The Cleveland Plain Dealer has published an article that is highly critical of Ohio’s workers comp managed care program. The analysis performed by the paper (and subsequently reported by AP and other news outlets) notes that administrative costs associated with claims management have gone up much faster than the rate of inflation,while medical costs have experienced a similar trend.
Several other papers inside and outside Ohio are also focusing on the BWC managed care program.
That being the case, one could well argue that managed care in Ohio has been a very costly mistake. It has not reduced medical expenses, it has increased policyholders’ costs, and some of the deals negotiated by BWC seem, at the very least, to have favored one vendor over others.
I had some personal experience with the Ohio WC program early on, and again several years ago. I was asked to give a speech at a BWC-sponsored physician meeting that essentially was supposed to be an endorsement of BWC’s physician profiling/education program. Never mind that the program was not exactly leading edge, used superficial evaluation criteria, had not included physicians in the program’s original design, or that the officials did not really want me to dig into the program.
No, what they wanted was to hire a shill.
Managed care has been variously ridiculed, heartily promoted, touted as a panacea and blamed for driving costs up and doctors out of health care. What often gets lost in the sheer volume of the “discourse” is what exactly managed care is, and what version is the subject of that specific argument.
It will do the industry and its various stakeholdes no good if managed care is discarded. We need careful analysis, rigorous study, and thoughtful investigation, and the Plain Dealer’s work is all of the above.
I performed some small consulting work for BWC some years ago, after the managed care program was introduced, and since then have been observing from afar. My understanding is that BWC set up the program for two reasons: 1. to better address medical issues, 2, to wrest control over claims from the civil service protected claims adjusters. Thiis is an extremely regulated workers comp system which, when I was close to it, prohibited the claims adjuster from making a positive compensability decision until 21 days post injury (!). Early on I thought the performance measurement process seemed pretty well thought out, even if there were data and interpretation problems that may have masked actual performance.
It would not surprise me that after these number of years, the program may have deteriorated into a vendor game — like it is in much of what passes for managed care in workers comp.