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Medical Cost Containment Inventory From 51 Jurisdictions – WCRI


Medical Cost Containment Inventory From 51 Jurisdictions

WCRI Releases National Inventory of Medical Cost Containment Initiatives Adopted In 51 Jurisdictions. Last week, WCRI (Workers Compensation Research Institute released an authoritative work on the initiatives adopted nationally.

Medical costs have almost become runaway when compared to indemnity costs in most Workers Compensation claims.   State legislatures have become accustomed to tweaking or even overhauling fee schedules and other medical components.  Many states have attempted to reign in costs without much of an effect.

Graphic of Medical Cost Containment Medicine with Money

“This study provides a basic understanding of the cost containment initiatives adopted in 51 jurisdictions and provides additional references for those who want more detail,” said Ramona Tanabe, author of the report and WCRI’s executive vice president and counsel.

According to the study, medical cost containment became a focus for many states in the early 1990s when the medical portion of the workers’ compensation benefit dollar began to grow more quickly than other claim costs. This led to growth in the adoption and variety of cost containment initiatives since the 1990s.

I would have to agree with that assessment.  Indemnity cost containment was on the front burner in the 1980’s when I began my insurance career.  Medical cost containment was still on the back burner until the mid-1990’s.

The inventory includes tables of statutory provisions, administrative rules, and administrative procedures used by states as of January 1, 2015. Medical cost containment initiatives include price management methods, such as fee schedules and utilization management (e.g., utilization review or medical networks).

Picture of calculator and stethoscope Medical Cost Containment Inventory

The initiatives outlined in the study aim to curb the cost of a particular service or to reduce the amount of services provided. Cost containment regulatory initiatives entail a balancing act of limiting the cost of services and inappropriate or unnecessary treatment without negatively affecting the quality of treatment or access to care for injured workers.

For more information on this study or to purchase it, click on the following link: http://www.wcrinet.org/result/MCC_2015_result.html.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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