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Prince William County, located in northern Virginia, provides a full
range of local government services including police, fire and rescue,
court services, libraries and parks and recreational services to
approximately 350,000 residents. Prince William County, the Adult
Detention Center and Prince William Park Authority procure casualty
insurance and workers' compensation protection through the Prince
William Self-Insurance Group Casualty Pool and Workers' Compensation
Association.
When the County embarked on a search for a new third-party administrator
in 2001, one of their primary objectives was to find a TPA that could
provide them with easy access to their claims data and detailed
information on the nature of each claim.
Providing In-depth Reporting
"With our previous TPA we had no control
over how the claims reports were written," says Lori Gray, Risk Manager,
Prince William County. "PMA Management Corp. (PMAMC) has the technology
to break our claims data down by divisions and individual locations. If
we want to run a report to find out how many workers' comp claims a
particular fire station has had, the types of injuries incurred and the
related costs, we can do that with PMA. Having access to this kind of
data has enabled us to make improvements to our safety program."
To access their claims data, the County's risk management team logs on
to PMA CINCH®, an Internet-based risk management information system that
allows them to retrieve their loss information down to the dollar,
analyze risk data, report claims and generate full-color graphs on
expenditures and trends. "We're frequently upgrading our systems and
processes to find easier ways of doing business for clients like Prince
William County," says John Waggoner, Regional Manager, PMAMC. In
addition, the County capitalizes on PMA's Internet Loss Reporting
Capability, which enables the County to report claims easily.
Containing Medical Costs
PMA Management Corp. uses a combination of
cost-saving strategies to produce exceptional results. "We provide a
very high level of cost saving services, including reviewing each
medical bill for reasonable pricing, duplicate and appropriate charges,
and bundled/unbundled services. The County's employees can also get
their prescriptions filled at local pharmacies who will direct bill PMA
electronically at discounted rates and the County has access to a large
network of medical providers who offer quality care at pre-contracted,
reduced rates," says Waggoner. "These cost-saving measures in aggregate
saved the County $614,788 or 44 percent off billed medical charges of
$1,398,684 from July 1, 2004 through June 30, 2005."
Return-to-Work Success
Prince William County and PMAMC share the
same philosophy when it comes to returning employees to work. "If you
want to have a successful workers' compensation program, you have to be
willing to provide injured employees with modified duty until they are
fully functional, and the County works very hard to make that happen,"
says Waggoner.
PMAMC makes contact with the injured worker, the medical provider and
the employer within 24 hours of receiving a claim. On cases involving
lost-work time, PMA Claims Representative Beverly Deale and Disability
Management Coordinator Mary Simpson, RN, work together to make the
three-point contacts. "I try to serve as a resource for employees by
answering any questions they have about their injuries and encouraging
them to schedule appointments and follow through with their treatment
plans," explains Simpson. "Our goal is to make sure the injured worker
receives appropriate care in a timely fashion and returns to work as
soon as it is medically appropriate to do so."
This proactive approach has lowered the County's lost work-time incident
rate by 52 percent. "We went from 3.45 lost workday cases per 100
employees prior to our contract with PMA Management Corp. to 1.65 cases
in 2005," says Prince William County Risk Manager Lori Gray. "A lot of
the credit for our program's success goes to Mary and Beverly for their
thorough investigation and communication with regard to our claims."
Focus on Communication
PMAMC and County representatives meet
quarterly - and sometimes more often - to discuss pending claims and
strategies for moving the cases forward. "We also meet annually to
present the County with a stewardship report that provides claims and
risk management information with costs and savings breakdowns by year,"
says Waggoner, "but the key to our success is in the day- to-day
communication between our claims team and the risk management team in
Prince William County. Taking time to discuss the best way to handle a
claim or the pros and cons of moving one direction or another for a case
are keys to building a successful relationship and ensuring that every
situation is handled in the best possible way."
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