MIXED EFFORT BY FLORIDA EMPLOYERS TO PROMOTE MANAGED COMP: STUDY

Florida employers' efforts to educate workers about the state's requirements to use managed care for workers compensation injuries are haphazard, a study shows.

"The most striking result of this study is that the required employee educational component of the managed care arrangement for workers compensation has not been uniformly or consistently implemented at the employer level in Florida," according to the study, which was released late last month.

The recent study is the second of five planned by the state's Division of Workers Compensation.

By not striving to educate workers, employers may be missing a key opportunity to build a relationship with workers that will encourage them, if they become injured, to return to work as soon as possible and not hire attorneys, said Catherine Johnson, president of HJH Group Inc. HJH and Reveley Resources Inc., both of Tampa, Fla., are two consulting firms that are helping researchers from the University of South Florida in Tampa to conduct the studies.

At the beginning of this year, Florida became the first state to implement a managed care mandate for its entire workers comp system.

"The education of both employees and employers about how managed care operates was considered to be a key element for the implementation of any managed care program," the study said. The state's Agency for Health Care Administration set guidelines directing employers to provide clear documentation about how they disseminate program details.

The guidelines require that each worker receive a copy of informational materials indicating "the provisions, restrictions and limitations of the workers compensation managed care arrangement," including at least descriptions of health care providers, coverage for emergency and urgently needed care provided within and outside the service area, limitations on referrals and the grievance procedure.

"The intent is that the educational process occur beforehand," though the guidelines did not specify that, according to Jay Wolfson, a professor at the university and a researcher on the study.

Self-insurers had a better record of following the intent of the law than did insured employers, according to the 16-page study.

A majority of the 10 self-insured employers surveyed trained their workers -- primarily supervisors -- prior to an injury. The supervisors then were expected to train the workers.

The 13 insured employers had a different experience, however. Insurers mailed instructions to the employers and relied on employers to educate the workers.

"Recognizing that not all employers will follow their instructions and invest the time to educate the employees prior to injury," insurers have placed their emphasis on making sure workers are aware of their rights and responsibilities after an injury occurs, the study found.

It's to be expected that employers that buy insurance -- generally smaller than self-insured employers -- provide workers with less pre-injury education, Ms. Johnson said.

In addition, "a lot of insured employers don't know they are operating under a managed care arrangement," said Linda Knopf, assistant director of the state Labor Department's Division of Workers Compensation.

This is reinforced by the fact that workers are used to being directed to specific workers comp health care providers, because they did not have the right to choose providers previously, she said.

The five-phase study is intended to help regulators and lawmakers establish best practices, develop educational and technical assistance programs and make policy decisions regarding managed care in workers comp. The first phase examined how managed care arrangements compared on their formal field audits with state and regulatory requirements for approval (BI, Sept. 8).

Meanwhile, the workers comp division is asking the Florida Legislature to extend the time period for the total $150,000 study from year end to June 30 of next year, so the three remaining studies can be completed. Thus far, $85,000 remains, Ms. Knopf said.

A copy of the second phase of the study is available for $20 from Jay Wolfson at the University of South Florida, 813-974-7663.