Who’s measuring, and what do they measure?

Employers used to keep tabs on the costs and outcomes of workers’ compensation care for employees injured on the job. Today, however, more and more companies monitor the costs and outcomes of care for all health-related absences including long- or short-term disability and extended or chronic illness.

In the most recent Staying@Work survey, companies report nearly two dozen cost management strategies such as case management, transitional return-to-work programs, and independent medical exams. (See "Effectiveness of Top Four Disability Management Activities," p. 52.) The strategies work, according to survey results, which suggest that employers will use them until they find better ones. The 1999/2000 version is the fourth annual Staying@Work survey conducted by the Washington Business Group on Health in Washington, DC, and Bethesda, MD-based Watson Wyatt Worldwide. (See cover story for additional survey findings.)

Generally, employers cover their disability and workers’ compensation costs through self-insurance or through benefits packages purchased from insurance companies or managed care organizations (MCOs). Either way, the expectations for provider accountability are becoming more sophisticated.

The American Accreditation HealthCare Commission/URAC is in the process of determining which data sources MCOs should use to design standardized measures of performance. URAC, based in Washington, DC, issues various accreditation certificates nationwide, including one for workers’ compensation networks.

In a survey last year, URAC found that the majority of MCOs measure quality in disability and workers’ compensation care. (For details, see box, p. 53.) Indicators include:

• disability-related performance or outcomes;

• patient satisfaction;

• access to health care services;

• functional status information;

• appropriateness of clinical care.

Liza Greenberg, URAC’s vice president of Research and Quality Initiatives, describes the findings as a snapshot of the data collection and analysis capacity among MCOs. However, standardized quality data on disability or workers’ compensation care are still a goal rather than a reality. "URAC wants to persuade employers to consider providers that deliver the best results on cost as well as return-to-work results," she notes.

Instead of relying on subjective clinical judgments, employers now turn to best practice data for expected length of absence in work-related injuries, according to Peter Rousmaniere of Rous-maniere Designs in Little Rock, AR. He is a consultant who works with insurers and employers on disability prevention and management in the work force. He notes that discrepancies between typical and best practice return-to-work cycles leave considerable room for improvement:

• Typical cycles: 50% return to work within 30 days, 90% within 180 days.

• Best practice cycles: 85% return to work within 30 days, 98% within 180 days.

There’s little doubt that employers who don’t currently require providers to practice outcomes will do so in the near future. Rousmaniere explains that short, nonwork-related absences are less rigorously tracked than those for disability and work-related injuries. But given the growing concern about absenteeism in general, that could change.

Need More Information?

For more on employer expectations and preparing providers to better handle health care involving absence from work, contact:

- Peter Rousmaniere, Rousmaniere Designs, 501 N. University, Suite 206, Little Rock, AR, 72207. Telephone: (501) 666-0556.

- Jennifer Christian, MD, President, Chief Medical Officer, Webility.md, 95 Woodridge Road, Wayland, MA 01778. Telephone: (508) 358-5218. E-mail: jennifer.christian@webility. md. Web site: www.webility.md.

- Bruce Flynn, Director, Disability Management, Washington Business Group on Health, 7777 N. Capitol St., N.E., Suite 800, Washington, DC 20002. Telephone: (202) 408-9320. E-mail: flynn@wbgh.com. Web site: www.wbgh.com.

- Liza Greenberg, Vice President for Research, American Accreditation HealthCare Commis-sion/URAC, 1275 K St., N.W., Suite 1100, Washington, DC 20005. Telephone: (202) 216-9010. E-mail: lgreenberg@urac.org. Web site: www.urac.org.

- Watson Wyatt Worldwide, Bethesda, MD. Web site: www.stayingatwork.com.