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Workers' Compensation & Managed Care

State Initiatives

An Overview of State Workers' Compensation Medical Care Initiatives

Presenter:

Stacy Eccleston, Director of Government and Regulatory Affairs, CalyxCare Systems, Inc., Cambridge, MA.


Stacy Eccleston, formerly with the Workers' Compensation Research Institute (WCRI), discussed the policy and legislative choices different States are making in regard to the implementation and regulation of managed models in workers' compensation.

Specifically, Ms. Eccleston highlighted the results of a recent WCRI survey that examined State legislative and regulatory activities with respect to workers' compensation managed care. She divided the strategies that States have adopted in this area into four approaches:

  • Mandating the use of managed care systems in workers' compensation medical programs.
  • Regulating workers' compensation managed care activities.
  • Using "permissive" managed care policies.
  • Allowing only limited use of managed care in workers' compensation programs.

Ms. Eccleston reported that the WCRI survey found that most States had adopted policies that fit into the last category. Specifically, a major emphasis of these States' policies was to limit the extent to which exclusive provider networks could be used within workers' compensation programs.

An interesting and related observation that Ms. Eccleston derived from the survey is that the introduction of managed care does not seem to have had a major impact on control of provider choice. According to data she presented, prior to managed care, 41 percent of employees were in environments in which the employer directed their care/provider choice. The latest survey indicated that, with the emergence of managed care, the percentage of persons whose employers dictated their care had only increased to 49 percent because of the ability of employees in many jurisdictions to opt out of networks.

Finally, Ms. Eccleston discussed the trend of developing treatment guidelines in workers' compensation programs. She noted that the WCRI survey identified 21 States that either developed or were in the process of developing treatment guidelines.


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