Managed care organizations play a valuable role in the workers’ compensation system, providing key claims resources to help employers. At Sedgwick Managed Care Ohio (MCO), we focus on getting injured employees back to work, lowering medical bills and managing the overall process for Ohio employers. From day one, we work to ensure the medical aspects of each claim are organized and we develop a clear, customized return to work plan.
Here are five key reasons employers choose us:
1) Sedgwick MCO is easy to work with
This seems like a vague statement and can easily mean very different things to different people. But think about your own experience. What vendors do you choose to work with? What bank do you use? Where do you like to go grocery shopping? Where do you take your car when it needs work?
Likely, you choose those who are easy to work with, because simplifying your life and work is important. Interestingly enough, this aspect of a relationship is often the easiest to overlook.
For Sedgwick MCO, ease of partnership starts with considering the needs of our client, that individual’s time and obligations, and the way our work reflects on them in the eyes of their organization and employees. When we reach out to a client to ask for or provide information, we hope they consider us to be a trusted ally who cares for them and the workplace and individuals they represent. We hope the information we share provides value and reassurance that their program is in good hands.
Where our client employers are concerned, the majority of our work boils down to communication. We are always examining our procedures and communication methods, as well as the expectations we place on employers, whether subtle or overt. Our goal is to make the process easier. While key aspects of our responsibilities as an MCO depend on obtaining information from employers, we are here as a facilitator and never want to be perceived as another burden to juggle.
2) Sedgwick MCO actively represents the interests of the employer as well as the employee
Our clients want their employees to get appropriate treatment for allowed conditions. They want them to recover quickly and return to work as early and safely as possible. They want the claims process to be clear and simple for their employee, and cost-effective for themselves. All of these objectives fit nicely within the BWC’s expectations for MCOs, and Sedgwick MCO is laser-focused on accomplishing these goals.
There is an expectation that an MCO should be impartial in its work to administer medical management of claims. And to be clear, representing the interests of employers is not in conflict with our responsibilities to take good care of injured workers and coordinate with medical providers. Resolving the claim and accomplishing return to work is the priority for everyone involved, and that’s where we excel. We take a great deal of care as we think about the impact of our actions on all parties involved, including the employer, which is one reason why our clients feel valued in the process. Demonstrating that we have our clients’ backs is what makes us relevant.
Standing out as a visible and aggressive advocate for the interests of both our client employers and their employees is important to Sedgwick MCO. We work within limits; we do not have a role in contesting claim allowances or Industrial Commission decisions. But we do think about issues that can impact not only the outcomes of a claim and the quality of life for injured individuals, but also the way claim resolution affects an employer’s future rates and costs – issues like post-injury management, negotiation of early return to work, oversight of medical treatment, review of prescription medications and scrutiny of medical bills. By providing clarity on medical issues and steering clients toward resources they need and choices that can benefit both them and their employees, we demonstrate our value to all involved.
3) Sedgwick MCO is proactive throughout the claims process
When clients hear from Sedgwick MCO to give them a “heads up” on claim developments, it stands out. Key events that turn claims into concerning premium drivers are often detectible in the medical details – diagnoses, physician’s notes, co-morbidities, treatment plan, lack of treatment plan, etc. Our fluid communication with clients on claim developments helps them prepare to manage the process and possible consequences. When clients see us take early action to gain clarity on claim issues and improve physicians’ focus in treatment plans, they consciously appreciate our work to accelerate a resolution.
4) Sedgwick MCO is engaged with physicians and injured employees to resolve claims
The real work of an MCO is seen in the way it engages with injured employees and physicians. Contacting physician offices to secure information, gain clarity, discuss modified duty options, and to talk through the merits of a treatment regimen are difference-making activities. Our interaction with injured employees lets them know we are here for them; we explain the workers’ compensation process and encourage their questions and cooperation. This level of partnership reflects positively on the employer we represent, but most importantly, it helps the employee maintain their focus on getting back to work and back to life.
Thoughtful discussion about the value of different treatment options and purposeful, evidence-based recommendations backed by real support and care truly make an impact.
5) Sedgwick MCO goes beyond the basic managed care service requirements to resolve claims
Sedgwick MCO routinely includes additional steps in our process to improve clarity, efficiency and provider accountability. Clients and their employees are able to realize a benefit from these activities:
- Negotiating with physicians for more purposeful treatment
- Review of prescribed medications in a claim
- Issuing the “ODG letter” to make physicians aware of anticipated lost time durations
- Sending a “provider infraction” to hold physicians accountable
All of these key activities help advance the employer’s goals within a workers’ compensation claim. Sedgwick also has the advantages of our broader organization to support clients, including our 425 colleagues and 106 registered nurses on staff across the state, in addition to our medical director, who know the communities and providers connected to our employers and how they can best help the employees in need of care. Our clinical approach emphasizes meaningful treatment focused on recovery.
Learn more at www.sedgwickmco.com.