Managed Care

MCO Selection Guide

MCO Selection Guide
Reading time 5 Mins
Published on May 1

Managed Care Organizations (MCOs) play a critical role in how efficiently and effectively workers’ compensation claims are handled. Since working with an MCO is required by the Bureau of Workers’ Compensation (BWC) and changing MCOs is only permitted during the biannual open enrollment period, it is crucial to select an MCO that best fits the needs of your company.

Here are our top tips for selecting an MCO partner you can trust.

Lean on Trusted Professionals

First and foremost, your MCO partner must offer medical management of all your workers’ comp claims with proven processes that are clinically focused, and results driven. From the First Report of Injury (FROI) to the injured worker’s return to active duty, your MCO acts as the main point of connection and collaboration between all interested parties.

At Sheakley UniComp, we provide exactly this kind of comprehensive medical management of workers’ comp claims. This includes everything from obtaining initial claim data and medical records for the BWC to the management and payment of all medical provider bills. Reviewing bills from providers helps keep costs down by ensuring all medical bills are appropriate for the claim.

We also work directly with medical providers, authorizing and denying medical treatment on your behalf, to facilitate the appropriate care necessary for each injured employee’s safe and quick return to work, all while keeping costs down.

Address the Realities of Addiction

It’s an unfortunate reality that prescription medications are often over-prescribed by doctors or abused by patients during recovery. As a result, Drug Utilization Reviews are a standard component of the claims management protocol. They allow your MCO to identify inappropriate prescriptions and/or excessive use so they can be addressed before they lead to addiction.

Our team utilizes just such an approach to ensure the health and safety of your injured workers is protected. With the prevalence of abuse of prescription pain killers by both medical providers and patients, taking measures to identify and halt potential abuse before it gets out of hand can significantly improve outcomes for your employees.

Leverage Proactive Return-to-Work Strategies

Lost-time claims are the most expensive type of claims. The costs associated with lost time can add up quickly and contribute to future premium increases. Your MCO partner should have solid return-to-work strategies in place to help return injured workers to the job as soon as they are medically cleared.

To help employers in industries such as construction or manufacturing that traditionally struggle to accommodate work restrictions, our strategy includes nonprofit return-to-work programs that help shorten the length of lost-time claims. Once an injured employee has been medically cleared to return to work with modifications, our programs place them with a local nonprofit organization that aligns with the company’s values and mission.

By staying engaged and connected to the workforce during recovery, the likelihood of positive outcomes for your injured worker dramatically increases and the claim is less likely to develop into a total disability.

Make an Informed Decision with Data

To make it easier for Ohio businesses to evaluate the performance of each MCO and make an informed decision, the BWC created the MCO Report Card. The report card is updated each year based on employer assessments gathered during the prior premium year. Rather than randomly selecting an MCO or being assigned one by the BWC, the Report Card puts the scores of every MCO in your hands so you can make the best decision possible for your company.

Treating the Whole Person

We understand that every claim is different and that every injured worker requires a unique level of assistance, that’s why we believe in looking beyond just the medical needs to treat the whole person. You need an MCO that recognizes your injured workers’ unique needs and will do what they can to help.

To illustrate this approach, here’s a real-world example of a case we encountered recently:

While being treated for depression, our client’s injured worker was found to be exhibiting the signs of early onset dementia and Alzheimer’s disease and a subsequent positive diagnosis was confirmed. Without family in the area to provide needed assistance and because of their health conditions, the injured worker started forgetting about and missing critical care appointments.

Realizing what was happening, the assigned Sheakley UniComp case manager was able to work with the injured employee to set up a system of reminders for both their medications and appointments, using post-it notes to keep track of important information and ensuring medications were blister-packaged for both morning and evening. Additionally, the case manager facilitated a connection between the injured worker and their local Council on Aging for ongoing assistance.

An MCO Partner You Can Trust

Sheakley UniComp has the industry experience and depth of knowledge necessary to guide you and your injured employees through the complex and confusing world of workers’ compensation. We can help you control your claims costs, manage your injured employees’ medical treatment, and facilitate their quick and safe return to work.

With this year’s open enrollment in full swing, now is the time to weigh your options and choose the MCO partner that will set you and your employees on a path to success. Discover why Sheakley UniComp is one of Ohio’s top MCOs. Complete our Open Enrollment form to select us as your MCO.

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