Project Results

Public Policy Goal:

To learn if a 24-hour medical coverage product impacts patient satisfaction, medical utilization and costs.

Project Objective(s):

1. To determine who enrolled in the 24-hour coverage and why;
2. To conduct an outcomes survey of employees filing workers compensation claims to determine their satisfaction with care provided under the 24-hour coverage model;
3. To analyze medical and compensation claims data to determine if the 24-hour coverage had a significant impact on utilization and costs.

Project Description:

This project will evaluate the impact of 24-hour coverage demonstrations in two California counties.

Key Findings and Accomplishments:

The project encountered significant obstacles to fielding two surveys developed by the RAND Corporation to achieve the project's objectives. This was primarily due to the hesitancy of participating employers to release information about which of their employees had work related injuries or illnesses. As a result, the Final Grant Report focused on the development, fielding and analysis of the enrollment survey. Major findings in this area were:

1. Employees who voluntarily enrolled in the 24-hour demonstration project were not systematically different from those who chose not to enroll
2. 76.5% of all injured workers responding to the survey reported that they were somewhat or very satisfied with the care they received for their work injury, while 23.5% indicated they were somewhat or very dissatisfied.
3. The patient outcomes survey showed no significant difference between the 24-hour coverage enrollees and other workers' compensation claimants with respect to satisfaction with care or self-reported functional and emotional outcomes.
4. Pilot firms had a substantial cost advantage prior to joining the 24-hour coverage pilot programs, particularly among their Kaiser FFS claims. Between 1992 and 1997, the average cost of claims declined more within control firms than in pilot firms.
5. The 24-hour pilot programs produced lower claims costs (4.7 to 6.5%) for temporary and permanent disability cases, but higher claims costs (20 to 34%) for medical only claims.
6. Overall, pilot firms paid 47.5% more in total KOJ premiums than if they had paid for KOJ claim on a FFS basis.

Tools Developed:

Claimant Telephone Survey
Enrollment Telephone Survey

Reports and Publications:

Kominski, Gerald F, Danielle Rose Ash, "Employee Choice in Managed Care Workers' Compensation," submitted to Medical Care Research and Review, June 2001. (Unpublished report)

Kominski, Gerald; Nadereh Pourat, Danielle Ash, Hongjian Yu, Marianne Cantwell. "Evaluation of California's 24-Hour Coverage Pilot Demonstrations." UCLA Center for Health Policy Research, 2001.

Rudolph, Linda, Dervin, Kathy, Cheadle, Allen, Maizlish, Neil, Wickizer, Thomas. "What Do Injured Workers Think About Their Medical Care and Outcomes after Work Injury?" Division of Workers' Compensation Research Brief (2001).

Rudolph, Linda, Dervin, Kathy, Cheadle, Allen, Maizlish, Neil, Wickizer, Thomas. "Injured Worker Satisfaction with Care in a 24-Hour Pilot Program." Division of Workers' Compensation, California Department of Industrial Relations, 2000.