Everyone knows the bulk of Workers’ Comp costs now are medical. Claims reps and nurse case managers handle injured workers and their medical costs with utmost care. Anecdotally, their work saves time and money. The problem is that concrete evidence of their value has been elusive—until now.
Magic?
How can costs avoided and time saved be measured? It’s like pulling invisible rabbits from a magician’s hat. It should be awe-inspiring, but what really happened? Quantifying what did not happen is usually impossible. However, quantifying and measuring savings is completely feasible when a different approach using predictive analytics is used.
The real magic
The Workers’ Comp industry does not readily embrace change or innovation. That is changing as pressure increases to become more efficient to sustain profitability as resources shrink. The best approach to meeting this challenge is incorporating advanced technical strategies such as predictive analytics that are designed to support and streamline the business process and make workers smarter. The collateral benefit is being able to objectively measure and report savings.
Solution design
The solution is to extensively analyze the organization’s historic data using predictive analytics and deliver the insights in the form of actionable information to all the stakeholders including claims reps, medical managers, and other decision-makers. Just a few steps are needed including data analysis, data monitoring, informing and integrating the efforts of stakeholders, and then measuring the savings. The first and most critical initiative is analyzing historic data using predictive analytics methodologies.
Predictive analytics
Analyzing historic data utilizes predictive analytics methodologies. Deeply analyze the organization’s data to identify cost drivers, actions taken, and outcomes. Organizations differ in their client bases so the kind of injuries they experience varies.
Organizations are also unique because they develop distinctive internal and cultural processes regarding claims handling and medical management. Therefore, an organization’s data is the most meaningful data in understanding future costs. Because of the differentiating factors, using others’ data, regardless of how large the database, can mislead.
Monitor the data
Situations and conditions found in the past are likely to recur. Once the risks are identified in historic data, they can be searched programmatically in current data through continuous data monitoring. When problematic situations occur in the data, appropriate responses and interventions are mobilized immediately. The insights are delivered to medical management stakeholders, including claims reps, medical case managers, senior management, and others as appropriate. The knowledge delivered is structured to assist them in decision support and coordinating efforts.
Deliver insights
Risk information in claims is delivered concurrently to stakeholders so they can make early and sound decisions, then initiate appropriate action. Importantly, all medical management participants receive similar information so initiatives are coordinated and integrated, thereby implementing strong, multi-disciplinary approaches.
Reserving
When risk conditions in claims are identified in this manner it means reserves in that claim need attention as well. When events and conditions in claims change indicating a need for more intense medical management, reserving should also be addressed. Based on predictive analytics, the probable ultimate medical costs are projected and portrayed for claims reps, thereby providing key knowledge to support appropriate action.
Coordination impact
Data monitoring identifies claims with risk conditions concurrently and informs the stakeholders immediately. Intervention efforts are coordinated between claims reps, medical case managers, and others, providing broad-based, integrated initiatives leading to improved results. Savings are gained through proactive, coordinated intervention by professionals who are offered key information for decision support making them accurate, efficient, and effective.
Measure savings
When claims are closed, objective savings are measured by comparing projected performance based on predictive analytics with what was accomplished through proactive, integrated initiatives across all medical management participants. The calculations are quantifiable and objective.
Outsource
The simplest and most rewarding approach is to outsource this process to a knowledgeable medical analytics company. Internal processes need not change, but professionals and business processes are made more accurate and efficient—a win for the organization, its employees, and its clients.
Technology is far less expensive than people. When it is designed to assist professional workers by making them more accurate and efficient, the return on investment is profound.
Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation, predictive analytics-informed medical management and technical services company. MedMetrics offers online apps that link analytics to operations, thereby making insights actionable and the results measureable. karenwolfe@medmetrics.org
