Contract provisions to ensure quality in workers' compensation managed care arrangements

Various strategies can be used for holding managed care organizations (MCO) accountable for providing high-quality patient care. Accountability measures are particularly important in the provision of care under workers' compensation (WC) insurance because employers and insurers, rather than patients, generally design and select the managed care plan. Potential approaches for ensuring the quality of medical care for injured workers include state protective legislation, certification and accreditation standards, and credentialing and licensing of providers. Another approach is explored: quality-of-care provisions in written contracts between purchasers and workers' compensation MCOs. A survey of 21 existing contracts from 12 states are reported on to determine the extent to which quality-of-care is currently being addressed. The policy implications and relevance of the study to state regulators are discussed.