BWC to Conduct Enhanced Care Program Pilot in Northeastern Ohio

For the past year, the Ohio Bureau of Workers’ Compensation (BWC) has worked with representatives from all the workers’ compensation stakeholder groups on ideas to improve the BWC healthcare-delivery model. These groups include business, labor, the medical community, trial attorneys and managed care organizations. 

All stakeholders agree each claimant should receive high-quality care, and there should be more care coordination in BWC’s healthcare system. There is also a desire to remove barriers that prevent providers from rendering treatment in a claim’s early stages. Finally, BWC and the stakeholders would like to give providers more flexibility to treat. These ideas will be tested via a pilot, called the Enhanced Care Program. 

Objectives of the Enhanced Care Program 

The program’s objectives are to expedite care early in the claim; give more treatment latitude to the physician of record (POR); and encourage the POR to consider the claimant more holistically and coordinate with other providers as necessary. This includes the claimant’s primary care provider. Thus, after evaluating a pilot claimant, the POR will need to develop a comprehensive treatment plan that addresses: 

  • The conditions allowed in the claim; 
  • Other injuries/issues not officially allowed in the claim but that the POR believes to be causally related to the workplace injury;
  • General health issues impacting the claimant’s optimal path back to work. 

The POR would need to submit this care plan to the MCO within five days. However, the POR would be able to begin rendering treatment with expectation of appropriate reimbursement if the care falls within the Official Disability Guidelines. 

Note: If proposed treatment falls outside these guidelines, prior authorization from the MCO will be required for those services.

Program details 

The Enhanced Care Program begins this summer in 16 northeastern Ohio counties: Ashtabula, Carroll, Columbiana, Cuyahoga, Geauga, Holmes, Lake, Lorain, Mahoning, Medina, Portage, Stark, Summit, Trumbull, Tuscarawas and Wayne. All claims initially allowed for only a knee injury will be eligible for the program as long as the claimant chooses a POR participating in the program. 

Any BWC-certified physician who practices in the pilot region and agrees to adhere to the enhanced responsibilities of a POR, which BWC’s Health Care Quality Assurance Advisory Committee developed, will be eligible to participate in the program. Primarily, the POR will be required to serve as the quarterback for managing the claimant’s care. BWC plans to provide enhanced compensation for PORs who agree to serve in this capacity for pilot claims. 

Next steps 

BWC will hold educational sessions for interested providers in the pilot region during the coming months. Please watch for communication from the BWC and the AMCNO for details about when and where we will hold these meetings.

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