Welcome to the MedMetrics Blog

The MedMetrics blog provides comments and insights regarding the world of Workers’ Compensation, principally, issues that are medically-related. The blog offers viewpoints regarding issues affecting the industry written by persons who have long experience in the industry. Our intent is to offer additional fabric, perspective, and hopefully, inspiration to our readers.

Search The MedMetrics Blog

Monday, November 11, 2013

Moneyball and the Art of Workers' Comp Medical Management

by Karen Wolfe

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.
 

No comments:

Post a Comment