WASHINGTON - Insurance companies and health maintenance organizations don't need state legislation to sell 24-hour health care policies to employers, according to two health care experts.
Appearing on a panel discussing 'Workers' Compensation: Keeping Your Costs Down' at the seventh annual National Managed Health Care Congress, Richard H. Eskow and Terry Sullivan, M.D., agreed there was nothing stopping HMOs or insurers from offering 24-hour plans that include workers' compensation and auto insurance.
'Legislation is not all that important to offer 24-hour coverage,' said Dr. Sullivan, chief operating officer and medical director of OHMS (Occupational Healthcare Management Services) of Denver. OHMS is a third party administrator for workers' compensation and a subsidiary of Rocky Mountain Health Care Corp., which operates Blue Cross and Blue Shield plans in three states.
'Product integration is a real oppornunity for the insurance industry,' Dr. Sullivan said. He noted there can be a combination of 24-hour coverage and one-stop shopping 'Workers' comp and auto insurance coverage can be folded in,' he said, adding that 'we've just started a property-casualty company.'
The National Association of Insurance Commissioners already has a model for 24-hour coverage in 18 states, according to Dr. Sullivan. 'I don't think you need legislation,' he said.
Dr. Sullivan displayed a menu of services a cafeteria plan could offer that included: wellness, demand management, point of service, workers' compensation, life insurance, health insurance, an HMO, auto insurance, managed mental health, short-term disability, long-term disability and an employee assistance plan.
'Coordination of the system is very important, and merger is less so,' Dr. Sullivan added. However, he said, systems can be merged using the industry's information systems. Nevertheless, he warned, 'The insurance industry is going to have to undertake risk.'
Last month, Mr. Eskow became president of TEC (Total Employee Care) of Stratford, Conn., a subsidiary of Physicians Health Services Co. Prior to that, he was vice president and director of medical management for Boston-based Liberty Mutual.
Of the three components of workers' compensation coverage - expense, indemnity and medical care - Mr. Eskow said the expense side is 'fairly uniform,' and that workers' comp. medical outlays in the U.S. average 42 percent of total costs.
'The remainder of the cost - indemnity - is physician driven to a significant extent,' he said. Those costs include length of disability, whether it is a temporary or permanent disability rating, litigation and patient perception, according to Mr. Eskow.
'The employer and the workplace supervisor are critical' in workers' comp. cases, he emphasized, adding that the third component is the adjuster or case manager. 'I would argue that medical care should be as timely and effective as possible.'
Mr. Eskow said he requires two 'essential' conditions in a provider contract. 'Will they guarantee to see a worker within 24 hours on a non-emergency basis, and will they see a patient within 20 minutes in an office visit?'
