How they pay providers

The "Fifth Annual Milliman & Robertson Survey of HMOs: Integrated Disability Management and Managed Workers’ Compensation Strategies and Products" report found that of health maintenance organizations offering managed workers’ compensation and integrated disability management services:

• 35% reported using state fee schedules as their No. 1 provider reimbursement model.

• 30% reported using a fee-for-service reimbursement model.

• 23% reported using a case rate reimbursement model.

• 9% reported using a provider capitation as a reimbursement model.

"Many analysts expected provider capitation to become the prominent reimbursement model for managed workers’ comp programs, but this year’s survey again indicates that very few respondents use a capitation model for reimbursement," notes report co-author William L. Granahan, CIC, LIA, CMC, a senior consultant and practice manager with Milliman & Robertson’s Boston office.

The main obstacle to using a capitated approach to managed workers’ comp and integrated disability management programs appears to be the long-term nature of workers’ comp claims, he notes. In addition, the variability in the types of illnesses and injuries and the inadequacy of historical data needed to establish capitated models appear to be deterrents, Granahan says.