MANAGED CARE FOR WORKERS COMPENSATION - 3 YEARS OF EXPERIENCE IN AN EMPLOYEE CHOICE STATE

Managed care techniques are becoming increasingly available to manage the medical and indemnity losses associated with injuries paid for und er the workers' compensation system. The authors describe 3 years' exp erience of identifying and abating workplace hazards and medically man aging cases utilizing a preferred provider organization established so lely for workers' compensation cases. In the model described, the occu pational physician/nurse case-management team coordinates the entire p rocess, from prevention of accidents to facilitated return to work. Du ring the study period (1992 to 1995), per-capita losses were reduced b y 23 %, from $241 in fiscal year 1992 (the year before the managed car e initiative), to $185 in fiscal year 1995. (Hereafter, each year refe rred to indicates that fiscal year) In 1992, 22 lost-time cases per 10 00 employees occurred, whereas the number of lost-time cases in the ye ars 1993 to 1995 averaged 12 to 14 pm 1000 employees. The rate Of ''me dical only'' cases dropped significantly from 155 per 1000 in 1992 to 96 per 1000 in 1995. The per-capita amount of monies spent on medical care decreased from $81 in 1992 to $63 in 1995. The most significant s avings in medical costs related to claims associated with new occupati onal injuries, injuries that occurred during the fiscal year. In 1992, the per-capita loss on such cases was $23 and in 1995 it was $13 a 43 % decrease. The number of temporary/total days dropped significantly from 163 per 100 employees in 1992 to 70 days in 1995. Concurrently, t he per-capita loss for temporary total disability was reduced from $53 in 1992 to $26 in 1995, Per-capita administrative costs, as well as o ther indemnity losses (predominately permanent partial disability), de creased only slightly over the study period ($58 to $54 and $6O to $51 , respectively). We feel that these results indicate that environmenta l-risk management and medical-care management can be integrated to pro duce substantial savings. It also suggests that managed-care technique s, which are becoming more available to employers, can even be applied in states that do not have managed care legislation.