Maximize Savings With Your Managed Care Organization

Episode Summary:

Join Doug Jenkins from the Findlay-Hancock County Chamber of Commerce for this episode of Chamber Amplified. This week, the focus is on employee health management during the open enrollment season for managed care organizations. It's a period that plays a big role in workers' compensation for Ohio's state-funded employers. Kiesha Martin of Sedgwick talks about the importance of an MCO in improving employee retention, expediting return-to-work processes, and providing essential medical management for workplace injuries.

In this episode, Kiesha highlights the many advantages of partnering with Sedgwick, emphasizing their impressive BWC report card and expansive resources, such as their safety and unemployment divisions. Learn how Sedgwick’s comprehensive approach to managed care can be a game-changer for employers seeking to cut costs and enhance employee satisfaction through well-managed workers' compensation claims. 

Key Takeaways:

• Every state-funded employer in Ohio must have a managed care organization (MCO) that handles workers' compensation claims.
• Sedgwick leads in MCO services due to their impressive turnaround times, accuracy, and vast resources, including a full-time medical director.
• The open enrollment period for MCOs in Ohio is from April 28th to May 23rd, providing a chance for employers to evaluate or change their MCO.
• Utilizing Sedgwick as an MCO can aid in employee retention by ensuring quick and efficient management of workplace injuries.
• Sedgwick also offers a third-party administrator (TPA) service, helping employers find cost-saving group savings programs.

Music and sound effects obtained from https://www.zapsplat.com

Transcript

0:00:02 - (Doug Jenkins): Hello and welcome to the show. I'm Doug Jenkins from the Findlay Hancock County Chamber of Commerce. On each episode of Chamber Amplified, we're examining issues impacting the local business community.

0:00:11 - (Doug Jenkins): You know what we talk about by.

0:00:12 - (Doug Jenkins): Now, Employee recruitment, retention, marketing, IT issues. It's really anything that can be impacting your business. Our goal is to give our members tips each week on at least one way they can improve operations and thrive in the current business environment. So, so let me ask you this. For your business, are you looking to save money? Probably a yes there. How about this? Are you interested in getting employees back to work a little more quickly if they're sick or injured? My guess is that's a yes as well.

0:00:38 - (Doug Jenkins): So if you are, let's just say you are for the sake of argument. It is a key time of year for your business. That's because it's open enrollment season for your managed care organization. Kesha Martin with Sedgwick is joining us today to talk about what your MCO should be doing for you and a little about other opportunities available through Sedgwick for Chamber of Commerce members. So a lot of good insight here. Things you need to be checking if you're going into this open enrollment season and you're maybe looking to go to a different provider. Maybe it's your first open enrollment season and you need a provider.

0:01:11 - (Doug Jenkins): We're gonna walk through all of that today. Thanks again for tuning in. Remember, if you're listening on Apple Podcasts or on Spotify, you can rate and review the show. It really does help spread the word. Now let's get into it. And welcoming back to the podcast as.

0:01:25 - (Doug Jenkins): We talk about your managed care organization, Kesha Martin from Sedgwick.

0:01:29 - (Doug Jenkins): Kesha, thanks for joining us again.

0:01:31 - (Kiesha Martin): Hey Doug, thanks so much for having me. I appreciate you giving me this opportunity once again.

0:01:36 - (Doug Jenkins): Well, it's a busy time of year. For every two years we come come.

0:01:40 - (Doug Jenkins): Around and it's, it's something that I.

0:01:43 - (Doug Jenkins): Think a lot of people maybe don't.

0:01:46 - (Doug Jenkins): Think about all the time. But having that managed care organization, something you really want to take a look at. Let's first just get people up to speed on what the MCO is.

0:01:56 - (Kiesha Martin): Yeah, sure. So every state funded employer in the state of Ohio is required to have a managed care organization, also known as MCOs. The MCOs medically manage the workers comp programs for employers throughout the state of Ohio. We work directly with the bureau with return to work, paying bills, authorizing and denying treatment. So anything medically related to a claim is going to fall under the umbrella of the mco.

0:02:25 - (Doug Jenkins): And so why is Sedgwick important to work with when it comes to getting signed up in this open enrollment season?

0:02:32 - (Kiesha Martin): Yeah, I mean, first and foremost, the BWC report card kind of speaks for itself. Sedgwick is leading with Freud turnaround with return to work with accuracy with bills. We are the largest mco. And me saying that does not mean just because we're the largest, we're the best. But we also have so many resources that go along with being the biggest mco. We have different divisions within Sedgwick that a lot of employers find very useful. We have an unemployment division. We have a safety division. We of course, have a tpa.

0:03:09 - (Kiesha Martin): So there's lots of resources when working with Sedgwick. And we're also an international company.

0:03:15 - (Doug Jenkins): And I would think that this kind of is a.

0:03:18 - (Doug Jenkins): An employee retention tool for a business where if you have a strong managed care organization, that can go a long way in making sure that you're providing the type of benefits that your employees need. And working with someone who has a good score on the report card like that, well, their experience is going to be better and they're going to be a little happier at work if they need it.

0:03:41 - (Kiesha Martin): Yeah, absolutely. I mean, just the fact that we are outperforming a lot of our competitors with return to work, that's a big cost savings when you get injured workers back to work quickly and timely. And again, I'm just so happy with how well we've performed on the report card. So lots of cost saving tools, return to work programs we offer. So, yeah, there's definitely benefits with being with Sedgwick mco.

0:04:10 - (Kiesha Martin): And I'm always happy to discuss, you know, anything about open enrollment. And if I could just say, Doug, that today is the first day of MCO open enrollment, April 28th. It goes through May 23rd.

0:04:23 - (Kiesha Martin): So it's. It's a fairly quick turnaround.

0:04:26 - (Kiesha Martin): How long?

0:04:27 - (Doug Jenkins): What's the process like?

0:04:28 - (Doug Jenkins): Let's say we always. We always use the Doug's widgets. That's my. My fake company that we use for examples here on the podcast. Let's say I wanted to take a look at changing my MCO for Doug's Widgets. What does that first conversation look like?

0:04:42 - (Doug Jenkins): How long of a turnaround is it?

0:04:44 - (Doug Jenkins): Since there's a fairly short amount of time to get involved.

0:04:46 - (Kiesha Martin): Yeah, it's a very easy process, Doug. Again, I'm happy to kind of go into detail with anyone that may want to hear more about Sedgwick mco, but it's just a matter of completing an enrollment form. It's a one page form. It can be done electronically. We get it submitted with the Bureau, it won't go into effect until MCO open enrollment is over. So if someone decides to come on board with Sedgwick mco, it won't take place until after MCO open enrollment is over.

0:05:18 - (Doug Jenkins): Makes sense. And it's an easy conversation to have.

0:05:21 - (Kiesha Martin): Yeah, it is. I mean, we have a lot to be proud of, so I feel like it's an easy conversation.

0:05:27 - (Doug Jenkins): Keisha, you mentioned tpa, something else that Sedgwick offers that's not necessarily your department, but we are partnered with you through that as well. If you can talk just a little bit about what that is.

0:05:39 - (Kiesha Martin): Absolutely. Our sister company, Sedgwick tpa, they are the third party administrator. The Bureau requires a firewall between the MCL and the tpa. However, our TPA is the group that can get employers into group savings programs to help them with their premium, either on the front end or the back end, depending on how their claims look and the claims history. But we've got a great tpa. I have several joint clients.

0:06:09 - (Kiesha Martin): Some of you may know Kelly Lowery, she's my partner on the TPA side, and we're always willing and happy to talk about that as well.

0:06:17 - (Doug Jenkins): And again, not having to go too far into it, but in a time where businesses need to really examine where their costs are going, I think this is a prime example of something you can look at and probably isn't going to take months to save some money here.

0:06:31 - (Kiesha Martin): Yes, for sure. I mean, there's new employers that come in, you know, to Ohio, and they don't always know what avenues they need to take. But again, you know, there's lots of savings. Depending on claims history, you could be looking at a up to a 53% discount on, on the front end if you qualify. And then there's also group retro, where you're looking at savings on the back end as well.

0:06:56 - (Doug Jenkins): We appreciate your information on that. Getting back to the managed care organization element of it, this is the time of the year where you're going to be having lots and lots of conversations with people.

0:07:05 - (Kiesha Martin): Yeah.

0:07:06 - (Doug Jenkins): What are some of the bigger questions that you hear when people reach out?

0:07:12 - (Kiesha Martin): Yeah. So a lot of people want to know how the MCO is set up. Will they be dealing with one person or, you know, who will they be dealing with that? That tends to be a big question here@sedgwick.mco, you will have a dedicated MCO team that includes a person like me who is an account executive, kind of oversee the program, but they would also be assigned a day to day claims person who is a non, that's a non clinical person.

0:07:41 - (Kiesha Martin): But then they'd also have a registered nurse assigned as well. So we have a team that works very hard to, you know, get your injured workers the treatment they need and then obviously get them back to work as quickly and safely as possible. So that tends to be a question. We also have a lot of questions about medical directors. I'm proud to say that Sedgwick is one of, I want to say, the only MCO with a full time medical Director on staff. Dr. Kessler.

0:08:10 - (Kiesha Martin): He is a great resource because, I mean, he's hands on. He comes to meetings. I could pick up the phone and staff a claim with him. So that is something we're also proud of, of having a full time medical director on staff.

0:08:25 - (Doug Jenkins): One of the things we really appreciate about working with you is I've always noticed, very quick to respond to any of my questions. And I always have random questions for you, Kesha. So we appreciate that. So if, if they respond that quickly to just my random questions, I think if you're a client within the mco, they're probably going to respond even that much quicker, which says something that, you.

0:08:48 - (Kiesha Martin): Know, we, we want to take care of our clients. So great communication is key.

0:08:53 - (Doug Jenkins): So, Keisha, if people want to start that conversation with you, what's the best way to go about doing that?

0:08:58 - (Kiesha Martin): Absolutely, I can be reached if I could provide my contact information. Again, my name is Keisha Martin. My email address is Kesha, that's K I E s h a.martin m a r t I n@c sedgwickmco.com My personal work cell phone number is 614-207-0390. Please don't hesitate to reach out. I'm always happy and willing to have a conversation.

0:09:29 - (Doug Jenkins): Oh, Keisha, we appreciate you joining us on the podcast once again.

0:09:32 - (Doug Jenkins): Have a great day.

0:09:33 - (Kiesha Martin): Thank you, Doug. I appreciate you as well. Thank you.

0:09:38 - (Doug Jenkins): So just like the Chamber energy program that we talked about a couple of weeks ago here on the podcast, this is another one where you really need to have someone look over numbers for make sure that you're getting the best possible value out of your mco. And certainly we're here to help you with that. Big thanks to Kesha for joining us once again. Chamber Amplified is a free podcast for the community. Thanks to the investment of members in the Findlay Hancock County Chamber of Commerce. Because of our robust membership, we're able to focus on providing timely information to the Findlay and Hancock county business community, run leadership programs for adults and teenagers, and be an advocate for the area.

0:10:12 - (Doug Jenkins): That's all while providing tools to help local businesses succeed. And if that sounds like something you'd like to be a part of, let me know and we can talk about how an investment in the Chamber of Commerce not only strengthens your business, but the community as a whole. That'll do it for this week's episode. If you have any ideas for topics that we should cover on future editions, just send me an email.

0:10:30 - (Doug Jenkins): Djenkinsindleyhancockchamber.com thanks again for listening, and we'll see you next time on Chamber Amplified. From the Findlay Hancock County Chamber of Commerce.