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Setting Up a Workers Comp Managed Care Program

A man gives a workers comp managed care presentation to a group of employees

Why do you need a workers comp managed care program? No matter how good an occupational safety program is, on the job injuries will occasionally occur. 

For our clients, Canal HR has developed a managed care program that includes plans in place to be able to provide care to those injured on the job and a network of preferred medical professionals and pharmacies, with an emphasis on getting employees back to work as soon as possible.

Here are some of the important things to know about a managed care program:

Workers Comp Managed Care: What is an Occupational Safety Program? 

Occupational health and safety programs are designed to help prevent injuries and job-related diseases from occurring in the workplace. At their best, these programs create a dialogue around the health and safety issues present in the workplace and then find ways to avoid these potential issues so that the workplace environment can remain safe and productive. The risk factor of the workplace is determined by the hazard rating of the industry. 

As an employer, the costs of workplace accidents can be significant. The costs include the incident itself, property damage, loss of productivity, and investigation expenses. For both the economic sustainability for employers and the safety of employees, it is important to have an occupational safety program in place. 

An occupational health and safety program can include the following: 

  • A statement of the intent as a company and the responsibilities of the employer, supervisors, and workers
  • Procedures for the inspection of your workplace, equipment, and practices, and a plan in case hazardous conditions are found
  • Written instructions and regulations available to all workers 
  • Holding periodic meetings with management to ensure activities in the workplace are safe and to take courses of action if needed
  • Immediate investigations of incidents to determine necessary actions to avoid recurrence 
  • Records, statistics, and reports of inspections, incidents, and investigations, and allowing this information to be available upon request from the proper person or committee
  • Maintain instruction and supervision of the employer to keep workers safe 

Keep in mind that this program is a formal program for those companies that fall into the more hazardous category. 

What Is a Workers Comp Managed Care Program?

A workers comp managed care plan is a type of health insurance that allows an employer to form a contract with healthcare providers and medical facilities to provide care for their employees at a lower cost. Depending on the amount an employer is willing to pay determines the flexibility of a plan. Plans that are more restrictive of choices typically cost less. 

Here are three types of managed care plans:

  • Health Maintenance Organizations (HMO) typically only pay for care that is given by an organization within one network. The chosen primary care provider coordinates the majority of the holder’s care. 
  • Preferred Provider Organizations (PPO) often pay more if the holder receives care within the network, and still pay part of the cost if the holder goes outside of the network. 
  • Point of Service (POS) plans offer more flexibility and bring together aspects of HMO and PPO plans. 

What is Workers Compensation Insurance?

Workers compensation provides assistance to employees who have been injured or have fallen ill in the workplace in the form of medical expenses, lost wages, and rehabilitation costs. Workers compensation is meant to also protect the employer. Although it is a federal program, each state has its own set of rules and regulations so that proper coverage is provided. 

Workers’ compensation is determined based on how similar businesses in each state follow injury patterns and losses. Combined into “classes,” these businesses are provided with rates based on the prior five years of loss costs due to injury. However, a system called “experience rating” allows for some businesses who have a long history of safety in the workplace to pay lower premiums. The converse is true for an unsafe business. 

Workers Comp Managed Care Preferred Provider Networks

Finally, as part of a workers comp managed care program, a preferred provider network is a type of health plan that creates contracts with medical providers, such as hospitals, pharmacies, and doctors to form a network of providers that can be accessed by holders of the plan. Using the providers in the network keeps costs lower than if providers or organizations outside of the network are used.  

Learn More About Canal HR’s Workers Comp Managed Care Program

Canal HR has developed a one-of-a-kind managed care program for those occasions in which a worker is injured on the job. This program includes on-site provisions, a network of talented providers, and lower workers compensation costs.  

We have a registered nurse on call for employees injured on the job who need immediate medical management intervention. For injuries of a serious nature, this early intervention ensures that proper medical treatment is delivered in a timely and cost-effective manner.

Canal HR has a network of preferred occupational medical providers who work with us to make sure that all injured employees are given the best medical treatment so that they can return to their jobs as quickly as possible. If an employee needs specialized care, they are directed through our Preferred Provider Network to an appropriate provider. Canal HR Business Services also has a nationwide preferred provider pharmacy arrangement, which ensures that medications are purchased at the lowest cost available.

The goals of Canal HR’s managed care program include lowered medical costs associated with on-the-job injuries and returning those injured workers to gainful employment as soon as possible. Canal HR has a proven successful track record with this program, which helps clients lower their workers compensation premiums.

At Canal HR, we have a team of employee benefits experts who want to help your small business thrive. Contact us today for a free consultation and to learn more.

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