Managed Care

MCO Success Stories

MCO Success Stories
Reading time 5 Mins
Published on May 8

A managed care organization (MCO) is entrusted by the Bureau of Workers’ Compensation (BWC) to medically manage workers’ comp claims, ensure injured workers receive appropriate and timely care, and keep overall claims costs under control.

To fulfill these goals, our Sheakley UniComp team continually strives to provide unmatched service to our clients and their injured workers. While we offer letters of recommendation to all potential clients, we know that real-world examples can paint a much better picture than a formal ever could.

Here are just a few of the successes we have shared in this past year.

Treating the Whole Person

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.

Every claim is different and that every injured worker requires a unique level of assistance, that’s why we believe in looking beyond the surface-level medical needs to treat the whole person.

Communication is Key

For the last couple of years, our MCO team has worked with an injured employee who’s undergone multiple shoulder surgeries and continues to have persistent pain and movement issues. The employee’s ongoing work restrictions and a prolonged recovery have led to an extremely inconsistent work schedule and left their employer scrambling to fill the gaps. This was obviously not an ideal situation for either party.

After yet another follow-up procedure a few months ago, the injured worker expressed to their case manager a desire to be released back to full duty as quickly as possible. However, when the injured worker next spoke with their physician, they were told that they’d likely have permanent work restrictions. Understandably, this left the employee frustrated and unsure how to proceed with their current employer and the already strained relationship.

Understanding that the employee liked their job and truly wanted to find a way to keep it, the Sheakley case manager suggested that the physician order a Functional Capacity Exam (FCE), which would determine the true extent of any necessary restrictions. Upon completion of the FCE, the physician was able to modify their previous findings and suggested a more limited, workable set of restrictions for the employee. As a result, the employer was able to accommodate modified restrictions and the employee is successfully working full duty in the same job they held prior to their injury.

Injury recovery can be a journey that requires perseverance, determination, and cooperation. Communication is often the key to ensuring positive outcomes for all parties.

Keeping You Informed

During an account review, the case manager for one of our larger school district accounts noticed that the client had rarely logged into the claims portal to view data on their claims. To be proactive and increase transparency, the case manager decided to start manually pulling and sending weekly claim reports to the district contact.

At first, the client wasn’t convinced that the reports would benefit them in any way and would just lead to more clutter in their inbox. However, after 6 months of receiving consistent weekly updates, they became a true believer. They said how beneficial the report was in providing them insight into outstanding claim issues that needed attention. This led to faster resolution, quicker employee recovery, and an overall reduction in costs.

At Sheakley, being “intellectually curious” is one of our core values. Our team is trained from day one to recognize, suggest, and implement strategies that streamline and improve our clients’ programs.

A Proactive Approach

Recently, another of our case managers was assisting an injured worker who had initially been told that they would need to be off work for 30 days. After reviewing the associated medical records and discussing options with the employee, the case manager suggested a potential light-duty assignment that would allow a quicker return to work. The case manager requested the employer complete a Job Demands Analysis (JDA), which was then sent to the healthcare provider for review.

Upon completion of the JDA review, the physician agreed that an earlier return to work was possible and released the injured employee to return to light-duty role after only 6 days.

By proactively pursuing a return-to-work strategy to benefit both the injured worker and the employer, our Sheakley case manager was able to shave 24 days off the lost-time claim, get the employee back to work safely, and help the employer save on the costs of the claim.

An MCO Partner You Can Trust

Taking care of your employees and keeping your claims costs down are our top priorities. You deserve an MCO that will always keep your best interests in mind and strive to ensure your program is as effective, efficient, and exceptional as possible.

MCO open enrollment is in full swing, take advantage of this time to review your current program and make sure you’re partnered with an MCO that fulfills your needs and exceeds your expectations. Complete our Open Enrollment form to select us as your MCO and discover the Sheakley UniComp difference today!

You may want to read

See all articles