This is not a controversial statement. Most people now acknowledge the importance of analytics. The question is what is the best approach to analytics in order to achieve optimum results? It’s not enough to prepare analytic graphs and pin them to the wall or publish them in reports for the C-Suite. The information might be eloquent, but nothing will happen or change until it is pushed into operations where action can be taken. Analytics should solve problems.
In Workers’ Compensation, a major problem is our inability to contain continually increasing medical costs. Cost containment initiatives implemented to date have helped, but the job is far from complete. Happily, a new methodology is now available—analytics-powered medical management.
Analytics is basically a fancy term for data analysis and there are many forms. A good place to begin is with descriptive analytics, a preliminary stage of data processing that creates a summary of historical data and integrates data from different sources to yield useful information. It also prepares the data for further analysis.
The data can be re-organized to make it easy to identify patterns and relationships, not otherwise obvious. The data can be queried and reported for more insight. It can also be re-packaged for better understanding or to initiate an action. To an individual in an organization, analytics can make the information derived from the data easy to locate, access, understand, and act upon.
Real time intelligence
When the data is monitored continuously, business units gain the advantage of near real time intelligence. Concurrent knowledge of conditions and events in a claim offers the opportunity for early intervention. Early intervention means the damage can be curtailed, thereby reducing claim costs and complexity. Outcomes are improved.
Information is most powerful when it is current. What occurred two months ago may not be accurate or even relevant now. Conditions about events may have changed substantially so time is wasted manually updating the information before taking action.
One of the most important benefits of analytics is the ability to push timely information to the people who need it and can act on it most effectively. In the case of Workers’ Compensation, those persons are most likely claims adjusters and medical case managers who are in the trenches with claims. When these business units are alerted to pre-defined conditions in claims, their responses are more authentic and better outcomes result.
Specific information in claims pushed to the appropriate person in near real time is powerful. That person might be a claims adjustor, medical case manager, supervisor, or medical director who will act on the information based on procedures developed by the organization. The organization determines what situations in claims should be addressed, those potentially the most costly or disruptive based on historic analysis. Moreover, the organization determines what actions should be taken, and by whom.
Structured notification and responses in the form of standardized procedures lead to consistency. As with any organizational procedure, allowances are made for professional authority, nevertheless, cost savings gained through consistent processes can be reliably measured.
Measures of medical management savings in Workers’ Compensation have been elusive. Without structured problem identification and response, apples to apples comparisons and analyses are impossible. A major benefit of analytics-powered medical management is the ability to dependably measure the benefits derived through data monitoring, analysis, notification, and response.