Coverage and Enrollment in Workers' Compensation
by Julie Sutton
The number and percent of Oregon employers covered by workers' compensation managed care organizations (MCO) increased from 64 percent (52,048) in 1999 to 68 percent (57,532) in 2000. This represents a gain of over 5,000 employers (10.5 percent) covered by MCO contracts in just one year. The percent of Oregon workers covered by managed care organizations increased from 62 percent in 1999 to 69 percent in 2000. The increases were due to additional contracts between insurers and MCOs, more employers obtaining Workers' Compensation coverage through the SAIF Corporation, and MCOs expanding their coverage into new geographical service areas.
Also in 2000, 40 percent (10,027) of accepted disabling claims were enrolled in MCOs, a slight increase from 37 percent in 1999. Enrollment differs from MCO coverage in that the injured worker is directed in writing to receive future treatment, if any, from providers who are on the MCO's panel. The number of claims enrolled by SAIF, increased by almost nine percent from 5,819 in 1999 to 6,327 in 2000. In addition, the percentage of SAIF's accepted disabling claims enrolled in managed care increased from 72 percent in 1999 to 76 percent in 2000. As in 1999, the MCO with the largest number of SAIF enrolled claims in 2000 was Oregon Health Systems. And, consistent with previous years, a number of private insurers and self-insured employers enrolled a higher percentage of claims than SAIF. This situation most likely reflects the different manner by which insurers enroll workers-either immediately upon receiving the claim and paying all related medical bills on denied claims, or waiting until the claim is accepted. Also, geographic dispersion of employers and employees within the state may preclude some insurers from enrolling a higher percentage of their claimants.
Liberty Northwest Insurance Corporation enrolled the largest number of claims of any private insurer in both 1999 and 2000. The percentage of claims enrolled by Liberty Northwest increased from 21 percent in 1999 to 24 percent in 2000. The MCO with the largest number of Liberty-enrolled claims in 2000 was again First Health. Similar to last year, Fred Meyer enrolled the largest number of claims of any self-insurer in 2000, representing 76 percent of their accepted disabling claims, a slight drop from 1999.
There were eight active MCOs during 2000. Providence MCO again received the highest number of enrolled claims, 2,767, about 28 percent of all enrollments. This high level of business reflects the numerous contracts Providence MCO has with SAIF, private insurers, and self insured employers. Other MCOs with widespread usage are Kaiser Foundation and Oregon Health Systems.
The total number of accepted disabling claims enrolled in each MCO in 2000 changed somewhat from 1999. Providence MCO experienced a drop in enrollment of seven percent, while Oregon Health Systems reported increased enrollment of 16 percent since last year. Similar to 1999, Providence was the MCO with the highest number of enrolled claims in 2000, while Oregon Health Systems and Managed Healthcare NW had the second and third largest numbers, respectively. Both Oregon Health Systems and Managed Healthcare NW received about 90 percent of their business (i.e., enrolled claims) from SAIF in 1999 and 2000. The fourth most active MCO was First Health, which had contracts with the Fireman's Fund Group, Employers Insurance of Wausau, and Liberty Group Companies in 2000. Kaiser Foundation had the fifth highest number of enrolled claims.
If you have questions, about the information contained in this document please contact by e-mail or phone: Julie Sutton , Research Analyst, Research & Analysis Section, Information Management Division (503) 947-7349
This web page was last revised: 02/06/02.