December 15, 2017

Ohio BWC Pilot Program Targets Improved Quality & Coordination of Care

Columbus, OH – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer recently announced a program to reduce delays in the treatment of Ohioans injured on the job. The Enhanced Care Program, developed by BWC in coordination with its partners in the business, labor and medical communities, will give physicians increased flexibility in the treatment of injured workers, returning them to their jobs more quickly and saving employers money in the process. The program will begin July 1, with a pilot in 16 northeast Ohio counties*.

“Ohio’s workers comp system is unquestionably better today than it was five years ago, as evidenced by lower rates, safer workplaces and fewer claims,” said Buehrer. “By improving processes that cause delays, and by better coordinating treatment, our enhanced care program will further improve care in complex claims. These improvements will help injured workers heal better and faster, while ultimately saving employers money.”

The Enhanced Care Program is the result of coordination with business and labor groups that worked closely with BWC over the past year to address solutions for the approximately 15 percent of claims that tend to languish in the system due to broader health issues or delays due to process and paperwork. The program will initially target reducing obstacles that either delay or fragment care to injured workers who sustain a knee injury at work and live in one of the 16 pilot counties. Northeast Ohio was selected due to the number of high-quality health-care providers and systems in the area.

Under the program, participating physicians will be expected to serve as the primary point of care for injured workers. They’ll establish a comprehensive care plan and coordinate with specialists and primary-care physicians to manage the claim holistically with a goal of facilitating a faster, safer return to work.

In exchange, physicians will be granted the flexibility to treat with assurance of payment instead of having to wait for approvals and adjudications, which cause delays. Physicians will have 60 days from the initial determination of an injury to not only treat the allowed conditions on the claim, but also medical issues causally related to the workplace accident that might negatively impact recovery of the knee. They will also be eligible for a 15-percent incentive payment over and above what BWC pays under its current fee schedule for certain services.

BWC will also provide employers with a 50-percent credit on eligible claims in the Enhanced Care Program. Employers will also retain the ability to appeal claims they believe either didn’t happen in the course and scope of employment or otherwise contest treatment they believe to be inappropriate. Those claims will fall out of the pilot.

The program is expected to run as a pilot between six to 12 months and if it proves successful in improving return-to-work outcomes and lowering claims costs, BWC will work with its partners to expand to other portions of the state.

*Counties included in the program are Ashtabula, Carroll, Columbiana, Cuyahoga, Geauga, Holmes, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas and Wayne.

Source: Ohio BWC

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