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HMO strategies for managing workers' compensation claims
1Milliman & Robertson, Inc., Radnor, PA, USA.
Summary
Health maintenance organizations (HMOs) are increasingly managing workers' compensation medical costs. By implementing managed care services and provider discounts, many HMOs achieve significant savings on occupational health claims.
Area of Science:
- Occupational Health
- Healthcare Management
- Workers' Compensation
Background:
- Health maintenance organizations (HMOs) are actively involved in managing workers' compensation medical benefits.
- This involvement includes various network models and support services like utilization review and case management.
- These services may operate independently of a specific provider network.
Purpose of the Study:
- To investigate the extent of HMO involvement in managing workers' compensation medical expenses.
- To identify the types of managed care services and network models employed by HMOs.
- To assess the cost-saving impact of these managed care strategies on occupational health claims.
Main Methods:
- A survey was conducted among 316 Health Maintenance Organizations (HMOs).
- Data collected focused on their engagement with workers' compensation medical benefits.
- Specific services and network structures were documented.
Main Results:
- 78 out of 316 surveyed HMOs reported cost savings.
- Savings ranged from 20% to 30% on occupational health claim costs.
- These savings were attributed to the use of managed care services and provider discounts.
Conclusions:
- HMOs can effectively reduce workers' compensation medical costs through managed care strategies.
- The integration of managed care services and provider discounts yields significant financial benefits.
- HMOs play a crucial role in optimizing the financial aspects of occupational health management.