Recently
I watched “Moneyball”, the movie for the third or fourth time. The story is compelling,
as is the book by the same name that preceded it.[1]
Moneyball is based on the concept called
sabermetrics, defined as "the search for objective knowledge about
baseball." The central premise of Moneyball
is that the collective wisdom of baseball insiders, including players,
managers, coaches, and scouts over the past century is subjective and flawed. The
book argues that the Oakland Athletics general manager, Billy Beane took
advantage of analytic, evidenced-based measures of player performance in order
to field a team that could compete successfully against far richer teams in
major league baseball. During the 2002 season, the Oakland ‘As’ won enough
games to make the playoffs in spite of a meager salary budget and "inferior" players.
Even though the two industries are diametrically dissimilar, distinct parallels can be drawn between Moneyball, a story about the Oakland Athletics baseball team and Workers’ Compensation Medical Management.
Similar
Resistance to analytics
One comparison that can be drawn between the
two is resistance to adopting analytics as a knowledge tool. Baseball insiders
and managers opposed Beane’s analytics, sometimes vehemently. Long-held beliefs
among baseball insiders promoted measures of performance such as stolen bases
and batting averages. Beane’s metrics debunked the old methods, revealing
unrecognized strengths in lesser-known, more affordable players.
Similarly, Workers’ Compensation leaders have
relied on traditional medical provider networks and personal preferences to
select medical doctors. If doctors are in a network and offer a discount on
medical services, all is good. Yet, industry research has shown that not all
doctors are equal. Doctors and other medical providers who understand and
acknowledge the nuances of Workers’ Compensation drive better outcomes. It’s a
matter of finding those doctors.
Finding
best performers
The purpose of Moneyball sabermetrics is the
same as Workers’ Compensation medical metrics—to find the best performers for
the job. The way to do that in baseball is to analyze the data defining actual
performance in terms of outcome—games won. In Workers’ Comp the data must be
scrutinized to find doctors who drive positive claim outcomes. In both cases, a
variety of metrics are used to support the most effective decisions.
Performance
indicators
As in baseball, the goal in medical
management is to apply objective information to decision-making using evidenced-based
measures of performance. For both industries, cost is a factor. However, in
Workers’ Compensation, the cost of medical care must be tempered by other
factors: What is the duration of medical
treatment? What is the return to work rate associated with individual doctors? What
providers are associated with litigated claims?
As in baseball, the list of indicators for
performance analysis is long. However, the sources of data differ significantly.
The data challenge
In baseball, all the data necessary for analysis is neatly packaged in games played. Statistics are gathered while the game is in progress. In Workers’ Comp the data that informs medical management resides in disparate systems and must be gathered and integrated in a logical manner.
Essential data lives in bill review systems,
claims adjudication systems, pharmacy (PBM) systems and can also be found in
utilization review systems, peer review systems, and medical case management
systems. The data must be integrated at the claim level to portray the most
comprehensive historic and current status of the claim. Data derived from only
one or two sources omits critical factors and can distort the actual status or
outcome of the claim.
Once the data has been integrated around
individual claims, meaningful analysis can begin. Indicators of performance can
be analyzed with new conclusions drawn about the course of treatment and
medical provider performance. Moreover, concurrently monitoring the updated claim
data leads to appropriate and timely decisions.
Data positioned
as a work-in-progress tool
In baseball, the data is used as a
work-in-progress information tool. Decisions about the best use of players are
made daily, sometimes hourly. Workers’ Compensation medical management can do
the same. Systems designed to monitor claim details and progress can alert the
appropriate persons when events or conditions portend complexity and cost.
Industry
status
Analytics in baseball is not exclusive to the
Moneyball Oakland Athletics. All of major league baseball now relies heavily on
its use. Unfortunately, there are still only a few visionary “Billy Beane’s” in
Workers’ Compensation medical management. Yet, applying analytics for cost and
quality control is simple, affordable and can be adopted quickly by all.
Karen Wolfe is the founder and president of MedMetrics®, LLC, an Internet based
Workers’ Compensation analytics company. MedMetrics applies analytics and technology to
significantly strengthen medical management in Workers’ Compensation and to
link the analytics to operations by means of user apps, thereby making the
analytics actionable.
[1]Lewis.
M. Moneyball: The Art of Winning an Unfair Game 2003. The film “Moneyball”, starring, Brad Pitt was
released in 2011.
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