1. Innovative Approaches in Other States Panel Introduction – May 2, 2003 Lessons from the Robert Wood Johnson Foundation Workers’ Compensation Health Initiative Jay S. Himmelstein, M.D. - Director Allard E. Dembe, Sc.D. and Sharon E. Fox, Ph.D. - Co-Deputy Directors University of Massachusetts Medical School Center for Health Policy and Research http://www.umassmed.edu/workerscomp

2. Overview of WCHI Grant Program Created in 1994 in response to escalating costs of WC medical care, introduction of MC into WC, pressure from States, and Clinton proposal to ‘integrate’ WC medical care Created in 1994 in response to escalating costs of WC medical care, introduction of MC into WC, pressure from States, and Clinton proposal to ‘integrate’ WC medical care Objectives Objectives  “ …to contain costs and improve the quality of care” Focus Focus  Coordination of benefits, managing disability in the workplace, measuring and improving access and quality, altering provider incentives Structure Structure  2 “Calls for Proposals”  Demonstration and evaluation projects

3. Major Accomplishments to Date 21 grants awarded for total of $6 million 21 grants awarded for total of $6 million Enhanced national focus on quality of WC care Enhanced national focus on quality of WC care Forged new links between WC and general health services research Forged new links between WC and general health services research Resources and tools developed to facilitate the measurement and improvement of WC medical care Resources and tools developed to facilitate the measurement and improvement of WC medical care

4. Examples of Projects Involving WC Medical Care Quality American Accreditation Health Care Commission (AAHCC/URAC) American Accreditation Health Care Commission (AAHCC/URAC)  Development of WC performance measures Rhode Island Technical Resource Center Rhode Island Technical Resource Center  A state-based model for collecting and disseminating information about access to and quality of workers’ compensation medical care.

5. URAC WC MCO Performance Measures Project: Objectives Create a national set of performance measures, using standard specifications, to assist workers’ compensation Managed Care Organizations (MCOs) in voluntary reporting of data Create a national set of performance measures, using standard specifications, to assist workers’ compensation Managed Care Organizations (MCOs) in voluntary reporting of data Test the measures to ensure that data reports are useful in comparing and improving workers’ compensation MCO performance Test the measures to ensure that data reports are useful in comparing and improving workers’ compensation MCO performance

6. URAC WC MCO Performance Measures Project: Categories of Measures Access to Care Access to Care Prevention/ Disability Management Prevention/ Disability Management Appropriateness of Clinical Care Appropriateness of Clinical Care Coordination and Communication Coordination and Communication Cost/Utilization Cost/Utilization Patient/Payer Satisfaction Patient/Payer Satisfaction Client Outcomes Client Outcomes

7. URAC WC MCO Performance Measures Project: Results Developed MCO Performance Measure Set which is publicly available through the WCHI website Developed MCO Performance Measure Set which is publicly available through the WCHI website Performance data is collected by MCOs through three inter-related tools: Performance data is collected by MCOs through three inter-related tools:  Patient survey  Administrative Data Specifications  Medical Record Audit for specific conditions Tools are field tested and ready to be utilized Tools are field tested and ready to be utilized Limitations include the variation in MCO data availability and quality, and voluntary participation by MCOs and payors. Limitations include the variation in MCO data availability and quality, and voluntary participation by MCOs and payors.

8. The Rhode Island Technical Resource Center: Objectives To bridge the gap between information and policy development in WC through the collection, interpretation and dissemination of data related to the access and quality of care provided to injured workers. To bridge the gap between information and policy development in WC through the collection, interpretation and dissemination of data related to the access and quality of care provided to injured workers. Building on URAC quality measures, provide WC stakeholders with easy access to credible information, data and guidance about how to provide appropriate high quality care. Building on URAC quality measures, provide WC stakeholders with easy access to credible information, data and guidance about how to provide appropriate high quality care.

9. The Rhode Island Technical Resource Center: Methods Stakeholder leadership group agreed on 5 top healthcare quality dimensions and their ‘indicators’ Stakeholder leadership group agreed on 5 top healthcare quality dimensions and their ‘indicators’ System established to collect data from insurers, employers, health care providers and injured workers System established to collect data from insurers, employers, health care providers and injured workers Pilot data collection for all instruments accomplished and results reported to stakeholders Pilot data collection for all instruments accomplished and results reported to stakeholders

10. The Rhode Island Technical Resource Center: Results Successfully demonstrated ability for state entity to collect data from multiple sources (including workers) related to WC medical care Successfully demonstrated ability for state entity to collect data from multiple sources (including workers) related to WC medical care Provides a model for involving key stakeholders in a quality monitoring and improvement project Provides a model for involving key stakeholders in a quality monitoring and improvement project Systems must address building consensus on quality and data issues (privacy, voluntary submission, technical). Systems must address building consensus on quality and data issues (privacy, voluntary submission, technical).

11. Lessons Learned and Next Steps Building off lessons from the general health care system, approaches now exist for measuring the quality of care provided to injured workers Building off lessons from the general health care system, approaches now exist for measuring the quality of care provided to injured workers WC systems have yet to implement approaches to systematically monitor the quality of health care received by injured workers. WC systems have yet to implement approaches to systematically monitor the quality of health care received by injured workers. New efforts to assist states in implementation are underway. See www.umassmed.edu/workerscomp New efforts to assist states in implementation are underway. See www.umassmed.edu/workerscompwww.umassmed.edu/workerscomp

12. Today’s Panel Presentations Amy Lee – Coordinator, Research and Oversight Council, Texas Workers’ Compensation Commission Amy Lee – Coordinator, Research and Oversight Council, Texas Workers’ Compensation Commission Tom Wickhizer – Professor, Health Services and Community Medicine, University of Washington Tom Wickhizer – Professor, Health Services and Community Medicine, University of Washington Barbara Wynn – Senior Policy Analyst, RAND Barbara Wynn – Senior Policy Analyst, RAND