DEPARTMENT: Office of Risk Management
DEPARTMENT HEAD: Debra M. Ojo, MPA
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT: Workers' Compensation Health Care Network Services
SUMMARY:
This ordinance authorizes the City Manager or her designee to enter into a contract with Injury Management Organization, Inc. (IMO) to provide medical cost containment services through a Workers' Compensation Health Care Network (HCN), which is in accordance with chapter 1305 of the Texas Insurance Code for the City of San Antonio. The term of the contract is three (3) years with two (2) additional one year renewal options subject to and contingent upon funding by City Council, beginning March 1, 2019 and ending February 28, 2022. The estimated annual cost is $455,000, and $265,300 for the remainder of FY 2019. If all options are exercised, the estimated total cost of the contract is $2,275,000. The cost of the HCN will be offset by efficiencies introduced by the HCN program.
BACKGROUND INFORMATION:
The City receives an average of 1,300 workers' compensation claims, annually. The City retains the services of Tristar Risk Management for third-party claims management, which involves the investigation, adjusting and payment of benefits and medical providers.
Under the current workers' compensation program, City employees have provider of choice for workers' compensation injuries. The HCN will provide and manage a network of contracted and credentialed physicians and specialists to provide the highest quality and appropriate care to City employees. The HCN will ensure a broad range of Network coverage throughout San Antonio and surrounding areas; facilitate faster access to medical care through telephonic or field case nurse services; assist with facilitating a "Return-to-Work" program with physicians and employees; implement a Network Quality Improvement Program; and adhere to established performance measures. The HCN will also be responsible for the medical cost conta...
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