Employers face multiple pressures when considering ways to advocate and care for injured workers and manage costs in complex state workers’ compensation systems. One of the keys to balancing these needs is to take advantage of all available resources and tools embedded in state systems. When employers consistently apply available solutions, the systems strengthen and better case law is made. This is to both protect the injured worker and to allow for caring for them in an affordable way.
The need for employer engagement is very true in key high-cost states like Illinois. As one of the most expensive states for employers with injured workers, the employer’s voice in management of ongoing claims, as well as advocating for positive change are the keys to making a difference. We can do more to ensure the focus of system change is efficiency and excellence in care for injured workers within a fair system.
A combined effort for change in Illinois led to reforms which promised an impact of a 30% reduction in medical spend for employers. The latest follow-up research by WCRI – with a focus on early impact of reforms – is the basis for a recent Crain’s Chicago Business article entitled, “Why Illinois reforms only made a dent.” While the fee schedule’s impact was touted as a 30% decrease in medical costs, you’ll note that this is not seen in overall spend trends statewide. The reason for this is complex, but rooted in both increased utilization in medical care and increased costs for other benefits and settlements/judgments in Illinois.
Doug Whitley, the outgoing chair of the Illinois Chamber, spoke at the Chamber’s recent workers’ compensation conference about its ongoing commitment to change that will help keep business in Illinois. A 74-page book was distributed entitled, “The Impact of Judicial Activism in Illinois.” It outlines key decisions in the state and gives background on Supreme Court judges and where they fell on key cases. This document is a good reference for employers interested in understanding the litigation trends in Illinois, as well as how they impact overall cost of managing cases in this state.
At Sedgwick, we talk with our employer partners all the time about what can be done on a day-to-day basis. Here’s a short list of key considerations for Illinois employers:
- Consider participation in a Preferred Provider Program (PPP): The PPP is the first time in history that we have an option for direction of care in Illinois. While the legislation surrounding this is not as robust as California, it absolutely provides an opportunity to refer employees to a quality care physician. Key considerations for employers participating in a PPP are not just administrative – ensuring that notice requirements are met – but center on finding a way to refer workers to the highest quality physicians possible from the time an injury occurs.
- Use utilization review consistently: Utilization review in Illinois was long looked at by many employers as a retrospective tool. The prospective use of utilization review on specific treatment types, much like we saw in California, will help educate providers and ensure we are providing the right treatment to injured workers at the right time in the case’s life cycle. Utilization review, when applied consistently, is a tool that helps the entire system – including patient education and costs.
- Consider return-to-work options: Productivity is really important for a healthy and safe return to work. Employers in Illinois can consider the use of volunteer return-to-work options to get people back to full duty more quickly while also contributing to the community in a positive way.
- Pay attention to large losses: Employer engagement in large claims makes a difference for the injured worker, the employer and the workers’ compensation system. As the number of large claims grows, it becomes clear that caring for injured workers’ needs early on elicits better results. We work hard at Sedgwick to identify these losses early to enable us to better manage them for everyone involved.
What can we do for the future? The system in Illinois still lags behind others in the country in terms of statewide use of technology and the generous structure for benefit payments. As changes are proposed that could impact employers and the safety of injured workers, employers can join efforts to ensure their interests are represented. As a group, we can work to influence many positive changes. Right now, it is most important to take advantage of the opportunities the system affords us and to do it consistently, leading to legislation that is fair and does not over-burden employers with cost or administrative process. Advocacy for change will help make Illinois’ system fair and efficient.
Kathryn Tazic, SVP, Client Services