Medical Cost Containment
The purpose of this section is to assist each member in maximizing the best medical care available for its injured workers in the most economically beneficial manner possible.
Managed care has had a long history in workers compensation. The first generation of managed care focused primarily on medical fee schedules and bill reviews. These functions could be done in-house or by an independent vendor. These vendors were usually paid a percentage of the savings.
In the early 1990s, hospital costs began to shift into areas without strong cost containment. As a result, the contracting with Preferred Provider Organizations (PPOs) began, along with negotiating discounts and utilization reviews. The PPOs network is measured by the extent to which managed care operations are put in place to provide treatment to injured workers. This along with the average discount for fee schedules has become the prevalent practice.
Understanding the overall benefits of a managed
medical plan has been the initial force behind this program. The
difference between managed care of a personal hospitalization plan
and workers compensation claims are dramatically different. By focusing
on returning the worker to full health and productivity as quickly
as possible, the workers compensation industry has a good basis
for portraying its goal as fundamentally different from health insurers.
In workers compensation, we are concerned with the overall plan
of getting an injured worker back to either a pre-injury work status
or back into the work force as a productive, self-sufficient individual.
ACIG, along with its insureds, desires to provide for injured workers
the most complete medical care by utilizing the opportunities available
to create this environment.