Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project I - Medical outcomes and patient satisfaction

OBJECTIVES. This study examined the effect of managed care on medical outco mes and patient satisfaction as part of an evaluation of the Washington Sta te Workers' Compensation Managed Care Pilot. METHODS. One hundred twenty firms (7,041 employees) agreed to have their in jured workers treated in managed-care plans. Managed care introduced two ch anges from the fee-for-service (FFS) delivery system currently used by inju red workers in Washington State: (1) experience-rated capitation, and (2) a primary occupational-medicine delivery model. The FFS control group includ ed injured workers employed at 392 firms (12,000 employees). A total of 1,3 13 workers who experienced occupationally related injuries or illnesses bet ween April 1995 and June 1996 were interviewed by telephone at 6 weeks afte r injury regarding their medical outcomes and satisfaction:action with care . Workers whose injuries resulted in four or more lost workdays (n = 372) w ere also interviewed at 6 months after injury on the same topics. The areas surveyed included functional outcomes and satisfaction with care, provider s, and access to providers. RESULTS. The measures of functional outcome reflected no consistent differe nces between the managed care and the FFS conditions. The workers who atten ded the managed-care system reported lower levels of satisfaction with care , particularly with access to providers. For example, 58% of managed-care p atients reported satisfaction with their attending physician as compared wi th 69% of FFS patients (P < 0.01). CONCLUSIONS. Workers treated through managed-care arrangements were less sa tisfied with their care, but their medical outcomes were similar to those o f workers who received traditional FFS care. The current workers' compensat ion system in Washington State affords injured workers great latitude in ch oosing providers. If provider choice is substantially restricted by managed care, worker satisfaction is likely to diminish.