Problems with Data Hinder Evaluation of Managed Care in Workers' Compensation Health Initiative Project

Demonstration and evaluation of performance measurements for workers' compensation managed care organizations

From 2001 to 2002, staff from the American Accreditation Health Care Commission, now generally known as URAC, developed and tested a set of standardized performance measurement tools for managed care organizations that provide workers' compensation care.

The project was part of the Robert Wood Johnson Foundation (RWJF) Workers' Compensation Health Initiative national program.

Key Results

  • The project team:

    • Created a set of performance measures for managed care organizations that assess performance in nine key areas. The project team also developed specific instructions on sampling, data collection and analysis for each measure selected.
    • Developed and conducted limited tests of three performance measurement tools—a worker survey, an administrative data tool and a medical chart audit tool—that managed care organizations can use to assess the care they provide to injured workers:
      • Two managed care organizations tested the worker survey.
      • One managed care organization attempted to test the claims data protocol; however, the company reported that they had insufficient information to report data on cost, utilization and treatment patterns by diagnosis.
      • No managed care organization was willing to test the medical records audit tool.
    • Produced a technical manual—Measuring Quality in Workers' Compensation Managed Care Organizations: Technical Manual of Performance Measures—that would allow managed care organizations to reproduce the performance measures.

Conclusions

  • The project team concluded that a number of barriers exist to introducing standard performance measures for workers' compensation care in managed care organizations. These include:

    • The inadequacy of patient data maintained by managed care organizations.
    • The low demand from purchasers for the standard performance measures.