In order to accurately measure performance of the managed care system, the Ohio Bureau of Workers’ Compensation has launched a system to measure an MCO’s ability to affect an injured worker’s return to work. Using their Healthcare Management Guidelines, Volume 7, Milliman & Robertson (M&R) engineered the new system called Degree of Disability Management. The system measures the number of days an injured worker is off work in comparison to an optimal return to work (RTW), set by the M&R standard for the same NCCI manual class and ICD-9 diagnostic code.

M&R selected the top 877 ICD-9 codes in the workers’ compensation system to set optimal rates. They took the real world Ohio history of two years’ data to define the "Loosely Managed" return to work days.

Data Required
ICD-9 codes
NCCI Manual Job Classifications
RTW – number of days off work

Comparison Benchmarks
Well-Managed Benchmark – the M&R optimal standard
Loosely Managed Benchmark – the actual return to work data from the MCO system

Results
The Degree of Disability Management (DoDM) percentage

Using the DoDM
An example of how the system works: For an injured worker with an ICD-9 code of 726.1 in the NCCI class for clerical worker, the MCO returns the injured worker to work in 4 days. If the Well-Managed Benchmark (WMB) for the same ICD-9 code and NCCI class is 3 days and the Loosely Managed Benchmark (LMB) is 7 days, there would be a 75% DoDM for the injured worker. The "actual" RTW, 4 days, is 75% along the continuum from the Loosely Managed 7 days to the Well Managed optimum of 3 days.

In the same example if the actual RTW were 7 days the DoDM % would be 0% and likewise if the actual RTW were 8 days the DoDM rate would be -25%. The higher the DoDM, the better the MCO is performing.

Although at first glance the system is complicated and difficult to understand, it is the first step in truly measuring the most important outcome to an employer: return to work. As new information systems develop to manage MCOs, many are starting to incorporate the DoDM, loosely managed benchmarks and well managed benchmarks into their systems. This allows the case managers on-line access to their performance as they go about their day to day management of the injured workers. For additional information on specific values for the 266 ICD-9 codes or about the evolution of the information systems used to manage these benchmarks, you may contact Karen Conger at Ohio Employee Health Partnership, 888-844-0039.