Hot Topics
from Vantage Occupational Health Plan
and the desk of Barb Wright, RN, CDMS
An Occupational Health Plan Publication
The Companies of
Occupational Health Plan
Issue 1, Volume 1 August 2009
Welcome to VOHP Hot Topics!
Our objective is to provide user-friendly information to our clients to assist them in understanding the Ohio Workers’ Compensation system. Through our 18 years of experience in working with medical providers and employers, we still find that our clients need assistance in understanding how to manage Workers’ Compensation claims and related premium costs in our ever changing environment.
Integrated Services
Founded in 1991, Occupational Health Plan recognized that Workers’ Compensation costs were rising and medical providers were not positioned to service employers’ needs. OHP developed affiliated companies to offer employers and providers a comprehensive and integrated approach to manage Workers’ Comp costs. Occupational Health Plan consults with Occupational Health Providers and we offer employers’ policy development and vocational rehabilitation services to control workers’ compensation costs and claims. Vantage Occupational Health Plan, is a certified state-wide Managed Care Organization (MCO). We are paid by the Ohio BWC to medically manage Workers’ Compensation Claims. Ohio Employers are required to choose or be assigned an MCO. Occupational Risk Management, is a Third Party Administrator (TPA) which is an optional employer representative to provide total cost management of Workers’ Compensation claims and premium. Our TPA also offers our employers a Group Rating program.
Evaluating the Quality of Return to Work Management for an Ohio Managed Care Organization (MCO)
An important quality measure for a Workers’ Compensation Managed Care Organization (MCO) is return to work (RTW) management. In Workers’ Compensation they say 10% of the claims make up 90% of the cost. A lost time claim is a high cost claim due to the “disability compensation” and reserves allocated to these types of claims. To this end, employers want assurance that if a claimant requires time off work to recover that the duration of time off is appropriate for the allowed condition or diagnosis. To control these costs employers are encouraged to provide Transitional Work programs and Wage Continuation to support minimal lost time. The question of quality RTW management is, “What is the appropriate amount of time off?” Often this is more subjective than objective between the treating physician and claimant. How Employers should Evaluate MCO DoDM: Volume Driven Scores vs Direct Service and Experience If an employer is interested in evaluating the quality of RTW management of an MCO they should inquire about Official Disability Guidelines* (ODG) scores on specific claims, diagnoses or employer claim population. This will give you an objective evaluation based on best practices that assures a safe RTW outcome for the injured workers. The Value of Official Disability Guidelines (ODG)
• ODG is evidence-based • These studies are focused on one
outcome: What is best for the injured worker. Quality and timely care in workers’ compensation cases have become synonymous with overall cost containment
• ODG provides clear data on optimum
frequency and duration of treatments, in addition to expected time away from work, to ensure that injured workers receive the appropriate levels of intervention precisely when they are needed. VOHP encourages pro-active utilization of ODG best practice guidelines upon claim certification with the treating physician, injured worker and employer. This objective information offers management criteria to achieve the most effective claim outcome that is in the best interest of all parties. Our goal is to provide unbiased claims management that achieves a safe, cost effective and non-adversarial resolution to the claim. The OHIO BWC measures the quality of MCO RTW Management through a formula called DoDM (Degree of Disability Management). DoDM evaluates 266 ICD-9 codes (diagnostic conditions) against a benchmark OSDD (Ohio Specific Disability Duration). OSDD is Ohio RTW data that looks at the average duration of time off work based on the ICD-9. DoDM compares actual MCO RTW claim durations to OSDD averages and scores a “well versus loosely” outcome.
*Work Loss Data Institute continued on side 2
ON THE BACK SIDE…..
Meet our Featured Staff Member of the Month— Barb Wright, RN, CDMS, and CEO of Vantage Occupational Health Plan.
• ODG Mission: “To create, maintain,
and market information databases to implement standards for managing workforce productivity based on strict principles of evidence based methodology…”
Side 2
Evaluating the Quality of Return to Work Management for an Ohio MCO
...continued from side 1
Historically, MCO’s have scored greater than 100% in this formula and the total range of scores are from 115% to 150% with many MCO’s within tenths of a percentage point of each other. These scores are reported in the BWC MCO report card that is used to define MCO RTW quality for employers. The question of concern is related to a volume driven average DoDM score. The more claims you have in the formula the less impact a bad claim will have on the average. The opposite is also true in that a bad claim will have a significant impact on the DoDM average score with a small claim volume. There is also a question of whether OSDD is a “best practice” RTW management measurement. These concerns led to a recommendation to the BWC to change from DoDM and OSDD to ODG (Official Disability Guidelines) as the “best practice” benchmark.
Featured Staff Member of the Month Barb Wright, RN, CDMS, and CEO of Vantage Occupational Health Plan
We would like to take this opportunity to introduce Barb Wright, RN, and Certified Disability Management Specialist (CDMS), and CEO of Vantage Occupational Health Plan (VOHP). Barb’s expertise has been behind the scenes at VOHP for the past 5 years. Prior to VOHP Barb had 19 years experience in the Ohio Workers’ Compensation industry. She was instrumental in the State of Ohio in developing and administrating vocational rehabilitation services for severe workers’ compensation claims. Her objective disability management intervention has been instrumental in establishing the VOHP mission in delivering managed care services. Ms. Wright directs our return-to-work disability management programs for employers and injured workers to achieve objective and cost effective return to work outcomes.
Contact Us: (614) 717-4705—(877) 847-5459 Barb Wright, RN, CDMS, CEO Vantage: bwright@ohpinc.com Brandy Jordan, Account Representative: bjordan@ohpinc.com Heidi Beachy, Claims Manager: hbeachy@ohpinc.com Samantha Dixon, Claims Manager: sdixon@ohpinc.com Kathleen Stalter, Nurse Case Manager: kstalter@ohpinc.com
Internet Resources https://www.ohpinc.com
If you have any ideas that you think others would like to read about, email us at: dbugay@ohpinc.com
https://www.Youtube.com/dalebugay