Project Results

Public Policy Goal:

To assist managed care organizations in reporting on the quality of medical care provided to injured workers by developing and testing a standardized performance measurement and reporting system similar to the Health Plan Employer Data and Information Set (HEDIS) for general health care.

Project Objective:

To compile a standardized set of performance measures for managed care organizations providing care for workers' compensation cases and demonstrate the use of the measurement tool in up to five managed care organizations.

Key Findings and Accomplishments:

This is the first publicly available standardized protocol for the collection of performance and quality measurement indicators in workers' compensation health care.

Using a consensus approach, methods and tools were developed to measure worker access to medical care; coordination of care; communication with injured workers; return to work; health and physical functioning; patient satisfaction; prevention counseling; appropriate clinical care; medical costs; and utilization. Three data collection instruments were developed and subsequently tested in two MCO's.

Lessons learned:

1. Performance and quality measurement is in its infancy in workers' compensation;
2. It is important to have specific indicators for measuring the quality of care provided and performance measurement to ensure managed care organization accountability. This project accomplished that;
3. There are limitations in MCO data systems that currently limit the feasibility of all of the measures developed. Additionally, there is a limited understanding of how factors such as MCO structure or worker characteristics affect measurement. More research needs to be done on these issues;
4. MCO's have little incentive to report performance information; purchasers, state regulators and patients have not demanded that it be provided;
5. The tools provided (see below) have been tested sufficiently to adopt them for internal MCO quality improvement purposes, but further testing is recommended before adopting them for comparative purposes.

Tools Developed:

"URAC Performance Measures for Workers' Compensation Managed Care Organizations"

The four bulleted items listed below here can be accessed through title above "URAC Performance Measures for Workers' Compensation Managed Care Organizations"

• List of Performance Measures and Rationale
  
  
• Injured Worker Survey
  • Survey of Worker Experience
  • Survey Implementation Procedures
  • Analysis of Survey Data
  • Sample Survey Report Formats

• Measures from Claims Data
  • Sample Survey Report Formats
  • Definitions of Categories of Service

• Measures from Medical Record Data
  • Record Review for Clinical Quality
  • Medical Record Audit Form
  • Medical Record Audit Instructions

Grantee Web Site Address

Reports and Publications:

Greenberg, Liza. "Back on the Job." Healthplan Magazine (1998).

Greenberg, Liza, Leopold, R. "Performance Measures in 'Workers Compensation Managed Care Organizations." Occupational Medicine: State of the Art Reviews 13, no. 4 (1998).

Greenberg, Liza. "Measuring Quality in Workers' Compensation Managed Care Organizations: Technical Manual of Performance Measures." Washington, DC: URAC, 2001.

Leighton, R, Harris, J, Greenberg, L. "Defining an MCO for the Purpose of Measuring Performance." Journal of Workers' Compensation (2000).

"Measuring Quality in Workers' Compensation Managed Care Organizations: A Strategy for Purchasers." URAC, 2001.

Presentations:

Liza Greenberg, RN, MPH, "URAC- Performance Measures for Workers' Comp MCO's," Robert Wood Johnson Workers' Compensation Health Initiative Annual Meeting, September 6-7, 2001, Newport, RI.

Liza Greenberg, RN, MPH, "Advances in Measuring Quality of Care in Workers' Comp MCO's: Development of Standard Performance Measures," National Academy of Social Insurance, January 24-25, 2001, Washington, DC.