Why you should stay with Sedgwick MCO
MCO Open Enrollment: May 1 - 26, 2023

The Ohio Bureau of Workers’ Compensation (BWC) will conduct another Managed Care Organization (MCO) Open Enrollment during the month of May, and you will most likely receive several inquiries from MCOs. As your third party administrator we see the important impact an MCO has on claims management every day.  We are encouraging our clients to remain with Sedgwick Managed Care Ohio during this Open Enrollment period.

Sedgwick TPA’s focus is on reducing your premium liability. Containing costs through aggressive claims management is a fundamental priority. Among the key characteristics Sedgwick TPA looks for from the MCO is the consistent effort to maintain clarity on the recovery status, medical treatment plan, and return-to-work prospects of each claim. It is not uncommon for a single claim to drive much of the premium cost for a state-funded employer, and sometimes threaten discount and rebate options in the future.  Identifying potentially challenging claims early on is something we collaborate routinely with the MCO, so the communication between the TPA, MCO, and employer is essential.  We have found that the simplicity of the Sedgwick MCO partnership makes a difference.

MCO performance metrics are also important to consider.  Sedgwick MCO excels in a few areas that we feel make a tangible difference in the eventual financial impact a claim has on employers’ premium calculation.  For example:

• Lost workdays per claim
  Sedgwick MCO averages 10.9% fewer lost workdays per claim than other MCOs.¹  Limiting the lost time associated with a claim is essential to containing costs, not to mention staffing issues that prolonged absence can create.

• Duration of medical activity
  Sedgwick MCO averages 15.5% shorter duration of active status than other MCOs in current active claims.²  As shorter duration in active status indicates effective medical management, declining costs, and a resolved claim.   

• Medical Cost Containment
  Sedgwick MCO reduces medical costs by 17.2% beyond BWC fee schedule in 2022.³  Every MCO reduces bills to BWC fee schedule, but the additional savings can make a difference for an employer in their EMR calculation.

Ultimately the selection of an MCO is an employers’ choice. We work with all Ohio MCOs, but most extensively with Sedgwick MCO. Our experience, as well as objective results, leads us to strongly encourage you to continue to trust the MCO that we trust to take the best care of our clients – Sedgwick Managed Care Ohio. 

Click on the logo to visit Sedgwick MCO’s website and review more detailed information on their results and resources.

Sources:
1. BWC Public Data SP22-05025, 2021-2022 claims as of 12/13/2022
2. BWC Public Data SP 23-01162, Current Active Claims as of 3/21/2023
3. Sedgwick MCO billing data for 2022