Workers’ Comp and Wellness Programs Proven and tested Workers’ Comp programs Integrating Health and Wellness into your program State of Wisconsin

Loss Control / Prevention Programs Kell Holland Senior Vice President Willis

Loss Control / Prevention Programs Return to Work Job Safety Analysis Cost Allocation Fleet Safety Program Managing Claims that occur

Return to Work Purpose Coordinator Job Safety Analysis Communication with all parties Coordinate with claims department

Job Safety Analysis Identify physical demands Environmental conditions Observe job steps Higher productivity

Cost Allocation Management Commitment Accountability Options Caps % of Total Incurred Lost time/Medical Only/Notice Only

Fleet Safety Program Driver Hiring and Selection Training and Orientation Accident Investigation Vehicle Maintenance / Pre-Trip… Post Trip Inspections MVR Guidelines and Evaluations Hours of Service

Managing the claims that occur Reporting claims Adjustor’s role Nurse involvement Attorney involvement

THE COMPONENTS OF MANAGED CARE Diane J. Blaha, RN Vice President National Sales CorVel Corporation

The Facts 3% of Injuries Create 50% of Medical Costs Only 50% of Employees Off 6 MO, Ever RTW Greater Than 12 Months, Only 5% Ever RTW Physical Therapy Accounts for 30% Medical Diagnostics Account for 7-10% of Medical Aging Work Force – Average Median Age is 40 Shortage of New Workers 14% Less Since the 1990’s 37% Less Since the 1980’s for Age Group 25-34

Managed Care 101 Medical Bill Review PPO Networks Utilization Management Pharmacy Directed Care Networks Case Management RTW Programs

Medical Bill Review State Fee Schedules Usual and Customary Review Creative Billing Practices Related Appropriate Clearinghouse State Reporting and EDI

Medical Bill Review Savings The Reality of Savings Medical vs. Indemnity Considerations Savings vs. Accuracy Creeping Body Parts

Preferred Provider Organization Contracted Providers Credentialed Non Directed States Managed Care States Directed Care Networks Quality vs. Quantity

Utilization Review Types Prospective Concurrent Retrospective Components Care Setting Frequency Duration State Supported URAC

Pharmacy 5-10% of WC Dollar Quick Fix Mentality Interactions Overuse Safe RTW

Case Management Types Triage Early Intervention/TCM Medical Vocational Appropriate Provider Treatment Plan Early RTW Medical Relatedness and Necessity

Managed Care A Necessity Quality Care Appropriate Payment Patient Advocate Early RTW Secondary Gain Inflation

True Examples Oxygen - Hospital Charge $72.00/hr (4 day stay) - 36 hrs in each 24 hr period $3400 Overcharges -Orthopedic Mitek Anchor - Hospital Charge – quantity 6 $2,000.00/ea - Only 4 are Used in this Shoulder Surgery Overcharge $4000

Over Charging In California Total Charges = $480,920 Reduction = ($376,163) Allowed = $87,274 Total Savings = 78% Provider Paid $0.22/$1.00

Total Charges = $60,130 CorVel Reduction = ($37,055) Allowed = $23,075 Total Savings = 62% Provider Paid $0.38/$1.00 Over Charges in Indiana Total Charges = $60,130 CorVel Reduction = ($37,055) Allowed = $23,075 Total Savings = 62% Provider Paid $0.38/$1.00

Benefit vs. Requirement Taking Care of Employee Quality Care at the Right Cost Understanding the Cost Benefit Implementing Change that Produce Results Adversity is Expensive

Managed Care – Bill Review Bill Review Service Fees % of Savings of all reductions Line rate for Fee Schedule/Usual and Customary plus % of Savings for PPO Discounts Additional fees: Header fees Minimum number of lines Flat per bill fee

Determining the most effective bill review program Reports provided Savings achieved Duplicates Reconsiderations Enhanced savings PPO Network Savings Managed Care – Bill Review

Safety, Work Comp and Wellness State of Wisconsin Rollie Boeding Director of State Risk Management

Safety, Work Comp and Wellness Be careful what you ask for! State of Wisconsin

Aging and Wellness What is the impact of aging and employee safety? How will an aging workforce impact Workers Compensation costs? What role should Wellness have in an effective safety and Workers Compensation program? State of Wisconsin

Aging & Wellness Research Age Data from State of Wisconsin Workforce Planning and Fact Book for (OSER) Claims Count Data from Past Ten Years of Workers Compensation Claims System Compared Claims Data by Age Group State of Wisconsin

Aging and Claims State of Wisconsin

Aging & Claim Costs State of Wisconsin

Aging & Claims Costs State of Wisconsin

Conclusions Older workers present greater risk for claims Older workers present greater risk for claim costs – longer healing time period Being old doesn’t directly relate to wellness issues But being “well” shortens healing period for old and for young employees State of Wisconsin

What do we do about aging worforce? Don’t have the answers Researched what others are doing Including a budget initiative for Biennial Budget for Wellness program Include two FTE positions Soft side – promote healthy lifestyles Work with Employee Trust Funds to build wellness into Employee Health programs State of Wisconsin

Future Activities Work with unions to develop joint support and promotion of healthy lifestyles Real benefit on insurance costs - $750 Million Implement employee health screening as mandatory in employee health insurance Develop aggressive disease management programs through health insurance State of Wisconsin