Item C21
KevlseC11.I':J)
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 7/12/00
Division:
MANAGEMENT SERVICES
Bulk Item: Yes X No
Department: HUMAN RESOURCES
AGENDA ITEM 'VORDING:
Board of County Commissioner's approval of contract with CorVel Corporation for Managed Care
Services in accordance with Florida Statute 440.134.
ITEM BACKGROUND:
At the 1/19/2000 BOCC meeting the Board gave approval to go out for bids for managed care for the
workers' compensation program.
PREVIOUS RELEVANT BOCC ACTION:
Monroe County has had a contract with VINCAM/OHS effective since 1/1/97.
STAFF RECOMMENDATIONS:
APPROV AL
TOTAL COST: $30,000.00 yr.
BUDGETED Yes X No
COST TO COUNTY: $30,000.00 yr.
REVENUE PRODUCING: Yes
No X AMOUNT PER MONTH
Year
APPROVED BY: County Atty
OMB/Purchasing
Risk Management _
DIVISION DIRECTORAPPROVAL~ ~~~
James L. Roberts, County Administrator
DOCUMENTATION:
Included X
To Follow Not Required
AGENDA ITEM # lD I
DISPOSITION:
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with:CORVEL CORPORATION Effective Date: 10/0112000
Expiration Date:9/30/2001
Contract PurposelDescription:TO PROVIDE MANAGED CARE SERVICES FOR THE
WORKERS' COMPENSATION PROGRAM IN ACCORDANCE WITH F.S. 440.
Contract Manager:NANCY COHEN
(Name)
4449
(Ext. )
MANAGEMENT SERVI #1
(Department) I Courier Stop
for BOCC meeting on 7/26
Agenda Deadline: 7/12
CONTRACT COSTS
Total Dollar Value of Contract: $30,000.00 Current Year Portion: $Q
Budgeted? Yes[8J No D Account Codes: 501-07502-530-340-Q
Gran t: $
County Match: $
ADDITIONAL COSTS
Estimated Ongoing Costs: $ _/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Division Director
Changes ~
Needed - . V
YesDNo~ --------=
--
Date Out
County Attorney
.:3000 YeSDNO~~_~
1r;3~[ YeSDNo.,-~~~ 0 ~~.
"1I/1lfrd YesD NO~
. I
.~
~oo
7 -/3 -00
r
r-r2-r!b
Risk Management
O~.lPurchaSing
Comments:
OMS Form Revised 12/13/99
I
CarVel
Thursday, July 06, 2000
Mr. Sidney Webber
Interisk Corporation
1111 N. West shore Blvd., Suite #208
Tampa, FL 33607
Re: CorVel Corporation Florida Managed Care Arrangement
Service Agreement
Dear Mr. Webber:
Please find enclosed the final draft copy of our revised Managed Care service
agreement. Please note that I added to the last page a place to have ISAC the third
party claims administrator sign, and on the first page under the first paragraph, our
standard AHCA language to include ISAC. The reason for the addition ofISAC is for
the state's approval. When we file an amended AHCA application, they will require a
three party signed agreement. Thus, we can use this agreement for both purposes --
Monroe County and AHCA filing.
If you can think of any further questions, please do not hesitate to call me at 1-800-
229-4637 ext. 3025. We are looking forward to serving the needs of Monroe County.
Sin~tJ~
Amy Wellman
Account Executive
Enclosure: Final Draft of Service Agreement
cc: Ms. Nancy Cohen, Workers' Compensation Manager
Monroe County
5100 College Road, Rm #207
Key West, FL 33040
Advocating CareSM
WORKERS' COMPENSATION MANAGED CARE
SERVICE AGREEMENT
FOR
Monroe County
THIS AGREE1\.ffiNT made and entered into effective October 1, 2000 between CorVel
Corporation whose principal offices are at Irvine, California, hereinafter referred to as "CorVel"
and Monroe County, herein referred to for the purpose of this agreement as "Monroe County"
with principal offices located in Key West, Florida. Monroe County and its Third Party
Administrator, ISAC, and CorVel Corporation as the managed care network have read and
understand the Managed Care Plan of Operation as submitted for Monroe County.
WITNESSETH that
WHEREAS CorVel operates a managed care business which provides First Report of Loss
PreparationIFiling/Transmission services hereinafter referred to as "First Report Services;" and
Early Intervention Case Management services, hereinafter referred to as "Early Intervention;"
Outpatient and Inpatient Utilization Review services, hereinafter referred to as "Utilization
Review;" medical audit and review services hereinafter referred to as "MedCheck;" and on-site
medical case management and vocational rehabilitation services, hereinafter referred to as "Case
Management;" and
WHEREAS Monroe County desires to employ CorVel from time to time, to provide said services
for the benefit of Monroe County and/or the benefit of its insureds and/or their injured employees;
and
WHEREAS CorVel desires to be so employed by Monroe County to provide said managed care
services.
NOW, THEREFORE, in consideration of the premises hereof, and the mutual promises and
agreements made herein, the parties hereto, intending to be legally bound, hereby agree as
follows:
OBLIGATIONS OF CORVEL
1. FIRST REPORTIEARL Y INTERVENTION SERVICES
1.1 CorVel shall provide First Report services set forth herein to Monroe County on a non-
exclusive basis upon receipt by CorVel of specific requests from Monroe County. Prior to
the implementation of Cor Vel services and as required during the term of this Agreement,
Monroe County shall provide CorVel with instructions regarding the scope and extent of
the First Report and Early Intervention services to be performed by CorVel.
1.2 CorVel shall receive telephone calls from Monroe County, its insureds, and/or their
employees via a toll free 1-800 number, to gather the information required to complete the
First Report of Loss forms.
1.3 CorVel shall maintain at all times sufficient staff to handle all incoming calls within
established quality assurance standards. Furthermore, CorVel shall be prepared to
complete First Report of Loss forms for all applicable states.
1.4 Once the appropriate information is gathered by a CorVel representative, First Report of
Loss forms will be submitted to the applicable Monroe County branch claim office or if
desired, to a central Monroe County location and/or if desired, the applicable state
industrial accident board or commission as required by law. Whenever possible, this
information shall be electronically transmitted to the applicable state industrial accident
board or commission. Furthermore, CorVel will submit this information in a format
acceptable to Monroe County.
1.5 Any questions or concerns from an industrial accident board or commission concerning
First Reports of Loss completed by CorVel will be handled directly by CorVel. All
complaints will receive an initial response within 24 hours of receipt of the complaint by
CorVel. CorVel will keep Monroe County apprised of any complaints it receives and the
response thereto. CorVel will send a written response to the complainant within five
working days outlining the nature of the complaint and the resolution of same by Cor Vel.
A copy of this response will be sent to the attention of the designated Monroe County
representative. The parameters of CorVel's authority hereunder must be established in
consultation with and subject to the express agreement of Monroe County. Further,
Monroe County shall have the right, but not the obligation, at any time, to interject itself
into the dispute between CorVel and the industrial accident board or commission and to
resolve the dispute in a manner acceptable to Monroe County at its sole discretion.
1.6 Cases identified during the First Report of Loss process as meeting the criteria for Early
Intervention services, will be referred on a case by case or automatic basis (at Monroe
County's preference) for such services. The criteria for referral, i.e., lost time cases or
other predefined criteria, will be established by Monroe County in consultation with
CorVel. Direct referral from Monroe County field offices for Early Intervention services
involving cases that are not referred via the First Report of Loss service may also occur.
The Early Intervention service components for lost time claims include:
1. An initial contact with employeelemployer to gather data for first report of injury
preparation/submission (optional).
2. The channeling of patients to PPO network providers.
3. A multi-point (employee, employer, claims handler, provider) contact to gather
medical and treatment plan data.
4. A review of the provider treatment plan to determine medical appropriateness and set
outpatient treatment parameters.
5. A CorVel RN Case Manager completes an assessment report with recommendations
for submission to Monroe County within two weeks. These recommendations will
outline the next course of action (e.g., medical management, utilization review, lME,
vocational rehabilitation, etc.), ifwarranted.
The Early Intervention service for med-only claims include:
1. Initial contact with employeelemployer to gather data for first report of injury
submission, if required.
2. Channel patient to PPO network.
3. Contact employee, and if necessary, the treating physician to gather sufficient
information to determine potential for serious and/or lost time situations.
4. Confirm med-only status or recommend additional intervention as required
1.7 All other aspects of CorVel's first reportlearly intervention services not addressed herein
shall be provided in accordance with CorVel's service proposal and/or marketing
materials.
2. UTILIZA TION REVIEW SERVICES
2.1 CorVel shall provide utilization review services set forth herein to Monroe County on an
non-exclusive basis upon receipt by CorVel of specific requests from Monroe County.
During the term of this Agreement, Monroe County shall provide CorVel with instructions
regarding the scope and extent of the utilization review services to be provided.
2.2 Aided by CorVel's proprietary outpatient medical treatment protocols and "Expert
Systems" technology, our utilization review nurses evaluate proposed treatment plans for
appropriateness, care setting, and duration of care. If treatment is "certified," the provider
is advised of the length of treatmentlnumber of visits that are being authorized. When
utilized in conjunction with our MedCheck provider bill review program, actual treatment
rendered is monitored on an ongoing basis to assure compliance with pre-authorized
treatment. Services rendered which exceed established parameters are disallowed at the
time the bill is reviewed for Fee Schedule or U&C compliance. Monroe County will be
provided with a monthly out patient utilization review report which will document
projected savings.
2.3 The CorVel pre-admission certification program is a review service which verifies the
medical necessity of proposed hospital admissions and determines the appropriate length
of stay. The CorVel staff of utilization review nurses and reviewers, assisted by an
automated medical rules/protocols system and backed up by physician consultants,
individually evaluates every hospital admissions request.
Pre-certification objectives include the following:
- determine appropriateness of proposed treatment plan.
- determine the medical necessity for hospital admission/inpatient care.
- explore alternatives to inpatient treatment.
- prevent unnecessary inpatient hospitalizations and save customer dollars.
- if inpatient care is required, determine the appropriate length of stay and monitor the
patient's condition throughout the hospitalization to prevent unnecessary inpatient days.
- channel the patient to a CorVel PPO provider/facility.
- develop and implement a timely discharge plan.
- educate the employer and employees regarding physicians and services available, the
claims process, and how utilization review is implemented so that good decisions
regarding medical care and services can be made at the time of injury.
Documentation of all utilization review activities in the form of written correspondence
shall be communicated to the referring claim professional. A monthly savings summary
that documents all inpatient and outpatient hospital admissions shall also be provided to
Monroe County.
2.4 All other aspects of CorVel's utilization review services not addressed herein shall be
provided in accordance with CorVel's service proposal and/or marketing materials.
3. MEDCHECK
3.1 MedCheck shall provide hospital and medical bill audit/review services set forth herein to
Monroe County on a non-exclusive basis upon receipt by MedCheck of specific requests
from Monroe County. During the term of this Agreement, Monroe County shall provide
MedCheck with a copy of the bill(s) to be audited, along with instructions regarding the
scope and extent of the audit to be conducted by MedCheck.
3.2 The audit, if performed by MedCheck on-site at the local Monroe County branch claim
office, shall be completed within 48 business hours from receipt by MedCheck, unless
MedCheck requires additional time due to information deficiencies beyond its control. If
service is provided on a mail-in basis, bills shall be processed and mailed to Monroe
County within 3 to 5 days of receipt by MedCheck unless MedCheck requires additional
time due to information deficiencies beyond its control.
3.3 MedCheck will be responsible for monitoring and "flagging" duplicate billings of medical
bills. Any bills previously audited will be returned to Monroe County with a notation that
the returned bill is a "duplicate" or has been previously submitted and/or audited. There
will be no charge to Monroe County for total duplicate bills, however partial duplicates
covering new dates of service are charged.
3.4 Any conflicts or complaints from medical providers concerning bill audits completed by
MedCheck will be handled directly by MedCheck. All complaints will receive an initial
response within 24 hours of receipt of the complaint by MedCheck. MedCheck will keep
Monroe County apprised of any complaints it receives and the response thereto.
MedCheck will send a written response to the complainant within five working days
outlining the nature of the complaint and the resolution of same by MedCheck. A copy of
this response will be sent to the attention of the designated Monroe County representative.
The parameters of MedCheck's authority hereunder must be established in consultation
with and subject to the express agreement of Monroe County. Further, Monroe County
shall have the right, but not the obligation, at any time, to interject itself into the dispute
between MedCheck and the service provider and to resolve the dispute in a manner
acceptable to Monroe County at its sole discretion.
3.5 MedCheck will, at Monroe County's preference, provide Monroe County with on-site
MedCheck personnel to handle the services described in Sections 3.1 through 3.4.
Monroe County will provide MedCheck with sufficient office space to conduct MedCheck
services on Monroe County's behalf without charge to MedCheck, the location of which
space shall be determined by Monroe County. All arrangements for telephone and office
space must be made through Monroe County.
3.5.1 CorVel will be responsible for the provision and installation of its computer equipment in
all applicable Monroe County field claim offices where "on-site" bill processing service is
established. Installation and all related hardware and teleconnnunications costs are to be
borne by CorVel.
3.5.2 Monroe County may, from time to time, implement rules and regulations designed to
protect the building, its contents, and occupants where MedCheck's employees are
located. MedCheck shall cause its employees assigned to the building to be fully aware of
said rules and regulations and adhere to them. Any MedCheck employee who violates
said rules and regulations may be removed from the premises by Monroe County.
3.5.3 Monroe County shall at all times have the right of entry into, and exclusive control over,
the areas occupied by MedCheck personnel provided however, that Monroe County will
not, unless necessary, exercise such control so as to unreasonably interfere with the
performance of the obligations ofMedCheck under this Agreement.
3.5.4 At all times, MedCheck will provide at a minimum, off-site, telephonic supervision for all
of its personnel located on or within Monroe County claim operations.
3.5.5 MedCheck assumes responsibility for the activities of its employees and personnel while
they are present at Monroe County's premises. The supervisory personnel provided by
MedCheck shall have full authority over MedCheck personnel and shall be responsible for
the activities ofMedCheck personnel on the Monroe County premises.
3.5.6 MedCheck hereby agrees to indemnify and hold hannless Monroe County and its officers,
directors, and employees from and against any and all losses, claims, damages, or
expenses, including attorneys' fees, arising from injury caused by the negligence of
employees of MedCheck on Monroe County's premises, including injuries suffered by
MedCheck personnel which may occur on Monroe County's premises; provided however,
that Monroe County shall not be held harmless pursuant to this section 3.5.6 for its gross
negligence or willful misconduct or that of its employees or officers.
3.6 CorVel shall provide its Preferred Provider Networks as an integrated component of
MedCheck for the benefit of Monroe County, its insureds and their employees during the
term of this Agreement as outlined in MedCheck service descriptions.
3.7 In those jurisdictions where MedCheck cannot provide a suitable Preferred Provider
Organization (PPO) to Monroe County, MedCheck shall make best efforts to
accommodate an alternate PPO selected by Monroe County. Monroe County shall make
best efforts to create the ability for MedCheck to integrate the provider identification and
discount information into its bill review system.
3.8 As CorVel continues to expand its PPOs through the development of proprietary
networks, Monroe County will be notified of their availability in writing and shall be
provided immediate access to them, replacing the then-current PPO, if applicable.
3.9 In the case of hospital bills, CorVel shall pre-screen all bills to determine the need for
audit. Pre-screening services shall be provided at no charge to Monroe County. PPO
related hospital bills shall be pre-screened prior to PPO repricing to determine the need for
audit. Where applicable, CorVel shall provide the appropriate hospital bill audit services
involving both PPO and non-PPO providers.
3.10 CorVel agrees to supply Monroe County, at no additional cost, and in accordance with
Monroe County's specifications, a transmission or tape reflecting the results of its bill
review activities which would permit Monroe County to automatically generate provider
reimbursements. Such data shall be provided as to further allow for the application of
MedCheck fees to the individual claim file, the preparation of insured specific savings
reports and the reimbursement of MedCheck fees, or other applications at Monroe
County's discretion.
3.11 All other aspects of Cor Vel's bill review services not addressed herein, shall be provided in
accordance with CorVel's service proposal and/or marketing materials.
4. CASE MANAGEMENT
4.1 CorVel shall provide medical case management and vocational rehabilitation services set
forth herein to Monroe County on an non-exclusive basis upon receipt by CorVel of
specific requests from Monroe County.
4.2 CorVel defines case management as the establishment, coordination and control of the
treatment, direction, support, and assistance given to the injured worker from the onset of
injury through medical stability, to maximum medical improvement to return to work.
Actual case management services are dictated by both statutory and Monroe County
requirements.
The case management process will generally consist of the following steps:
Infonnation gathering
Data validation/assessment
Plan development
Plan implementation
Plan follow through and outcome assessment
Ongoing, timely reporting
The following medical case management services may be utilized:
(800) early referral/access systems
Patient assessment
Disability evaluation
Medical care coordination
Discharge planning
Catastrophic case management
Long term care assessment
Life care planning evaluations
Telephonic or on-site service deliyery
4.3 Examples of the various services provided in vocational rehabilitation are listed below.
These services are available on an unbundled or integrated basis as dictated by the
requirement of each case and Monroe County preference.
- Early return to work programs
- Vocational assessments
- Job analyses
- Job-seeking skills training
- Job development
- Job placement
- Expert testimony
- Labor market surveys
- Automated transferable skills analyses
- Vocational testimony
- SSDI benefit procurement
4.4 All other aspects of CorVel's case management services not addressed herein, shall be
provided in accordance with CorVel's service proposal and/or marketing materials.
5. INSURANCE
5.1 CorVel, at its sole expense, agrees to maintain, at all times during the term of the
Agreement, the required professional liability, errors and omissions, workers'
compensation, general, and auto liability insurance coverages as set forth on the
Certificates ofInsurance attached hereto as Exhibits "c" and "D." The insurance policies
in question shall provide that at least sixty (60) days prior written notice of cancellation,
change, amendment or exclusion in any of the insurance coverages required hereunder
shall be given to Monroe County.
6. OBLIGATIONS OF Monroe County
6.1 Monroe County will utilize its best efforts to ensure that its Third Party Adminstrator
utilize CorVel's CorCare Network for repricing and discounting of all PPO provider bills.
6.2 All hospital bills shall be pre-screened by CorVel to determine the need for audit. Should
Monroe County agree that an audit is applicable, Monroe County shall refer the bill to
CorVel for such services.
6.3 Monroe County shall pay CorVel for services as displayed in Attachment "A" (Fees for
Services) rendered within thirty (30) days of the date of receipt by Monroe County of an
invoice from CorVel.. CorVel charges are as set for in the Request for Proposal "Fees
For Services". Prices will remain firm for the first award year. Subsequent contract
renewal years will be subject to CPI increases not to exceed 5% per year.
7. TERM AND TERMINATION
7.1 The term of this Agreement is for a period of one (1) year from its effective date with two
one year renewals at the sole discretion of Monroe County.
7.2 This Agreement may be terminated without cause by CorVel or Monroe County upon
ninety (90) days written notice.
7.3 This agreement can be terminated by CorVel or Monroe County for cause upon sixty (60)
days written notice, i.e. if either party materially breaches this Agreement or fails to abide
by its obligations hereunder, and such breach continues for thirty (30) days from the date
written notice is given to the breaching party specifying the nature of the breach.
8. MISCELLANEOUS
8.1 CorVel, at all times hereunder, is acting as an independent contractor. Personnel supplied
by CorVel shall be employees of CorVel and will not be for any purpose employees or
agents of Monroe County. CorVel assumes full responsibility for the actions of such
personnel while performing services pursuant to this Agreement and shall be solely
responsible for the payment of salaries, wages, and benefits.
8.2 Each party agrees to hold in confidence any information obtained by it relating to the
business of the other and agrees to instruct its agents, employees, representatives, and
independent contractors to keep all such information strictly confidential. Each party
agrees that it will not directly or indirectly disclose, communicate, divulge, furnish to, or
use for the benefit of itself, or any other person, firm or corporation, any of the trade
secrets, designs, improvements, inventions, data, information, know-how, or other things
belonging to the other, or the designs, ideas or processes of manufacture of any product or
article sold or distributed or any service provided by the other which may be
communicated to it or which it may learn by virtue of its activities under this Agreement.
8.3 During the term of this Agreement and for a three-year period after the termination of this
Agreement, Monroe County shall be entitled to conduct an audit of CorVeJ/MedCheck
files related to Monroe County accounts. CorVellMedCheck will make its files available
for audit by Monroe County at a time and place that is mutually agreeable to both parties.
CorVeJ/MedCheck will make any and all Monroe County files available for audit.
8.4 In the event of invalidity of any provision of this Agreement, the parties agree that such
invalidity shall not affect the validity of the remaining provisions of this Agreement.
8.5 This Agreement contains the entire contract between the parties, as to the subject matters
hereto, and may not be waived, altered, or modified except by written agreement of the
parties. Any interpretation ofthis contract shall be governed by Florida statutes and laws.
IN WITNESS WHEREOF, CorVel and Monroe County have caused this Agreement to be
executed by the persons authorized to act in their respective names.
Monroe County
CORVEL CORPORATION
BY:
BY: ~d)~
Amy D. Wef1man
Account Executive
TITLE:
DATE SIGNED:
DATE SIGNED: ~ ~ ~
f
ISAC
BY:
TITLE:
DATE SIGNED:
APPROVED AS TO FORM
G F.'
Y
Attachment "A"
FEES FOR SERVICES
1. CorCare PPO Access Fee 23% ofPPO savings
* Capitated Rate Available Upon Request
( This fee is applicable in addition to per claim or flat fee structure)
* CorVel welcomes the opportunity to discuss a capitated fee for network access. Additional information is
necessary for this type of proposed fee structure.
2. Early Intervention - Per Claim Pricing
* Optional: Annual Flat Rate Pricing is Available
Lost Time Cases
$280/case I 30 days
Multi-point (employee, employer, ISAC adjuster, provider) contact to gather and communicate
treatment plan data.
Review provider treatment plan assisted by automated software system to determine
appropriateness of plan.
Make recommendations to assist in the determination of the next course of action (e.g., case
management, IME, vocational rehabilitation, etc.) to complete the early intervention phase.
Enter medical notes I recommended treatment into the ISAC claims system.
Medical Only Cases
$IOO/case / 30 days
Contact employer I employee to gather sufficient information to detennine potential for
serious and/or lost time situations.
Conftrm med only status or recommend additional intervention if necessary.
Review treatment plan and determine appropriateness of medical care.
3.Utilization Review Services Include:
Pre-Admission Review, Concurrent Stay Review
and Discharge Planning
$140.00/case
4. Medical Case Management
Telephonic - hourly fee
* Flat Rate Available Upon Request
On-Site - hourly fee
$68.00Ihour
$68.00 /IRS mileage rate
(mileage prorated
whenever possible)
5. Vocational Rehabilitation Services
$68.00 per hour
IRS mileage rate
(mileage prorated
whenever possible)
6. First Notice of Loss
Includes state submission
$25/FNOL
7. Peer Review I IMEs
$175 + Physician fee
8. Medical Bill ReviewlFee Schedule *
Includes sendbacks, duplicates and provider inquiries
$1.30/line (no line min)
9. Nurse Review
$68/hour
Medical Bill Review will be provided by ISAC; therefore, eliminating any per line charge. Our CorVel
PPO network discounts are already downloaded into the ISAC fee schedule bill review system. The
ISAC claims system will be utilized, thereby eliminating any online computer linking costs.
For basic AHCA compliance, Monroe County may elect our PPO lease at 23% of savings, which
will include PPO and CorCare channeling, grievances, quality assurance, educational materials,
provider recruitment and provider credentialing. All other services listed may be elected as
optional items.
07/13/2000 12:54
8132871041
HHERISf':
PAGE 01
INTERISK CORPORATION
Con3ulllmts
Risk ~~cncnt
Employee Benefits
1111 NortlJ Westshore Boulevard
Suite 208
Tamjlil, Fl.. 33607-4711
FAX COVER SHEET
DA TE:
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FAX #; L~05 - !J/15-1./3o/
# PAGES: 10
TO:
FROM:
k 0-klliA
PHONE #: (813) 287.1040
Interisk COfDoration
FAX #:
(813) 287.1041
SUBJECT: [.(flIJ)nhoil ~ '-fr)a.rA~'d (}up I2p~
MESSAGE ~ t:::; ~~ 1 fr:ir
gvLGtlEia> - j2~1fM)l- ;pD tw.
The information disclosed in this fao;imile is intended for the use or the addressee only. If you are not the
intended recipient nor the perwn responsible for delivering this to the intended recipient please notify us
"is telephone and return the original copy of the transmission to us via U.S. Mail. Distribution 91 this
facsimile is prohibited
07/13/2880 12:54
8132871041
HHERISf<
PAGE 02
MONROE Cm,JNTY
Ev ALUATlON OF MANAGED CARE Pll~
JUNE 2000
Monroe County's Managed Care progr-am has been successfully re-l1lMketed. The process ~
in mid April with the distribution of detailed bid specifications, providing interested proposerS
with the necessary information to submit a proposal. The specifications indicated that the County
would receive written requests for additional information until May 15" and that an addendum to
the specifications responding to the requests would be issued if needed. No such requests were
received, therefore no addendum was issued.
Proposers were instructed that their sealed submissions must be received by May 31" when they
were officially opened in accordance with the County's purchasing policies. A total of eleven
(11) companies submitted proposals which represents the majority of Managed Care firms within
the State of Florida.
Each proposal was reviewed in detail and the attached spreadsheet comparison of then major
features v."aS prepared. It should be noted that most of the proposers offered multiple pricitlg
structures. To facilitate the review process only the proposal that was in the best interest. Of~8
County has been displayed in the comparison. Following is a narrative review of each propoSal
sub~tted.
Amerisrs
Amerisys submitted a proposal that responded to all the requested services requested by the
County. Multiple pricing options were offered. Amerisys proposed using the CCN network of
providers that is offering fees betv1een $% and 15% below the State mandatory fee schedule. \
Arnerisys most competitive pricing structure included $95 per Medical Only claim and $320 for
each Lost Time claim. for these fees, Amerisys would provide Managed Care services for a.
period of 120 days. If the claim renuined open for a longer period, additional monthly fees of
$15 for Medical Only and $50 for Lost Time claims would apply. In addition, ~risys wO\l).d
retain 30% of all PPO reductions as a network access fee. Amerisys would aJso charge $25 for
each Notice of Injury prepared. The County would also be responsible for a $25 per ~
transmission fee.
A review of the CeN network indicated that a number of medical providers currently usedhy the
County are not members of the network. This coupled with the unfavorable pricing structure
resulted in Amerisys being eliminated from further cons.i~tion.
Care Manarement SV5tcms
Care Management Systems (eMS) did not offer aU the services requested by the County since
they proposed using Choice Managed Care network, which does not offi,I" PPO discounts. CMS
proposed a per claim fee of$325. Their proposed fee coupled. with the fact that no provi,der
discounts would be available resulted in eMS being eliminated from further consideration.
07/13/2000 12:54
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PAGE 83
BURch &: Assodaies
Bunch & Associates. offered a program that included all of the services requested by the County.
They proposed using the Focus HeaJthcare networic that offers an average of 10% discount off of
State mandated provider fees. BWlch prqlosoo a flat annual fee of $60,000 plus 28% of aU,
savings as a network access fee. In addition, $6.50 per bill would be charged to reduce them to
the discounted amount. Th.e overall cost of Bunch resulted in them being eliminated from fur.ther
consideration. '
hotegrit}..
Protegrity (formally Humana).submitted a proposal to include all services request.ed.b.y the
County. Protegrity has its own network that is limited within Monroe County. Provider
discounts ranging from 10% to J 5% would be available if Prodegrity were selected.
Fees of$100 per Medical Only and $425 for Lost Time claims would be charged plus Prodgrity
would retain 25% of all network savings. Because of the limited network in Monroe Coun~ and
the fact that more competitive fees were offered by other proposers, Prodegrity was eliminated
from funher conside~ion.
Con~ntra
Concentra submined a proposal to include all services requested by the County. They p~ed
using the Focus Network of physicians, which offers discounts of approximately 13%.
Concentra proposed fees of $95 for Medical Only claims and $395 for Lost Time claims.. lithe
claim remains open for more than 60 days, all future work would be on a time and expense baSis
at a rate of$85 per hour. In additi~Concentra would retain 300/0ofaJ! PPO savings and. 3~% of
savings negotiated for out of network providers.
A review of Concentra' s network indicates that a significant. amount of work would have to be.
performed to incorporate the physicians that the County is currently using. In addition, more cost
competitive proposals were received from other vendors. For these reasons, Conceotxa was
eliminated from further consideration.
.&dwood
Redwood. submitted a proposal to include all services requested by the County. They prcppsed
using its own Network ofphysicians, which does no(. offer any PPO discounts.
Redwood proposed fees of $1 00 if the claim remains open for less than 3 months or the m~ls
are less than $800. If the claim remains open for more than 90 days, or the medical costs exceed
$800 a fee of $300 WO\lld apply.
A review of Redwood's network indicates that a significant amount of work would have to be
performed to incorporate the physicians that the County is currently using. In addition, more cost
competitive proposals were received from other vendors. For these reasons, Redwood.was
eliminated from further consideration.
07/13/2080 12:54
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HHERISr:
PAGE EJ4
Re1Iiwco
Reviwco submitted a proposal to include aU services requested by the. County. They proposed
using the Choice Network of physicians. which does not offer discounts.
R.eviwco proposed fees of $40 for Medical Only claims and S65 for Lost Time. claims.. hL
addition to the fiXed claim fees, Reviwco would charge $70 per hour for all work performed
They would also charge $4.95 per bilJ reduced to the State fee schedule.
Based on the proposal, it appears as if Reviwco has limited experience in the State of Florida with
most of their work being perlormed in California. Their network of providet"S in Florida ~ not
well established and it would be a time consuming process to incorporate the physicians the
COWlty currently uses.
The combined flat and hourly fee l"l1Jllces Re.viwco non-<:ontpetitive from. a pricin,g per~ve.
This coupled with their limited experience in Florida and the depth of their network resulted in
Reviwco being eliminated from furthe. c.onsid~on.
Seltzer De/man
Seltzer Delman submitted a proposal to include all services requested by the CoUIl1y_ They
proposed using the Choice Network of physicians, which do not offer PPO discounts.
Seltzer Delman proposed fees of$200 if the claim is open fOf 89 days or less and $675 if the .
claim remains open for mOTe than 89 days. In addition, Sehzer Delman would clulIge a network
access fee of $25 for the first doctors. visit aod an additional $35 if subsequent ~ent is
required.
More competitive pricing was proposed by other vendors, therefore, Seltzer ~ was
eliminated from further consideration, '
Genex
GerJex submitted a proposal to include all services requested by the County. Theyproposed..qsing
the Choice Network of physicians, which do not offer PPO discounts.
Gene". pr~osed fees of $250 for Medical Only claims and $750 for Lost. Time claims. If the
claim remained open for more than I year, a.dditional fees of$150 per month would apply.
Since other vendors proposed more competitive fees,. Genex '\III3S elim..inated from cons~on.
Occupational HeaJh S~'stems rOHS)
OHS is the Coumy' s currem Managed Care provider. They became their providers when they acquired
Vincarn Health Care Network. While there has been a few problems OHS' services have been viewed as
sati.sf <ll.;tol!'.
OHS proposed to renew the CWTent contract with the. Count)' for the same peT claim fee ($100 for c4Ums
v.ith an il1Cl.lJTed claim tUn,oum of equal to or less than $500 and S325 for claims witl'l an incun:ed loss
greater than $5(0) however, OHS' minimum fee would be raised 10 $30,000 (current minimwnis $25,(00).
07/13/2888 12:54
8132871841
nHERISI<
PAGE 85
OHS proposed using Choice Managed Network of prcniders, which is the current network, used by the
County. OHS bas offered to p-ovide all the sen ices ~ of the County. -
The fact th31 OHS is the County's incumbent vendor, the level of service is \iewed as satisfoctory and the
fee structure is viewed as being acceptable, iI was decided to coodua a telephonic interview with OI::JS to
ensure their proposal was properly intetpret..ed and incorpor.ue the in1e~iew in the OOcision process.
(.cn-e/
C01Vel submitted a proposal that included. all services requested hy dle Coumy. They prop.osed
using their proprietary network (Corecare) of physicians, which offers PPO discounts rangihg
from 10% to 20%. While Corvel has an extensive network in Monroe and Dade Couottes, it
would have to be e"Panded to include some of the pro'\.idecs currently being used .
Corvel proposed fees of $280 for aU claims submitted for managed care services. lfthe claim
remained open for more than 30 days the ser<.ices would 00 converted to a time and ~eose basis
with a charge ofS68 per hour. In addition, Corvel would r.:uin 23% of all PPO ~as a
network access fee.
A unique feature ofCorvel's proposal is that the County and.its,c1aims ~mioi~rv.:ou.l.d
determine which claims would be assigned to Corvel for medical management. This is view-ed as
a positive feature since the claims administrator can acleql'ately control most of the County's.,
claims. It should also be noted that Corvel has been selected as the Managed Care Provider for
other organizations th.ar. use ISAC (the. COWl!.y's third party a.d.ministrator). Corvel has integrated
their fee reduction system with ISAC's prognuns that allow ISAC to reduce bills without '
incurring additional charges.
Because Corvel will permit the County and ISAC to assign claims on an "as needed" basis and
the fact that Corvel is viewed as one of the leading Managed Care provider.> within the State, it
V/3S decided to conduct a telephonic interview with Corvel andincarporat.e the ~Qfthe
interview within the decision process. '
T I!hpbonlc l.nt~TlII01'$
Telephonic interviews were condlli:ted with OH.S. and. CorveL During the i.nte.rview with OHS,.,
the issue ofPPO discounts was discussed at length. Currently the County is enjoying the benefits
of PPO discounts using the Choice Managed. Network, however OHS' proposal ind.ica1ed. ~ no
discounts are available from Choice. It was learned that the discounts currently being received
are from Hospitals and ancillary services such as physical ther.lPY. h was learned that the CQUIItY
has averaged $3,099 in such discounts over the pa..c:t seven (7) months. This equates to $37,190
on an annual basis. It was also learned that the County's medical bills if reduced to.th.e S~ Fee
Schedule would average $395,424 per year. OHS indicated that the County could e:q>ect the'
level ofOHS' services to continue as. in the.past.
The majority of Corvel's telephonic interview focused on the process of expanding their network
to include the physicians and other providers currently being I.lSed by the County. This is ~ed
as critical in the evaluation process to provide a smooth transition in the event a new :Managed
Care Provider is selected. Corvel stated tha! it wouldtake between three (3) and four (4..).weeks
to enroll all the providers the County desired.
07/13/2888 12:54
HHERISV:
8132871041
The concept of the County and ISAC retaining the right to assign only those cases that they
believe need medical management was. discussed. Corvel. indicated that they initia!eQ this
program in response to other client's requests and it has resulted in significant savings.
R ({'{HJ'I-,",,(/n"ons
Following the review of the proposals submitted and the telephonic interviews with. Corve1.and
OHS, it is believed that either OHS or Corvel could adequately provide the services needed by
the County. It is. believed that Carvel has a little more stable workforce that. wouldprovide.I;l1ore
continuity to the Managed Care process. '
As indicated by the attached schedule of tiMncial analysis, assiening only those cases. that truly
require medical management would produce 3 lower overall cost. The analysis assumes that any
claim with a total incurred. in excess of $500 would be assigned. for nurse case management- This
is believed to be a conservative assumption and the number offiles actually assigned would be
considerable less than forty-six (46). If this occurs~ it further supports selecting CorYel~ the
County's Managed Care Provider. .
Based on the proposals received and the interviews with OHS and Carvel, it is reoommended~at
Corvet be selected as the COlmty's Managed Care Provider. It is believed that this will produce'a
more stable program while reducing the County's overall COSI.ofsatisfying its Worj(ers'
Compensation obligations. '
PAGE uf,
07/13/2000 12:54
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07/13/2000 12:54
8132871041
nnERISr:
Monroe County
Managed Care Evaluation
Occupational Health Systems
~nd
Corvel
Total Fee Schedule PPO Utifizatjon Net Bill Bills per
ailled Reduction Reduction Reduction Paid Fee Schedule
49,176 12.438 4,919 807 31 012 35 931
75,866 18,751 8,712 684 47,719 56,431
48,895 26,090 1,025 19,780 20,805
32,186 11,468 1,785 3,117 15,816 17,601
43,993 14,024 1,205 1,282 27,482 28,68 '
30,333 10,906 954 2.985 15,-488 16 442
84,291 29,524 3,094 51.673 54,767
51,820 17.600 3.099 1,268 29.853 3.2
Annualized 621,640 211,202 37,190 15.214 358.234 395,424
10% of Fee Schedule 3&.~
Fee Schedule Bill5less 10% 355,882-
Netwonc Access Fee 9,0$5
Net PPO Savi 30.448
Claim Count
140
45
PAGE 10
COf'WI
'0
12,680
30,448
(17,568)