Managed occupational health care in an HMO.

Abstract

This paper describes the efforts of an HMO to improve its delivery of occupational health services. Customer needs identification, occupational health structure, data systems, case management, clinical guidelines, and quality management are outlined. Our experience suggests that high-quality occupational health services can be integrated into managed care systems thereby offering cost-effective care to large numbers of workers. Comparing 1991 to 1995, physician authorization of total disability days was reduced 17.9% per disability case (p < .0001). Based on July 1994 to June 1995 Oregon State Accident Insurance Fund (SAIF Corporation) data, HMO average total claim cost was $916/claim representing respectively, a 21% and a 20% reduced cost compared to two PPO model programs (MCO 00 and MCO 01). Patient satisfaction data indicated that 90% of patients were satisfied or very satisfied with the physician they saw. The savings appear to be due to cost-effective treatment and rapid return to work.