Sedgwick CMS Unveils New MPN to Take Advantage of Benefits from Calif. Workers’ Comp Reform

November 16, 2004

Sedgwick Claims Management Services Inc. (Sedgwick CMS) has established a new medical provider network to optimize the economic benefits available to California employers through the medical control provisions of SB899, the state’s recently approved workers’ compensation reform legislation.

Beginning Jan. 1, 2005, California employers may in most situations direct employees to a pre-designated list of service providers for all treatments of job-related medical conditions without limit as to the length of the treatments. Geared to the unique California regulatory and medical environment, the Sedgwick CMS California Medical Provider Network (MPN) is designed to deliver prompt, competent and appropriate treatment of occupational injuries; and expedited, sustainable return of injured workers to productive activity.

The Sedgwick CMS California MPN offers extensive screening of candidate providers based on both economic impacts and treatment outcomes. The process first evaluates primary care physicians, specialists and other medical service providers in terms of:

· Experience in occupational health or sports medicine
· Demonstrated effectiveness in disability management
· Capability to involve both employees and employers in treatment programs
· Ability to evaluate and communicate physical capacities and restrictions in establishing appropriate transitional work assignments for recovering workers

· Understanding of the workers’ comp system
· Conformance with evidence-based guidelines of the American College of Occupational and Environmental Medicine and the Official Disability Guidelines

Candidate providers are further scored on detailed metrics for economic and treatment outcomes. Examples of a few of the metrics used in this scoring process are length of patient recoveries (average lost days), average paid per claim, speed and frequency of referrals to specialists and physical therapists, and patient satisfaction as reflected in percent of cases resulting in litigation.

Consideration is given to peer benchmarking and the particular difficulty of cases under specialist care. Final selections reflect consultations with employers, nurse case managers and claims examiners.

Sedgwick CMS will assure the ongoing performance and continuous improvement of its MPN through regular provider scorecards, patient satisfaction surveys, employer reviews, and support for providers including training and informational resources and feedback on outcomes. Adjustments to the dynamic network will be made based on client requirements and provider performance.

Sedgwick CMS has teamed with Concentra , a national healthcare services management organization, to identify an ample network of qualifying providers for the Sedgwick CMS MPN and monitor their ongoing results. Individual employers may add the California health centers of Kaiser On-the-Job to their program by electing the Sedgwick CMS Extended MPN. Kaiser On-the-Job is the occupational health specialty arm of Kaiser Permanente.

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