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Survey: Measuring Managed Care Performance

Welcome to the Fourth Annual Survey of Measuring Managed Care Performance. This survey is one of several sustained programs to evaluate and improve managed care in workers compensation. Other such programs include the following:

• The Workers Compensation Research Institute has been issuing assessments of medical-care outcomes and costs for several years.
• URAC (formerly the Utilization Review Accreditation Commission) has published standards of practice for managed care organizations and utilization review.
• The Robert Wood Johnson Foundation Workers’ Compensation Health Initiative has been assembling data from dozens of funded projects.
• The California Workers’ Compensation Institute and the Texas Research and Oversight Council on Workers’ Compensation publish studies on system performance.

Since 1999, The Journal of Workers Compensation has been involved in the annual survey on workers compensation managed care performance.

1999 Findings

The inaugural survey identified the key performance measures for which there was a reasonable degree of consensus among all major stakeholders: employers, claims payers, medical providers, and managed care organizations. The key shared-performance measures, in rough order of their current and projected use, were:

• overall claims costs;
• return to preinjury functioning;
• lost-workday reductions;
• frequency of lost-time claims;
• claimant satisfaction;
• employer satisfaction; and
• compliance with regulations.

The first year’s survey set the pattern for subsequent surveys to determine the degree of commonality among stakeholders in their experiences and perceptions and to highlight where differences appeared significant.

2000 Findings

The 2000 survey focused on how stakeholders approached the design and use of medical-provider networks. The survey found that claims payers and employers presented networks with overlapping and, in some respects, inconsistent expectations. Claims payers tended to prefer measurable, business-to-business functions, such as timeliness in scheduling visits, timeliness of reports from initial providers, the ability to define and document work restrictions, and average medical costs. At the risk of oversimplification, claims payers wanted a “purchase-order model” in their medical-provider networks with check-off-the-box service specifications and pricing terms.

Employers, on the other hand, were more interested in a multifaceted, in-depth partnership, reflected in a more informal relationship approach and in measurement choices. These choices included responsiveness of providers to requests for information, appropriateness of referrals to specialists, and quality of clinicians. On the whole, employers appeared to want a more involved relationship with medical providers than did claims payers.

During 2000 and, subsequently, in 2001, Internet-based injury management products came onto the market. They focused on collaboration among all parties, but particularly on collaboration with the employer rather than the claims payer. This trend in Internet-based products suggested that vendors of these systems perceived that employers were more avid users of collaboration tools than claims payers.

2001 Findings

The 2001 survey focused on information technology in managed care and, more broadly, workers compensation. Over 300 responses were received. Not surprisingly, survey results showed that all stakeholder groups were devoting more attention to technology than they did five years prior. Furthermore, all groups reported high expectations that technology could significantly improve the process of managing injuries. They viewed the Internet as effectively delivering the benefits of a paperless office. However, they were markedly selective as to how technology, including the Internet, could deliver greater efficiency, communication, and collaboration. Moreover, stakeholders were skeptical about the potential impact of technology on reducing claims costs and directly improving other outcomes.

Employers and health-care providers were generally perceived as the leading beneficiaries of investments in technology, even if made by claims payers or managed care providers. Ironically, employers felt more challenged than other stakeholders did in taking advantage of technology, while also expressing the highest confidence in technology’s potential benefits.

Process gains were uppermost in respondents’ minds, but efficiency meant different things to different stakeholders. Claims payers and managed care providers tended to focus on mastering the flow of large volumes of transactions. Employers and health-care providers had broader uses of technology. Relatively few were confident they could easily measure the benefits of technology.

The 2002 Survey

This year, the survey focuses on key innovations in workers compensation since the early 1990s. It was therefore designed to help build a consensus about the value of key injury management innovations from the past and today, as well as those anticipated in the future. What works? What doesn’t? The results will appear in the Fall 2002 issue of The Journal of Workers Compensation.

You are invited to respond to the Fourth Annual Survey by completing this survey on the Internet at: http://www.FreeOnlineSurveys.com/rendersurvey.asp?id=7265

ABOUT THE AUTHOR

The Journal of Workers Compensation is a quarterly review of risk management and cost containment strategies published by Standard Publishing in Boston, Massachusetts. For more information, please visit our Web site, www.standardpublishingcorp.com, or contact the editor at 800-682-5759, extension 222, or subscription services at extension 228.

riskVue | The webzine for risk management profesionals
June 2002