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Workers Compensation

Workers Compensation. Responses to Council Questions. MCO Questions . Isn’t the MCO more appropriate for employers, like the State, who have diversified locations?

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Workers Compensation

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  1. Workers Compensation Responses to Council Questions

  2. MCO Questions • Isn’t the MCO more appropriate for employers, like the State, who have diversified locations? • The recommended bidder has been complimented on its work for the State, but if they are able to provide such good service for an employer with a workforce in many locations, providing excellent service for a centralized location should present no problem.

  3. MCO Questions (cont.) • What experience does the recommended bidder have of Georgia workers’ compensation law if they do not include any large Georgia counties in their list of clients? • All Georgia employees, including State workers, are subject to the same laws as CCG employees, and this MCO has had the State account for 10 years.

  4. MCO Questions (cont.) • State workers do not do the same jobs as CCG employees. Won’t that impact the job the MCO can do for Columbus? • State workers include law enforcement, engineering, Public Works, parks and recreation staff, etc. Personal injuries and methods of treatment are constant around the country.

  5. RFP Questions • We need a complete package of services, not just claims administration. • The RFP requested proposals for a complete package, to include medical case management, adjusting services, loss control services and excess coverage capability. The completeness of the proposal was taken into consideration by the Evaluation Committee.

  6. RFP Questions (cont.) • The RFP stated we were only interested in an MCO. • The RFP stated that any bidder who did not utilize an MCO should detail equivalent services and price those. The majority of responses did not offer an integrated MCO, but detailed equivalent, contracted, services.

  7. RFP Questions (cont.) • Was our current provider’s experience taken into account by the Evaluation Committee? • ACCG’s was given full credit for their experience. The evaluation criteria were as follows: Qualifications/Experience 45% Service Plan 35% Demonstrated loss prevention 15% Cost 5%

  8. RFP Questions (cont.) • How can we obtain loss control services that equal those offered by our current provider? • Some services offered by the recommended bidder exceed those currently available to us, including a multi-day site visit and recommendation report to help us improve the safety of the work environment, as well as ongoing analysis of loss runs/injury trends in Columbus.

  9. RFP Questions (cont.) • What guarantee do we have that a new TPA will provide as good service to us as ACCG? • Apart from the contract renewal cycle, we requested that bidders offer a negotiated performance guarantee. All bidders, except ACCG, offered one. ACCG stated they do not provide performance guarantees.

  10. Cost Questions • If we leave ACCG, will we have to pay more for excess coverage due to the fact that we will have to go to the open market for coverage? • Our excess coverage is already placed in the open market. A ballpark quote was requested prior to the issuance of the RFP and was close enough to our 2013 premium to indicate that there would be little difference in the cost were we to switch TPAs.

  11. Cost Questions (cont.) • What savings will a switch in TPAs realize? • Administrative savings in first year will be approximately $200,000 • Claims savings are harder to quantify and will take longer to see due to carry-over • Each claim that saves six weeks of primary care by moving to specialist care faster will save us approximately $6,000 in medical costs and lost time

  12. Cost Questions (cont.) • How much have we spent on claims this year? • Through September 2013 ACCG made a total of 1,547 payments amounting to over $3 million • CCG has an average of 172 active claims for which payments have been made each month

  13. Cost Questions (cont.) • Are the amounts we pay per invoice or are they reduced by customary and reasonable practice? • All fees and charges by providers of WC services are payable at the State Fee Schedule rate. Invoices which exceed that rate are reduced accordingly • Large TPAs often have fee agreements with providers that further reduce the charges for services

  14. Other Questions • Can we track claims by department? • Currently, no. The reporting categories on the ACCG computerized system are not customizable by CCG, and break our departments into multiple functions. • Example – Public Works employees did not have a separate category until after the April 23rd, 2013 Council meeting. Prior to that date their employees could fall into any one of five categories

  15. Other Questions (cont.) • What are we doing about reducing our injury rate? • Working with the Safety Review Board and Public Works I have already begun putting in place policies and procedures which are showing good results • The onsite visit by the safety professional, with resulting recommendations and assistance in implementation will be of great importance • Loss report analysis (by department) will also help pinpoint areas which need greater focus

  16. Other Questions?

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