A double-digit percent plunge in the average medical cost per new California workers’ compensation claims between 2003 and 2004 reportedly highlights the success of Liberty Mutual’s response to the first round of reforms that became effective in January of 2004.
To build on this success and assist its policyholders and their employees in gaining all of the benefits of the reforms, one of the state’s private writers of workers’ comp has created a new position: California Loss Management Director.
Marc Glaser, a 28-year veteran of California workers’ comp, will spearhead this initiative for Liberty Mutual’s National Market business unit. He’s tasked with continuing to:
* Fine-tune the insurer’s operations in light of the reforms;
* Create measures tracking the results of both Liberty Mutual’s new workflows and the reforms;
* Educate clients on reform developments and the opportunities they provide to better manage costs;
* Play an active role in industry groups monitoring reform developments.
California’s workers’ comp reforms hit in two waves. The initial one stabilized soaring medical costs by setting fee schedules and requiring providers follow nationally recognized medical treatment guidelines. About a year later, other key changes went live, including the ability for insurers and employers to direct the care of injured workers for the life of the claim by creating networks of medical care providers.
“The reforms didn’t change our goal – managing the cost of treating injured workers by quickly getting them well and back to work,” noted Glaser. “But they sure gave us some powerful new ways to reach it.”
So in response to the reforms, Liberty Mutual:
* Built a network of 27,000 providers by selecting only those caregivers who demonstrated the keys to delivering quality care efficiently: occupational health experience, return-to-work commitment, appropriate billing practices, and effective use of occupational therapy/physical therapy/chiropractic resources;
* Strengthened the claims process by adding the state-mandated medical treatment guidelines to Liberty Mutual’s online claims management system. Now claims managers compare proposed treatments against the regulations. To quickly resolve questions on applying the general guidelines to a specific claim, Liberty Mutual created a way for claims managers to get an expert medical opinion within 48 hours by electronically sharing the claim file with a consulting physician;
* Heightened Liberty Mutual’s ability to manage workers’ comp medical costs by updating its bill review systems to reflect the new state-mandated fee schedule;
* Created a way to flag bills for medical treatments that were not pre-approved. To prevent unnecessary medical treatments, the reforms require insurers pre-approve caregivers’ treatment plans. No pre-approval, no payment;
* Established a California specific “Reform Scorecard” to measure the impact and effectiveness of the reform.
“While initial results are encouraging, it’s too early to judge the reforms’ lasting impact on the California workers’ comp market,” cautioned Glaser. “Some of the legislation only went live in January and regulators are still hashing out other parts of the reforms. Only time will tell if the reforms made the market more stable and attractive.”
Was this article valuable?
Here are more articles you may enjoy.