Workers Compensation Managed Care. By: Laura Deterding, ACAS, MAAA Midwest Employers Casualty Company. Ratemaking Implications of Managed Health Care on Workers Compensation: Components and their Ratemaking Implications.
Laura Deterding, ACAS, MAAA
Midwest Employers Casualty Company
Components and their Ratemaking Implications
The goal of Workers Compensation Managed Care is to integrate cost containment with optimal treatment to facilitate expeditious re-entry into the workforce.
Caution: There is a potential for utilization abuse. Should evaluate treatment frequency.
Caution: There is an incentive for the provider to reduce the treatment frequency.
Caution: Must verify adherence to fee schedules through in-house review or through an independent vendor who shares in the percentage of savings.
Vocational rehabilitation is a systematic tool utilized to facilitate re-entry into the workforce. Parameters for vocational rehabilitation are established by the TPA/claims adjuster include setting objectives and measuring outcomes within established time frames.
One of the fundamental principles of managed care involves employer participation.