1. What do Injured Workers Think of Their Medical Care? Kathy Dervin, M.P.H. DWC Managed Care Program May 1, 2003

2. Health Care Organizations Workers’ Compensation health plans certified by the state DWC - rapid growth in 2002-2003 Must meet standards for network access, UR, case management, quality review, H&S reporting, grievance system, RTW coordination and annual data reporting Employers using certified HCO have additional duration of medical control (90- 180 days)

3. Kaiser Foundation Health PlanHMO Med Ex Health CareWCHCPO CompPartners DirectWCHCPO CompPartners AccessWCHCPO CorVel CorporationWCHCPO CorVel Select HCOWCHCPO MedEx2 Health CareWCHCPO Sierra Health and LifeDisability Ins. Sierra Health and Life Disability Ins. Health Net/Comp America PrimaryWCHCPO Health Net/Comp America SelectWCHCPO Intracorp HCO Plan AWCHCPO Intracorp HCO Plan BWCHCPO Prudent Buyer HCODisability Ins. *WCHCPO: Workers' Compensation Health Care Provider Organization 14 Certified Health Care Organizations (As of April, 2003)

4. HCOs and Patient Satisfaction As part of quality improvement and patient review of care, HCOs must use standardized patient satisfaction survey provided by DWC (DIR Rule 9777 (e) DWC worked with UC Berkeley Survey Research Center to develop pilot and administer a specialized WC Patient Survey of satisfaction with medical care and outcome (1995-1998) Pilot test (1996) and survey administration (1998)

5. What Do Injured Workers Think of their Medical Care and Outcome Following Work Injury? Administered both mail survey (96 pilot test) and telephone survey (98) Telephone survey of 813 injured workers drawn from a sample of : –24 hour pilot program –Pacific Business Group on Health members –HCOs –Non-HCO managed care plans

6. Survey Areas Anchoring in work-injury episode of care Access to care, type of providers seen Satisfaction with doctor-patient interaction Overall satisfaction with care Doctor’s occ medicine orientation Self report of pain and functional outcomes (including satisfaction with RTW process) Respondent characteristics and open ended question

7. Survey Results Response rate = 61% Representative of injured worker population Reported injuries predominantly sprains and strains of back/upper extremities Overall satisfaction rate –very satisfied/somewhat satisfied = 76.5% –very dissatisfied/somewhat dissatisfied = 27%

8. Survey Results (cont’d) Key issues by subgroup and process of care –Latino, Spanish speaking workers much less satisfied with communication and doctor- patient interaction –Substantial, ongoing problems with impact of the work injury due to pain, 6-8 months post injury, reported by large number of respondents –Respondents with upper extremity nerve disorders report poor post-injury function

9. Percent excellent or good patient ratings of providers How well provider listened 77.8% Showed courtesy and respect 79.5 Explained things understandably 70.3 Examinations careful/thorough 63.7 Figured out diagnosis and what to do 64.9

10. Patient Report on Occupational Medicine Behaviors (%) Talked about job tasks some/a lot71.2% Understood job very/fairly well79.0 Understood impact of injury on ability to perfom job (very good/excellent)61.3 Talked some/a a lot about work restrictions to return to work67.5 Suggested job changes to help heal72.7 Told how to avoid reinjury64.0

11. Self reported pain* after work injury Pain frequency: –all the time/constant12.9 –Almost everyday17.2 –Several time a week13.1 –Once in awhile29.2 –Not at all27.6 –** pain due to this work injury

12. Self reported pain* after work injury Pain interferes with my life –all the time12.6 –much of the time15.3 –some of the time51.1 –none at all21 –** pain due to this work injury

13. % High satisfaction with doctor- patient interaction (very satisfied or satisfied African American respondents57.3 White68.6 Latino42.6

14. Using Patient Satisfaction Results to Target Quality Improvement HCOs must meet specific quality of care standards set by DWC HCOs have stable population of patients for 90- 180 days of care (compared to 30 days) HCO care is delivered in-network by providers under contract with HCO HCOs must have nurses case managers, customer service, 800#s and grievance process which all help to solve problems as they arise

15. Using Patient Satisfaction Results Results provide feedback to organized system of care like an HCO Identify areas of low satisfaction –provider level (communication, patient understanding, access, knowledge of occ med) –system level (case manager, administration) –outcomes (RTW, pain, daily functions) –employer interaction (esp on RTW process)

16. Challenges in Collecting Patient Satisfaction Data How do we fund ongoing survey administration and analysis ? –Mail survey (lower cost, lower response rate, literacy issues, language issues) –Telephone survey (higher cost, higher response rates) –Who should pay ? state? HCOs? Purchasers? –Get buy-in from purchasers to value and use results

17. More Challenges –Methodological issues: sample selection, timing or survey, adjusting for different mix of patients, injuries industry, employer size. –HCO system is one example, but what about outside a stable managed care network where control and care is quite variable? –Reporting results to employees, unions, purchasers in a way they will use.

18. AB 749 Provisions on Quality DWC to look at: –performance measures for workers’ comp medical care –quality indicators –  patient satisfaction  –case management to promote RTW

19. Where do we go from here? Need to see patient satisfaction as part of broader quality of care improvement effort Need stakeholders to embrace satisfaction survey as important measure of patient view of care/outcome What survey should we use? DWC survey ---> development of national survey by URAC, at least for managed care plans Survey needs to be available minimally for English and Spanish speaking workers