Just a day after state leaders announced a massive cut in workers' compensation rates statewide, Buffalo-area employers gained a new option for an insurance plan.
Lifetime Health Medical Group, a regional physicians practice owned by Rochester-based Lifetime Healthcare Companies, on Thursday unveiled a new workers' compensation insurance plan here that mirrors a 10-year-old program already in place in Rochester.
Called Lifetime Health Business-Works, the new preferred provider organization features an integrated mod el for patient care, bringing together both the medical professionals and the insurance side under one roof.
The model has operated in the Rochester area for more than a decade as Workers' CompChoice, but is now also called BusinessWorks. Officials said it has been shown to reduce lost time and wages, increase productivity for employers, free up employees from the stress of managing their own care, and get them back to work earlier.
Like HMOs, PPOs negotiate lower fees with doctors in the network. According to the state Health Department, PPOs in Monroe County saved employers $20 million over five years.
"It is imperative that New York businesses have available methods to reduce workers' comp costs and return employees to productivity quickly and safely," Dr. Arthur Orlick, Lifetime Health Medical Group's chief medical and operating officer, said.
Workers compensation has long been a sore spot for businesses in New York state, which has the highest costs in the nation at an average of $19,727 in claims per person, according to the National Council on Compensation Insurance. A 2004 survey by the Business Council of New York State found that 34 percent of employers would consider moving out of New York because of those costs.
"Workers' comp, in combination with other high expenses, makes New York a less attractive place to locate or expand a business," said Andrew Rudnick, CEO of the Buffalo Niagara Partnership.
Coincidentally, the announcement of the new plan comes just after Gov. Eliot Spitzer and state legislative leaders on Wednesday announced that workers' compensation insurance rates in the state will drop more than 20.5 percent, saving New York businesses about $1 billion in the 2007-2008 fiscal year. That's the biggest single-year drop since at least 1975, officials said, and is nearly double what had been anticipated.
Insurance Superintendent Eric Dinallo ordered the rate cut following an analysis of market trends and the reforms to the state Workers Compensation Law adopted in March after years of fruitless debate.
The agreement, developed with the support of business and union leaders, was designed to lower the cost of workers' compensation insurance for businesses by capping the duration of payments for permanent partial disabilities, even while boosting weekly benefits for workers by 75 percent.
It also speeds up the resolution of disputes, lowers administrative costs, provides for more effective care at lower cost, and creates fee schedules and networks to cut high drug, equipment and testing costs. And it added anti-fraud provisions.
BusinessWorks was created through a joint venture of Lifetime and HealthWorks-WNY. Under the new PPO, injured employees are assigned a certified nurse case manager to oversee every part of their care, ranging from scheduling doctor's appointments to speeding approvals to talking to the employer to find alternate work assignments. That ensures prompt medical care by forming an immediate contact between workers and doctors.
The three nurses currently on staff, all employees of Lifetime, are certified in case management and experienced in occupational health, officials said. They act as the single point of contact for employees, employers, doctors and third-party administrators. More case managers will be hired as needed.
"We are the people connecting all the dots," said BusinessWorks program director and nurse Marsha Fitzgerald. "Employees who use the program get access to medical care with practically no wait time."
Meanwhile, employers can use a secure Web site to get updates about their injured workers and the treatment they're getting so they can plan for the employees' expected return.
Under federal law, employers can see records related to a workers' compensation injury.
But with traditional workers' compensation insurance, employees can go anywhere for care -- including the emergency room -- so there's no central point of contact for employers to look. In the meantime, the employer is short one worker, and productivity and morale among other employees suffers.
With a PPO, however, case managers can mandate where members get care during the first 30 days, and will make appointments for them or speed up access. Along the way, they're monitoring the care. And only 2 percent of Rochester employees "leaked" out to other doctors, which officials say indicates satisfaction with the care.
"It really is a lot of handholding," said Cynthia L. Eberl, regional director of marketing services for Lifetime Medical.
There are more than 200 physicians in the network, including specialists in orthopedics, dermatology, hand surgery, chiropractors and physical therapy, as well as both Kaleida Health and the Catholic Health System. Lifetime operates the network, but only 10 percent of the doctors are from its own practice.
"Our physicians are part of the PPO, but it's not strictly our physicians that are in the PPO," said Lifetime spokeswoman Stacy VanBlarcom.
The Buffalo plan is still awaiting approval from the state Department of Health, expected by the end of July. But already, Lifetime has received "strong interest" in the plan from at least one and possibly both of the area's two big hospital systems, as employers, and from companies in the manufacturing and automotive industries.
To learn more, call (585) 339-4038.