HMOs across the country are continuing to expand their workers' compensation services in response to employer demands for risk management programs and medical management of occupational claims.
That was the finding of a third annual survey conducted last year by the actuarial and benefits consulting firm Milliman & Robertson.
Although many states, including California, Missouri, Pennsylvania and New York, have enjoyed a drop in workers' compensation costs, many employers continue to view workers' compensation as a significant risk.
Seventy percent of responding HMOs in 41 states and the District of Columbia said they offer or are planning to offer workers' compensation networks or services. That compares with 74% in the 1995 survey and 51% in 1994.
Seventy percent of HMO networks provide workers' compensation services on a non-risk-bearing model, the survey found. This shows most HMOs have not been able to devise methods of capitating providers in their workers' compensation programs, the study said.
In contrast with prior years' surveys, HMOs are reporting on employers' wage replacement or indemnity savings nearly as often as they report medical savings. This is an indication of HMOs' awareness of the need to manage the total cost of an occupational illness and to get workers back on the job as quickly as possible, the survey said.
Reported savings on medical expenses are 24.5% on average; average savings on wage-replacement costs are about the same, 25.7%.
Almost all (96%) HMOs reported providing case management services. Eighty-nine percent of HMOs offered utilization management. More than 70% offer claims payment or management and bill review services.
About 61% provide loss control and safety advice, up from 13% in 1994 and 19% in 1995. Eighty-nine percent assisted clients with return-to-work protocols.
Network composition of all responding HMOs included 19,853 specialists, 12,352 primary-care physicians and 995 occupational medicine physicians.
HMOs may have treated as much as 12% of all workers' compensation claimants in 1996. Their networks most frequently target individual large- and medium-sized employers and self-insurance groups.
The survey was mailed to 401 HMOs with at least 20,000 group health enrollees, representing 97% of total HMO enrollees in 1995. Seventy-seven HMOs responded. Because of strong response from larger HMOs, respondents represented 31%, or 15.8 million, of total enrollees.