What Does a Fish Know?

“What does the fish know about the water in which it swims?” Albert Einstein.

An existential question
Leave it to Einstein to ask the existential question regarding what we know about the environment in which we live. Of course, he was referring to the universe, but his question might just as well be applied to the Workers’ Comp world. Those of us who have long-labored in Workers’ Comp assume we have full knowledge of it. But do we? We swim in such a huge vessel of information, can we actually know much of it?

The industry is swimming in data
The Workers’ Comp industry has successfully amassed vast amounts of data. Computers become available to manage claims in the late 1970’s and early 1980’s when digitalized data was first collected. However at that time, few companies could afford to computerize. Computers were bulky, costly and the software available to run them was scant. Not until the late 1980’s were simple DOS-based claims management systems available and more affordable.

Since that time, in just twenty-five years, the industry has collected immense amounts of claims-related data. Yet, we know little of it!

What don't' we know?
Mark Twain put it this way, “What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so”.

We assume we know the industry in which we work. Moreover, we feel sure of the operations and actions of our own organization, along with their effects. The truth is, we actually know little of the Workers’ Comp world in which we live, but we could know much more through analytics.

Analytics is a solution
Analytics can be a forbidding notion, but it simply means data analysis, analysis of the data to gain knowledge, find meaning and direction. Data, without analytics, is useless because in its natural form, data is fragmented bits of information. Relationships are unknown. Conclusions cannot be reached. Decisions are not supported. Predictions cannot be found. Raw data keeps us profoundly unaware of the world in which we live.

When analytics are applied, the data are summarized, calculated, calibrated, and re-presented so that relationships become apparent. Conclusions and decisions are quicker, easier, and more defensible. Predictions can be made based on past experience. As a result of analytics, processes can be made more standardized and cost efficient. Computer-aided management is made real.

More specific to Workers’ Comp medical analytics, data subjected to analytics can provide even more awareness and efficiency. The spotlight can be trained on providers, treatment pathways, and outcomes. Such analyses lead to derivative knowledge about the treatments and processes that lead to successful outcomes.

Reasons for resistance
The question then becomes, if analytics is so powerful, what has kept the Workers’ Comp industry from embracing it? Among the reasons the Workers’ Comp industry has been slow to embrace analytics, a couple can be noted here.

People have long discussed the data silos in Workers’ Comp. Data silos include claims systems, bill review systems, UR systems, provider network systems, and medical case management systems, along with digitalized FROI (First Report of Injury), and OSHA (Occupational Safety and Health Administration) reports. Each lives within its own business domain that does not communicate with the others. Yet, each contains critical claim information. Essential to analytics is integrating data, however to date, appetite for data integration is tepid.

Another reason for slow adoption of analytics, particularly relating to the medical portion of claims is those most knowledgeable are not computer savvy or involved in IT. Medical professionals do not understand what is missing and the possibilities for enlightenment. They cannot imagine possibilities related to using data as a work-in-process tool. They have no experience to rely on. So they do not ask and they are not sought for input.

Nevertheless, the barriers to analytics in Workers’ Comp are easy to overcome. The industry needs to step up to analytics, particularly medical analytics, the most unenlightened portion of claims management. There is little reason to continue swimming in water we know little of.

Please visit MedMetrics for more information.