Sedgwick Capabilities - Ohio MCO 2023

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As employers and employees have continually adapted to workforce challenges, so has Sedgwick Managed Care Ohio (MCO). For more than 26 years, we have been helping Ohio employers control medical costs, minimize lost workdays and navigate the complex medical issues involved in workers’ compensation claims.

When an employee is injured at work, our dedicated team guides our clients and their employees through the entire managed care process, resolving challenges and ensuring appropriate care along the path to recovery. No matter where the journey leads, our teams across the state are here to smooth the way and lighten the burdens, to overcome obstacles, to walk through it all together.

We are focused on ensuring injured employees recover and return to work as quickly and safely as possible. This approach has led to tangible results for our clients and their employees.

If you currently work with our company, we thank you for the trust you have placed in us. If we are not your managed care organization, I encourage you to read the following pages to learn more about our expert services, our dedication to taking care of people and the results we help our clients achieve.

Our managed care solutions simplify the claims process for our clients and their employees. We help people get the care they need, supporting effective recovery, return to work and return to life.

We are focused on:

• Simplifying the process for employers and injured employees

• Setting early expectations for treatment and return to work

• Ensuring thoughtful engagement of physicians for best medical outcomes

• Pursuing transitional and early return to work options

• Understanding our clients’ business challenges

• Keeping clients engaged in the process

As changes with staff and contacts have occurred within our company, [our account executive] has always continued to be extremely friendly, kind, knowledgeable and accessible. Even when I have made small requests for things that aren’t necessarily his job directly, or have asked questions that I’m sure he’s been asked a lot, he treats each interaction as if he is happy to talk to me and happy to help. I work with so many vendors in my position, and Sedgwick has been the most consistent, accessible vendor I’ve ever worked with. I have never had to call, wondering why I hadn’t received something from them and have never had to wonder who my contact was (this is a really big deal). They seem passionate about what they do, and they even seem to give off the impression that they don’t work with any other companies except mine.

Taking care of people is at the heart of everything we do.


I am so appreciative of how fast your company alerts and resolves issues that I could not ask for more!

We take customer service and the employer experience very seriously

• Thoughtful consultation to guide our clients toward effective stay at work and return to work options, strong outcomes for injured employees, clarity in the claims experience, and increased stability and peace of mind

• High customer satisfaction level and overall performance results, driven by our communication and focus on medical resolution and return to work



(includes more than half of all workers’ compensation claims in the state 2 )

We have expertise and resources available where you need us

• Medical management and client services teams located in four regions — Dublin, Cleveland, Cincinnati and Toledo

• 20 dedicated account executives averaging over 20 years of Ohio workers’ compensation experience, providing:

— Personal attention

Expertise in challenging industries

— Strong medical provider relationships

Accountability for all claim parties

We take pride in providing clinical resources and strategic data for our clients

• Physician-led case management with on-site medical director

• Versatile reports for trending analysis

• Convenient injury reporting, data access and claim updates

106 REGISTERED NURSES supporting clients

More than


Outstanding results

Sedgwick MCO positions employers for success by focusing on the real cost drivers in claims. Medical management with a return to work focus, and the examination of treatment trends and medical expenses ensure timely, cost-effective claims resolution.

Faster claims resolution

In addition to achieving a return to work in claims, managing claims to a medical closure is extremely important in predicting costs and premium rates. A shorter duration of medical activity is an indicator for effective medical management and declining reserve costs. We negotiate directly with medical providers to help drive faster claims resolution. Sedgwick MCO outperforms other MCOs by 15.5% in longevity of active status in current active claims4 – nearly a full year difference.

Fewer lost workdays

Our goal is to ensure a safe and efficient return to work, minimizing costs and lost workdays. We have been extremely successful in this area, especially in comparison to other managed care organizations (MCOs). For claims incurred between 2021 and 2022, Sedgwick MCO had 10.9% fewer lost workdays per claim compared to the average for other MCOs.2

10.9% FEWER lost workdays per claim2

26.8 Sedgwick MCO 2

30.1 Other MCOs 2

4.9 years

Sedgwick MCO4

15.5% shorter duration of active status claims4

5.8 years

Other MCOs 4

Exceptional medical savings

Our clients benefit from our aggressive bill review and re-pricing system. We go beyond the Ohio Bureau of Workers’ Compensation’s (BWC) fee schedule; in 2022 alone, we produced over $34.1M in medical cost reductions for clients. This represents an additional 17.2% in medical savings, making an impact on long-term premium rates.3



What this means for you

• Less time away from work lowers claim costs and reduces operational challenges

• Quick response to injuries enhances employee confidence and cooperation with policies and best practices

• We ensure all bills are accurate and review all charges to ensure employers are saving as much as possible


I have been working with this team for quite some time. What I love about them is that they keep track of the little nuances that apply to us specifically and how we like certain situations to be handled. The quarterly meetings keep me from being overwhelmed and give a bird’s eye summary of my claims to the point where I am confident that I am proceeding in the right way.

I can count on them to always be on top of things. It shows that they really work as a team and keep each other informed. When [our account executive] is out, someone quickly picks up and keeps the ball rolling without delay. I am so confident with them. They are definitely my crutch. I don’t know what I would do without Sedgwick!


Outstanding performance

Our experts focus on getting people back to work and life sooner

Lost time is the biggest cost driver in workers’ compensation claims and achieving a successful return to work is crucial to containing costs. Sedgwick MCO has outperformed other MCOs in lost days per claim since 2018.2

We care about prescription safety and the health of your employees

Inappropriate medications interfere with recovery, add significant costs and often extend lost time duration. With our team’s expertise, we successfully eliminate unneeded medications and harmful combinations of drugs for injured employees and increase savings for clients.

Our team helps your team return to work faster and reduce premiums

Effective medical management reduces costs associated with lost workdays and excessive treatment, and helps employers achieve lower premiums. Controlling claim-related costs can also help reduce their experience modification rate (EMR), which gauges past and future workers’ compensation claims costs to determine premiums. The average EMR for Sedgwick MCO clients is lower than the average for other MCOs.1

Percentage of clients with EMR under 1.0

(current rating year)

39.4% Sedgwick MCO1

24.8% Other MCOs1

Average client EMR

(current rating year)


Sedgwick MCO1

0.69 Other MCOs1

We care about your bottom line

When lost time and medical costs are contained, employers increase savings opportunities. More than 57% of our clients currently participate in discount and rebate programs that demand outstanding claim performance compared to only 42.7% of employers using other MCOs.1


[An injured employee] was not expecting her C9 to be returned so quickly. [Our client] let her know really quickly that it is due to her having a claims examiner who knows her job and addressed each claim as needed in a very timely manner!


57.3% SedgwickMCO1

42.7% Other MCOs1

15% more group/group retro employers are with Sedgwick MCO1

What this means for you

• Fewer lost workdays

• Lower claim costs related to lost time

• We help you keep your employees healthy and safe

• We work together to make the claims process as smooth as possible for everyone involved

Our clinical approach emphasizes meaningful treatment focused on recovery

We go beyond the task-driven requirements for Ohio MCOs. The return to work process requires the cooperation of everyone involved — the injured employee, treating physicians, employer and MCO. We avoid frustration by fostering clarity between all parties and pursuing the most appropriate treatment path. Our medical management approach includes:

• Emphasizing medical provider accountability

• Driving high-quality, efficient care for injured employees

• Removing barriers to accelerate a safe return to work

• Providing physician-led case management

Dr. David Kessler

• Serves as a full-time, on-site resource for medical management

• Provides ongoing insight on clinical matters

• Consults on complex cases

Our results are tangible and visible. We compare each employee’s circumstances against key data points to help predict and guide our approach to their claim, and we provide custom reports that track overall program activity and progress.

• Oversees treatment negotiations

• Collaborates with our clinical team, treating physicians and healthcare organizations

Drug utilization review (DUR)

Prescription oversight is essential for effective medical management. Medication side effects can often delay a return to work, or even endanger employees once they are back at work. Our DUR services are focused on:

• Ensuring medications are appropriate for the allowed conditions and active treatment

• Eliminating unrelated and excessive prescriptions and monitoring opioid use

• Identifying alternative, non-narcotic medications that produce fewer side effects and permit earlier return to work

• Submitting sound and well-researched DUR requests – each one is reviewed by our physician panel to ensure we facilitate the best possible outcome

• Providing detailed medication reports

What this means for you

• Clinical guidance from our expert team ensures the best possible treatment

• Our high quality service, in-depth medical insight and carefully designed solutions help get injured employees back to work as quickly and safely as possible


This partnership has enabled us to provide our employees with the necessary information to be informed of important claim information and resources to get them back to work and feeling better. We are thankful for the support and guidance that Sedgwick has been able to provide to us and our employees.

CEBS/vice president, human resources

Buehler’s Fresh Foods

Sophisticated resources to resolve complicated claims

Vocational rehabilitation

Sedgwick MCO partners with a select network of rehabilitation professionals that historically achieve the best return to work results in claims that may benefit from an enhanced rehabilitation program.

Transitional work

Most workplace injuries are relatively simple and are medically resolved in a short time. The most crucial work of a managed care organization is evident in the more complicated injuries and challenging circumstances that drive up lost time and costs. The depth of resources available through Sedgwick MCO positions us to invest extensively in the analysis of each injury to identify barriers and address challenging issues.

Accelerating the return to work is essential to cost containment and preserving valuable employees. Sedgwick MCO achieved the highest performance results among all managed care organizations for the utilization of transitional work. This is a major factor in our success in limiting lost workdays in claims.


Thank you for your continued focus on putting the customers FIRST.

Modified duty off-site

Our modified duty off-site program matches up injured employees with suitable temporary work opportunities. We help identify and oversee the transitional work process in cases where the employer is not able to easily accommodate work restrictions. Ask us about our modified duty off-site program.

Additional return to work programs

Sedgwick’s medical management team takes time to evaluate each claim to assess the need for additional resources. Programs such as remain at work (RAW), job retention services (JRS), on-site physical therapy and transitional work services (TWS) represent approaches to remove barriers to claim resolution.

What this means for you

• We leverage a wide range of tools and expert resources to help employers address challenges and resolve claims

• Our communications and thoughtful focus on medical resolution and return to work help drive our client satisfaction and overall performance results

Technology and reporting


viaOne is our convenient, online system that offers real-time access to claim information. Clients can view details on claim status, treatment, payments, providers and more. With viaOne, our clients can:

• Set alerts that include notifications related to key claim developments

• Identify watch list claims for the most relevant issues

• Access and download reports

• Easily search notes and documents


Sedgwick MCO collects and catalogs a tremendous volume of claim data, allowing us to customize reports for analysis. We also have a variety of standard reports that offer a wealth of information to help clients respond to compliance requests and meet business requirements. Some of our standard reports include:

• Prescription utilization

• Claims activity and status updates

• Claim counts and lost workdays

• Stewardship and injury trending

• Medical savings and provider activity


No matter what managed care challenges you face, Sedgwick MCO has the expertise to help you solve them.

We foster a caring culture, and an environment that offers meaningful work and enables our colleagues to feel welcomed, valued, respected and heard. We are grateful that they have rated Sedgwick as one of the greatest places to work for women and veterans, and their positive feedback has also earned us additional workplace awards.

As a part of Sedgwick, our broad resources, proven stability and expert solutions ensure we can support Ohio employers now and into the future. Through a global team of 31,000 colleagues, Sedgwick takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact performance.

Taking care of our clients and colleagues is at the heart of everything we do. The experienced team at Sedgwick MCO ensures injured employees get the care they need to recover and return to work, while helping employers control costs and navigate the managed care process. We guide them toward strong outcomes, toward clarity in the claims experience, and toward increased stability and peace of mind, even when facing bumps or curves in the road.

You know where you need to be and what you want to achieve. Sedgwick MCO can help get you there. Join us on the path forward.

1 BWC Employer Demographic Data, January 2023. | 2 BWC Public Data, 22-05025, as of 12/13/2022. Claims with DOI 2021-2022. 3 Sedgwick MCO billing data, bills processed in 2022. | 4 BWC data, rounded to nearest .1 as of 3/21/2023. Public Data Request SP23-01162. SEDGWICKMCO.COM/OPENENROLLMENT P 888.627.7586 E F 888.711.9284 Convenient injury reporting options: © 2023 Sedgwick Visit us at