Sedgwick CMS Medical Provider Network To Leverage Benefits Of California Workers' Compensation Reform

MEMPHIS, Tenn., Nov. 16 /PRNewswire/ -- Sedgwick Claims Management Services, Inc. (Sedgwick CMS) has established a new medical provider network to optimize the economic benefits available to California employers through the medical control provisions of SB899, the state's recently approved workers' compensation reform legislation.

Beginning January 1, 2005, California employers may in most situations direct employees to a pre-designated list of service providers for all treatments of job-related medical conditions without limit as to the length of the treatments. Geared to the unique California regulatory and medical environment, the Sedgwick CMS California Medical Provider Network (MPN) is designed to deliver prompt, competent and appropriate treatment of occupational injuries; and expedited, sustainable return of injured workers to productive activity.

The Sedgwick CMS California MPN is unmatched among major company MPNs in its extensive screening of candidate providers based on both economic impacts and treatment outcomes. The process first evaluates primary care physicians, specialists and other medical service providers in terms of:

   -- Experience in occupational health or sports medicine
   -- Demonstrated effectiveness in disability management
   -- Capability to involve both employees and employers in treatment
      programs
   -- Ability to evaluate and communicate physical capacities and
      restrictions in establishing appropriate transitional work assignments
      for recovering workers
   -- Understanding of the workers' compensation system
   -- Conformance with evidence-based guidelines of the American College of
      Occupational and Environmental Medicine and the Official Disability
      Guidelines

Candidate providers are further scored on detailed metrics for economic and treatment outcomes. Examples of a few of the metrics used in this scoring process are length of patient recoveries (average lost days), average paid per claim, speed and frequency of referrals to specialists and physical therapists, and patient satisfaction as reflected in percent of cases resulting in litigation. Consideration is given to peer benchmarking and the particular difficulty of cases under specialist care. Final selections reflect consultations with employers, nurse case managers and claims examiners. Sedgwick CMS goes well beyond conventional processes to identify the right people and resources for the job.

Sedgwick CMS will assure the ongoing performance and continuous improvement of its MPN through regular provider scorecards, patient satisfaction surveys, employer reviews, and support for providers including training and informational resources and feedback on outcomes. Adjustments to the dynamic network will be made based on client requirements and provider performance.

Sedgwick CMS has teamed with Concentra(R), a leading national healthcare services management organization, to identify an ample network of qualifying providers for the Sedgwick CMS MPN and monitor their ongoing results. Individual employers may add the California health centers of Kaiser On-the- Job(R) to their program by electing the Sedgwick CMS Extended MPN. Kaiser On- the-Job is the occupational health specialty arm of Kaiser Permanente, the largest U.S. nonprofit health plan and delivery system.

Sedgwick CMS makes participation in its California MPN more convenient for clients by offering training webinars; extranet access to forms, instructions and sample employee communications; and an application package for the filings employers or their insurance carriers must make with the California Administrative Director for approval of their MPN designation.

"General healthcare networks are not designed to deal with specialized occupational health issues," said Sedgwick CMS President and Chief Executive Officer David A. North. "California has authorized promising utilities for addressing the multi-billion dollar failures of its workers' compensation system. The challenge now is effective implementation. We recognize that best practices in occupational medicine and return-to-work therapies will produce superior economies for California employers and healthier lives for employees."

Sedgwick Claims Management Services, Inc. is the leader in innovative claims and productivity management solutions. Sedgwick CMS provides cost- effective claims administration and related managed care, program management and allied services to major employers through the expertise of 3,500 colleagues in more than eighty offices in the U.S. and Canada. Specialty areas include workers' compensation, short and long-term disability, and other absence management programs; and general, auto and professional liability. Sedgwick CMS designs and implements customized programs based on proven practices that meet client needs. For more visit http://www.sedgwickcms.com/ .

Contact: Frank J. Huffman, director of corporate communications, Sedgwick Claims Management Services, Inc., (901) 415-7548, fhuffman@sedgwickcms.com.

Sedgwick Claims Management Services, Inc.

CONTACT: Frank J. Huffman, Director of Corporate Communications ofSedgwick Claims Management Services, Inc., +1-901-415-7548, orfhuffman@sedgwickcms.com

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