
- Hospital Charge – quantity 6 $2,000.00/ea
- Only 4 are Used in this Shoulder Surgery
Overcharge $4000
Over Charging In California
Total Charges = $480,920Reduction = ($376,163)
Allowed = $87,274
Total Savings = 78%Provider Paid $0.22/$1.00
Total Charges = $60,130CorVel Reduction = ($37,055)
Allowed = $23,075
Total Savings = 62%Provider Paid $0.38/$1.00
Over Charges in Indiana
Total Charges = $60,130CorVel Reduction = ($37,055)
Allowed = $23,075
Total Savings = 62%Provider Paid $0.38/$1.00
Benefit vs. Requirement
• Taking Care of Employee• Quality Care at the Right Cost• Understanding the Cost Benefit• Implementing Change that Produce Results• Adversity is Expensive
Managed Care – Bill Review
Bill Review Service Fees
% of Savings of all reductions
Line rate for Fee Schedule/Usual and Customary
plus % of Savings for PPO Discounts
Additional fees:
Header fees
Minimum number of lines
Flat per bill fee
Determining the most effective bill review program
Reports provided
Savings achieved
Duplicates
Reconsiderations
Enhanced savings
PPO Network Savings
Managed Care – Bill Review
Safety, Work Comp and Wellness
State of Wisconsin
Rollie Boeding
Director of State Risk Management
Safety, Work Comp and Wellness
Be careful what
you ask for!
State of Wisconsin
Aging and Wellness
What is the impact of aging and employee safety?
How will an aging workforce impact Workers Compensation costs?
What role should Wellness have in an effective safety and Workers Compensation program?
State of Wisconsin
Aging & Wellness Research
Age Data from State of Wisconsin Workforce Planning and Fact Book for 2006-09 (OSER)
Claims Count Data from Past Ten Years of Workers Compensation Claims System
Compared Claims Data by Age Group
State of Wisconsin
Aging and Claims
% of Employees and Claims
0
5
10
15
20
25
30
35
20-29 30-39 40-49 50-59 60plus
Age Group
Pe
rce
nta
ge
% ofEmployees% ofClaims
State of Wisconsin
Aging & Claim Costs
Average Cost per Claim
$0
$1,000
$2,000
$3,000
$4,000
$5,000
20-29 30-39 40-49 50-59 60 plus
Age Group
State of Wisconsin
Aging & Claims Costs
% of Employees and Claim Costs
05
1015202530354045
20-29 30-39 40-49 50-59 60 plus
Age Group
Per
cent
age
% ofEmployees
% of Costs
State of Wisconsin
Conclusions
Older workers present greater risk for claims
Older workers present greater risk for claim costs – longer healing time period
Being old doesn’t directly relate to wellness issues
But being “well” shortens healing period for old and for young employees
State of Wisconsin
What do we do about aging worforce?Don’t have the answers
Researched what others are doing
Including a budget initiative for 09-11 Biennial Budget for Wellness program
Include two FTE positions
Soft side – promote healthy lifestyles
Work with Employee Trust Funds to build wellness into Employee Health programs
State of Wisconsin
Future Activities
Work with unions to develop joint support and promotion of healthy lifestyles
Real benefit on insurance costs - $750 Million
Implement employee health screening as mandatory in employee health insurance
Develop aggressive disease management programs through health insurance
State of Wisconsin
