Benefits Program Development

Shine Some Light on Your Vendors: Promises vs. Actual Performance

Below is a menu of questions to ask your various vendors in order to develop a better understanding of their performance, including but not limited to, the following:

Managed Care Organization

What is the percentage of return to work success?
How and when do they inform you of the claim and claim number?
Are average medical costs below or above BWC fee schedule?
How much?
What is the turnaround time on the payment of medical bills?

Third Party Administration

How closely do they work with your Managed Care Organization?
How is reserve accuracy measured and reported?
Are claims payments made in a timely and accurate fashion, and without duplication?
Can the services be unbundled?
How does the Third Party Administrator’s pricing structure relate to expected outcomes?

Substance Abuse

Can they assist in establishing corporate policy?
Can services be delivered on a mobile basis?
What is the turnaround time on positive results?

Case Management

How is initial and ongoing contact between you, the injured employees and the physicians accomplished?
Do they make sensible use of vocational rehabilitation?
What triggers telephone contact?
What triggers on-site visits or a coordinator?
Who reviews medical treatment plans?

Systems

What reports are available on-line?
Are the measurements useful?
Is file information viewed simultaneously or by more than one party?
Who owns the information?

All Vendors

Do they have proper incentives for reducing the cost and number of claims?
Do they provide an appropriate return for your service fee investment?
In what ways do they support the use of substance abuse programs?