Sweeping
changes underway
Multiple articles have been
published recently warning of sweeping changes impacting the Workers’ Comp
industry. In an article entitled, Take Time for Technology, Steve
Penman, COO at Sedgwick states, “Workers’ compensation is a data intensive
system and it remains a challenge for virtually all employers. Increasing
regulations, rising medical costs, and the uncertainty posed by healthcare
reform continue to make this a formidable issue on all fronts. Technology is having a profound influence on the
way organizations are managing their workers’ compensation programs.”[1] Yet, many organizations continue to do business
as usual rather than embrace technology to understand and effectively manage through
the quickly evolving business scene.
Beyond storage headaches
Payers in Workers’ Comp
have long used computer technology to manage bill payments and document actions
or events associated with claims. The result after many years of
computerization is the vast quantity of data. However, little has been done in
the industry to leverage that data to make it a viable decision support tool
rather than just a storage headache. Little has been done to convert the data
into a working tool that can impact claim process and outcomes.
Obama Care impact
In
another recent article, Is your workers’ compensation technology platform readyfor healthcare reform?
Mike Allen asks, “Is your workers’ compensation
technology platform ready for healthcare reform?”[2] Allen offers a litany of
initiatives taking place before our eyes in general healthcare. He continues, “No doubt there are many
opportunities to leverage the technologies implemented as part of new American
medical model to improve treatment of injured workers. What steps are you
taking to make this happen?”
In yet
another article entitled, Affordable Care Act of 2010 - Workers' Compensation Community, Take Heed![3] Todd Brown, EK Health's Director of Bill Review,
states “The
Affordable Care Act of 2010 in section 10109 gave authority to the Secretary of
HEW to periodically review and determine whether or not Property and Casualty
including workers’ compensation insurance should be brought up under the HIPAA
umbrella. The act requires that the consideration for inclusion of Property and
Causality under HIPAA be reviewed every three years.” In other words, Workers’
Comp payers may be quickly swept into the Obama Care technology surge at any time.
Heads-up!
The
warnings are well-founded and clear. To manage change, the use of technology is
increasingly important for the Workers’ Comp industry. Unfortunately, the
industry is already significantly behind others. The Affordable Care Act (Obama
Care) is driving the rush to technology in general healthcare and it will
significantly impact Workers’ Comp whether or not it is formally included in
the Act. Moreover, the greatest challenge to Workers’ Comp payers is not
gathering more data. It is changing the way technology is applied to the data
to make it a powerful tool.
New uses for technology
The use
of technology must move beyond traditional computerized documentation and
reporting. To their credit, some Workers’ Comp organizations have successfully
applied predictive modeling techniques to the data to derive important
knowledge about potential risk. But intelligence must be linked to operations
through technology to make it actionable.
Integrated platforms
The
major thrust in general healthcare technology in response to Obama Care is to
significantly improve quality of medical care while controlling costs. Platforms that integrate patients’ medical
records from hospitals, laboratories, doctors’ offices, and ancillary providers
are in place or well underway.
In
Workers’ Comp, integrating the data from all sources associated with a claim is
crucial. Bill review, claims, pharmacy, medical case management, and
utilization review systems should be integrated at the claim level to gain the
total picture of the claim at any point. In other words, documentation must
continue, it must improve in accuracy, and the information must be integrated
across the claim.
Decision support
Workers’
Comp data must also be re-presented to the business units for real time
decision support. Claims and medical professionals should be able to access
current comprehensive claim information to make decisions about best doctors
and other factors pertinent to quality and cost management.
Data made a working tool
Additionally,
the data in Workers’ Comp must be translated to make it a work-in-progress
tool. The integrated data from all sources in Workers’ Comp should be monitored
continually and concurrently using technology to identify conditions in claims
that portend risk and cost. Monitoring historic and current claim data
continuously and applying rules for alerts and interventions will improve
quality of care and outcomes while automatically documenting the process. Such
is the nature of the new technology.
Integrated
claim data is monitored electronically to uncover conditions identified in
predictive modeling, industry research, and gleaned from the wisdom of
experienced professionals. When such conditions in a claim are identified,
technology is used to automatically notify the appropriate person to intervene.
Early, knowledgeable intervention avoids complexity and results in quality and
improved outcomes while costs are controlled.
Better late…?
The
technology imperative is urgent and clear for Workers’ Comp. “Better late than never” does
not apply because the impact in underway. Never is not an option!
Ms. Wolfe is president and CEO of MedMetrics®
that offers technology and analytics designed to strengthen medical and cost management
methods in Workers’ Comp. MedMetrics'
suite of technical services and online power apps offer payers, managed care
service providers and provider networks a quick and affordable path to cutting
edge technology that recharges managed care. For questions, contact
karenwolfe@medmetrics.org
[1] Penman, S.
Take Time for Technology. WorkCompWire May 6,
2013 http://www.workcompwire.com/2013/05/steve-penman-take-time-for-technology/
[2]
http://michaelgallen.wordpress.com/2013/05/07/is-your-workers-compensation-technology-platform-ready-for-healthcare-reform/
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