Costs continue to rise
Regardless
of the myriad of interventions directed at containing claim costs in Workers’
Compensation, costs continue to increase. Now that the medical portion of claim
costs amounts to sixty percent or more, the fact must be acknowledge that
traditional managed care initiatives are inadequate. Moreover, new medical
costs seem to be appearing from unfamiliar places, leaving no apparent recourse.
Costs are finding new avenues of expression in the form of drug costs, complex medical
procedures, and exponential costs due to comorbidities.
What now?
Many think everything that can be done, has been done. Managed care programs
including provider networks, bill review, utilization review, peer review, and
medical case management are conceptually well-founded. Still, outcomes are
disappointing. What more can be done?
Starting
over is absolutely not an option. Disbanding current managed care programs and
creating new ones is completely impractical. Sunk costs of existing programs
are huge, and building new ones is not feasible or affordable. Besides, managed
care programs in Workers’ Compensation are well-founded conceptually, and based
on solid principals. They just need to function more effectively.
Managed care in WC is tired
Managed
care programs in Workers’ Compensation are tired. Like much of our country’s
infrastructure, they have not been revitalized over the years of their
existence. They operate today just like they did twenty years ago. Specifically,
most managed care programs have not taken advantage of the exponential advances
in technology during their tenure.
Same tenure—different results
Think
about it. As recently as twenty years ago (1992 seems like yesterday) Microsoft’s
Disk Operating System (DOS) was the predominant operating system for personal
computers. PC’s were large, expensive, and scarce in companies. Local area
networks were just emerging and required hard-wiring to connect, servers, PC’s
and printers. The Internet was not yet available for general use. Significantly,
this was also the time of Workers’ Comp managed care ascendency. Yet, it would
be some time before managed care programs were even computerized.
Computerization
in managed care is relatively recent and the uptake has been laboriously slow.
At the same time, evolution in technology has been explosive. Reluctant technology
upgrades in managed care have been restricted to hardware and operating
software at a pace consistent with Microsoft operating system advances—slow.
Little has been done in managed care to exploit technology to actually benefit
outcomes.
Technology explosion
In contrast,
smart phones have proliferated. It is estimated over 5 billion cell phones are
in use worldwide. They are enabled with text messaging, web browsers and
cameras, as well as by wireless connectivity in place of landlines to reach
remote communities. The iPad and other notebooks have overtaken PC’s in sales.
Social networks that enable collaboration on more and more devices proliferate.
As recently as 2005, Facebook was a start-up phenomenon, Twitter was still a
sound, the cloud was something in the sky, and 4G was a parking space.[1] The flood of technology
and its applications has serious and exciting implications for Workers’ Comp
managed care.Differentiate through technology
Underscoring the point, Joel Cawley, the vice president for strategy at IBM is quoted as saying, “Two things will differentiate companies, countries, and individuals from one another. One is analytics. Once everyone is connected, prosperity will depend on how well you or your company can analyze and apply all the data pouring through these networks to optimize your ability to provide better…(services).”[2]
The
Workers’ Compensation industry must of necessity step up to the challenge because
continuing to do business as usual is ever more unconscionable in light of claim
costs and deteriorating outcomes. Workers’ Comp organizations, whether they are
insurers, third party payers, self-insured employers, or service providers to
the industry, must leverage technology to improve their services and control
costs. To do otherwise is dereliction of duty.
Move to the intersection of technology and
managed care
Analyze
the data to gain insight into best practices and procedures and who is
providing them. Leverage the data to find best in class doctors and other
providers. Enable current data to inform adjusters and medical case managers of
claims containing potentially calamitous conditions. Let technology notify
appropriate persons of approaching key benchmarks and other pivotal conditions.
Most importantly, act on the findings of analytics.
Actionable analytics
Drive
the results of analytics to operations to mobilize appropriate action to
intervene in time to prevent further damage. Make analytics and technology
work-in-progress tools that lead people to informed decisions and enable them
to taking action early enough to contain costs. Most importantly, embrace
technology to ramp-up, revitalize, and recharge managed care programs. Use
analytics backed by technology to take charge of outcomes. Move to the
intersection of technology and managed care.
Learn
how MedMetrics will move you to the
intersection of technology and managed care, thereby gaining more control of
costs and improving outcomes.
[1]
Friedman, T., Mandelbaum, M. That
Used to Be Us: How America Fell Behind in the World
It Invented and How We Can Come Back. Farrar, Straus and Giroux. 2011. Updated by
author.
[2]
Ibid.
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