5 reasons for employers to keep Sedgwick MCO 
By Lance Watkins, VP, client services, Sedgwick MCO

It’s open enrollment for Ohio managed care organization (MCO) services from May 3-28, 2021 and, if you’ve already partnered with Sedgwick Managed Care Ohio, we look forward to continuing our service for you and your employees for the coming years. We are here for you! As you consider the value of your MCO partnership, think about these five reasons why staying with Sedgwick MCO is the right choice for your program.

➀ Sedgwick MCO is easy to work with
This seems like a vague statement and can easily mean very different things to different people. But think about your own experience. What vendors do you choose to work with? What bank do you use? Where do you like to go grocery shopping? Where do you take your car when it needs work? Likely, you choose those who are easy to work with, because simplifying your life and work is important. Interestingly enough, this aspect of a relationship is often the easiest to overlook.

For Sedgwick MCO, ease of partnership starts with considering the needs of our client, that individual’s time and obligations, and the way our work reflects on them in the eyes of their organization and employees. When we reach out to a client to ask for or provide information, we hope they consider us to be a trusted ally who cares for them and the workplace and individuals they represent. We hope the information we share provides value and reassurance that their program is in good hands.

Where our client employers are concerned, the majority of our work boils down to communication. We are always examining our procedures and communication methods, as well as the expectations we place on employers, whether subtle or overt. Our goal is to make the process easier. While key aspects of our responsibilities as an MCO depend on obtaining information from employers, we are here as a facilitator and never want to be perceived as another burden to juggle.

➁ Sedgwick MCO actively represents the interests of the employer as well as the employee
Our clients want their employees to get appropriate treatment for allowed conditions. They want them to recover quickly and return to work as early and safely as possible. They want the claims process to be clear and simple for their employee, and cost-effective for themselves. All of these objectives fit nicely within the BWC’s expectations for MCOs, and Sedgwick MCO is laser-focused on accomplishing these goals.

There is an expectation that an MCO should be impartial in its work to administer medical management of claims. And to be clear, representing the interests of employers is not in conflict with our responsibilities to take good care of injured workers and coordinate with medical providers. Resolving the claim and accomplishing return to work is the priority for everyone involved, and that’s where we excel. We take a great deal of care as we think about the impact of our actions on all parties involved, including the employer, which is one reason why our clients feel valued in the process after choosing us as their MCO. Demonstrating that we have our clients’ backs is what makes us relevant.

Standing out as a visible and aggressive advocate for the interests of both our client employers and their employees is important to Sedgwick MCO. We work within limits; we do not have a role in contesting claim allowances or Industrial Commission decisions. But we do think about issues that can impact not only the outcomes of a claim and the quality of life for injured individuals, but also the way claim resolution affects an employer’s future rates and costs – issues like post-injury management, negotiation of early return to work, oversight of medical treatment, review of prescription medications and scrutiny of medical bills. By providing clarity on medical issues and steering clients toward resources they need and choices that can benefit both them and their employees, we demonstrate our value to all involved.

➂ Sedgwick MCO is proactive throughout the claims process
When clients hear from Sedgwick MCO to give them a “heads up” on claim developments, it stands out. Key events that turn claims into concerning premium drivers are often detectible in the medical details – diagnoses, physician’s notes, co-morbidities, treatment plan, lack of treatment plan, etc. Our fluid communication with clients on claim developments helps them prepare to manage the process and possible consequences. When clients see us take early action to gain clarity on claim issues and improve physicians’ focus in treatment plans, they consciously appreciate our work to accelerate a resolution.

On the other hand, when an employer perceives that they are the one prompting their MCO to take action or to explain a complicated medical issue, they are more likely to question the value of their MCO or the differences from one MCO to another. We hear this during open enrollment when we have the opportunity to meet with employers shopping for a new MCO. We often remind people to think about the value of good MCO work to help them get ahead of difficult claims and give them the best chance of avoiding costly situations that can be a disadvantage to both them and their employees.

➃ Sedgwick MCO is engaged with physicians and injured employees
The real work of an MCO is seen in the way it engages with injured employees and physicians to resolve claims. Contacting physician offices to secure information, gain clarity, discuss modified duty options, and to talk through the merits of a treatment regimen are difference-making activities. Our interaction with injured employees lets them know we are here for them; we explain the workers’ compensation process and encourage their questions and cooperation. This level of partnership reflects positively on the employer we represent, but most importantly, it helps the employee maintain their focus on getting back to work and back to life.

Every MCO can say they communicate with physicians and injured workers. But thoughtful discussion about the value of different treatment options and purposeful, evidence-based recommendations backed by real support and care truly make an impact. If your MCO’s efforts go beyond processing C9s and medical bills and collecting data, but rather actually build common purpose with all parties, they can become an indispensable ally.

➄ Sedgwick MCO goes beyond basic MCO requirements to resolve claims
Sedgwick MCO routinely includes additional steps in our process to improve clarity, efficiency and provider accountability. Clients and their employees are able to realize a benefit from these activities:

• Negotiating with physicians for more purposeful treatment
• Review of prescribed medications in a claim
• Issuing the “ODG letter” to make physicians aware of anticipated lost time durations
• Sending a “provider infraction” to hold physicians accountable

All of these key activities help advance the employer’s goals within a workers’ compensation claim. Sedgwick also has the advantages of our broader organization to support clients, including our 425 colleagues, 106 registered nurses on staff across the state and our dedicated medical director, who all know the communities and providers connected to our employers and how they can best help the employees in need of care. Our clinical approach emphasizes meaningful treatment focused on recovery.

We are grateful for our partners and we’re here to answer any questions you may have about your program, as well. To stay with Sedgwick MCO this open enrollment, you do not need to take any action. If you are not currently with Sedgwick MCO, learn more and enroll with us by May 28 at www.sedgwickmco.com.