Reforms – WCRI Conference
Reforms – WCRI – States – Texas, Pennsylvania, Oregon and Florida presented on the effects of reforms that were enacted in each respective state.
Texas-
- 270 insurance companies
- 2.2 billion in direct written premiums
Texas had pre-reform-
- High medical costs– over-utilization
- Poor Return to Work outcomes
- Poor access to care
- High insurance premiums
- Increasing Opt Out employers
- Increasing number of medical disputes
- Used data to identify medical cost drivers
- Built medical infrastructure similar to health insurance
- Evidence based medicine
- Measured outcomes
Texas solution –
- EDI (Electronic Data)
- Administrative Dispute Process was initiated
- pre-authorization requirements to have more carrier involvement
- Adopted Medicare billing structure
- Implemented certified networks
- Implement closed pharmacy formulary
Texas results-
- Average medical bill per claim was reduced significantly
- Average premiums decreased 50% since 2003
- Less employers opting out of WC system
- Medical disputes fell 71%
- Access to care improved
Pennsylvania
Act 44 – four areas of reform
- Reduce medical costs, while not affected level of care
- Address usage charges and utilization creep
- Addressing litigation increases and related costs
- Address the matter of who runs the insurance marketplace
Act 44 – results
- Medical expenditures- patterned after most state systems and Medicare
- Employer directed care expanded to 30 days
- Medicare based fee schedule
- Increasing litigation
- Competition in the WC marketplace
Act 57
- Medical Management
- Benefit Management
- Offsets – SSDI , etc.
- Limited PPD to 500 weeks
- Dispute Resolution Management
Oregon
Reform targets
- Ability to advise governor of bills that were not good for WC community.
- Medical care improvement
- Return to Work
- AOE/COE – medical substantiation
- Palliative care limits
- Timely Insurer benefit payments
Reform results
- Rate reduction
- Better medical care
- MD and DO increased treatment, chiropractic care reduced
Florida
System Success
- Medical bills filed and paid timely 98.5% of the time
- Petitions filed (litigation) has decreased by 2/3
- Actual case litigation down by 50%
- Coalition formed – 200 companies (carriers, employers, and associations)
Legislative continuity and leadership has been stable, no recent crisis
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