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Managed occupational health care in an HMO
1Kaiser Works, Inc., Portland, OR, USA.
HMO Practice
|November 3, 1997
Summary
Integrating occupational health services into managed care systems significantly reduces disability days and claim costs. This approach offers cost-effective care, leading to high patient satisfaction and faster return-to-work times.
Area of Science:
- Occupational Health
- Managed Care Systems
- Healthcare Management
Background:
- Health Maintenance Organizations (HMOs) sought to enhance occupational health service delivery.
- Key components for improvement included customer needs identification, service structure, data systems, case management, clinical guidelines, and quality management.
Purpose of the Study:
- To describe the process and outcomes of an HMO's initiative to improve occupational health services.
- To evaluate the integration of high-quality, cost-effective occupational health services within managed care.
Main Methods:
- Analysis of data from 1991 to 1995 to assess changes in disability days.
- Comparison of HMO claim costs against two Preferred Provider Organization (PPO) models using data from July 1994 to June 1995.
- Collection of patient satisfaction data.
Main Results:
- Physician authorization of total disability days decreased by 17.9% per case (p < .0001) between 1991 and 1995.
- HMO average total claim cost was $916/claim, representing a 21% and 20% cost reduction compared to two PPO programs.
- Patient satisfaction was high, with 90% of patients satisfied or very satisfied with their physician.
Conclusions:
- High-quality occupational health services can be effectively integrated into managed care systems.
- This integration results in cost-effective care for a large number of workers.
- The observed savings are attributed to efficient treatment protocols and expedited return-to-work.
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