Workers’ Comp and Wellness Programs

1
Workers Comp and Wellness Programs

• Proven and tested Workers Comp programs
• Integrating Health and Wellness into your program

State of Wisconsin
2
Loss Control / Prevention Programs

• Kell Holland
• Senior Vice President
• Willis

3
Loss Control / Prevention Programs

• Return to Work
• Job Safety Analysis
• Cost Allocation
• Fleet Safety Program
• Managing Claims that occur

4
Return to Work

• Purpose
• Coordinator
• Job Safety Analysis
• Communication with all parties
• Coordinate with claims department

5
Job Safety Analysis

• Identify physical demands
• Environmental conditions
• Observe job steps
• Higher productivity

6
Cost Allocation

• Management Commitment
• Accountability
• Options
• Caps
• of Total Incurred
• Lost time/Medical Only/Notice Only

7
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

8
Managing the claims that occur

• Reporting claims
• Adjustors role
• Nurse involvement
• Attorney involvement

9
The components of Managed Care

• Diane J. Blaha, RN
• Vice President National Sales
• CorVel Corporation

10
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 1990s
• 37 Less Since the 1980s for Age Group 25-34

11
Managed Care 101

• Medical Bill Review
• PPO Networks
• Utilization Management
• Pharmacy
• Directed Care Networks
• Case Management
• RTW Programs

12
Medical Bill Review

• State Fee Schedules
• Usual and Customary Review
• Creative Billing Practices
• Related
• Appropriate
• Clearinghouse
• State Reporting and EDI

13
Medical Bill Review Savings

• The Reality of Savings
• Medical vs. Indemnity
• Considerations
• Savings vs. Accuracy
• Creeping Body Parts

14
Preferred Provider Organization

• Contracted Providers
• Credentialed
• Non Directed States
• Managed Care States
• Directed Care Networks
• Quality vs. Quantity

15
Utilization Review

• Types
• Prospective
• Concurrent
• Retrospective
• Components
• Care Setting
• Frequency
• Duration
• State Supported
• URAC

16
Pharmacy

• 5-10 of WC Dollar
• Quick Fix Mentality
• Interactions
• Overuse
• Safe RTW

17
Case Management

• Types
• Triage
• Early Intervention/TCM
• Medical
• Vocational
• Appropriate Provider
• Treatment Plan
• Early RTW
• Medical Relatedness and Necessity

18
Managed Care A Necessity

• Quality Care
• Appropriate Payment
• Patient Advocate
• Early RTW
• Secondary Gain
• Inflation

19
True Examples

• Oxygen
• 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

20
Over Charging In California
21
Over Charges in Indiana
Total Charges 60,130 CorVel Reduction
(37,055) Allowed 23,075 Total Savings
62 Provider Paid 0.38/1.00
22
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

23
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

24
Managed Care Bill Review

• Determining the most effective bill review
  program
• Reports provided
• Savings achieved
• Duplicates
• Reconsiderations
• Enhanced savings
• PPO Network Savings

25
Safety, Work Comp and Wellness

Rollie Boeding Director of State Risk Management
26
Safety, Work Comp and Wellness

• Be careful what
• you ask for!

27
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?

28
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

29
Aging and Claims
30
Aging Claim Costs
31
Aging Claims Costs
32
Conclusions

• Older workers present greater risk for claims
• Older workers present greater risk for claim
  costs longer healing time period
• Being old doesnt directly relate to wellness
  issues
• But being well shortens healing period for old
  and for young employees

33
What do we do about aging worforce?

• Dont 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

34
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