OhioBWC - Basics: Employers and the Health Partnership Program
Employers and the Health Partnership Program (HPP)
Managed Care Comes to Ohio
Bringing high-quality, cost-effective workers' compensation
health care to the employers and employees of Ohio!
The Health Partnership Program (HPP) and Qualified Heath Plan
(QHP - for self-insuring employers) ushered in a new era in
health care for Ohio's injured workers.
Through the combined efforts of BWC, business, organized labor
and health-care providers, we've created a workers' compensation
managed-care system we hope will meet our customers' needs for
years to come.
HPP is truly a partnership, BWC and the private-sector managed
care organizations (MCOs) certified to participate in HPP are
working together to provide comprehensive claims-management and
medical-management services to the employers and employees of Ohio.
Selecting a managed care organization (MCO)
State fund employers have two opportunities to select a managed care
Benefits of HPP for state-fund employers
Approximately 30 days after applying for coverage, the new
employer will receive a New Employer Kit. Included in this
kit is an MCO Selection Guide. This guide provides instructions
to the employer on how to select a managed care organization
(MCO) to medically manage their workers' compensation claims.
The employer is given 30 days to select an MCO. If the employer
does not choose, BWC may automatically assign an MCO at the end
of the 30-day period.
The second opportunity an employer has to select an
MCO is during open enrollment. BWC will notify employers
when open enrollment starts providing a new MCO Selection
Guide. This guide includes a list of certified MCOs by
county and instructs the employer as to how to review each
MCO's performance and select a new one if desired. If an
employer does not want to change MCOs then no action is
Some of the benefits of the Health Partnership Program are:
- Competition between managed-care organizations (MCOs) is geared to drive up the quality of health care while containing cost;
- HPP focuses on providing quality care with the purpose of safely returning injured workers to the job;
- HPP will eventually reduce overall health-care costs to treat injured workers;
- Lower claims costs translate to lower premium costs for employers.
One of the key steps to make HPP work is the early reporting of an
- According to OAC 4123-6-28,
health-care providers must notify the MCO within 24 hours (or one
business day) of providing initial treatment of an injured worker.
This 24-hour reporting is a legal and contractual requirement.
Non-compliance could result in loss of BWC-certification, removal
from an MCO's panel or both for the health-care provider.
If your injured employee sought treatment without informing you of
the injury, the claim may already be filed. However, when the employer
learns of a work-related injury, a call to the MCO can determine if
a First Report of Injury needs to be completed.
To assist with early reporting, the MCO issues identification cards
to the employer for their employees. Per OAC
4123-6-061, each employee is to be given a card identifying his
or her employer's MCO.
Employers are encouraged to assist with early reporting in every possible
way. Statistics show that the quicker a claim is filed and a determination
made the lower the total costs of that claim will be. In the long run,
early reporting results in lower workers' compensation costs overall.
And lower claims costs translate to lower premiums for the employer.
Self-insuring employers and the Qualified Health Plan
To sign up for QHP, you must attend a BWC training session where
you will receive details of the QHP design and application process.
To sign up for a session call 1-800-OHIOBWC, and follow the options..
- QHP will improve the quality and medical management of health care.
- QHP provides a dispute resolution process.
- The plan requires the first notification of injury within 24 hours,
which provides early intervention and lowers costs.
- Participation in QHP is voluntary for current self-insuring employers
and mandatory for new self-insuring employers.
- With QHP, you will create or contract a QHP panel to provide medical
services for your company's employees. Submit this QHP for certification
- Once the QHP is certified, you and the QHP must educate your employees
about the QHP panel and how they should seek services if injured.
- QHP will be responsible for medical management of all workers' compensation
claims submitted by company employees.
- You are financially responsible for all services related to the