A recent post in LinkedIn noted the Japanese firm, Fukokui Mutual Life Insurance has replaced more than thirty office workers with artificial intelligence.[1] The Artificial Intelligence (AI) replacement in this case is the famed IBM Watson. Watson, or one of its doubles, is in fact impacting nearly all industries in multiple ways. Eliminating workers is the paramount goal. But could Watson replace workers in Workers’ Comp?
AI
AI has been around for decades but now with advanced technology, it has fully caught on and its applications are widely varied. AI is what drives driverless vehicles and operates machinery sans human involvement. Short of that and more practically, AI machine technology is used to enhance worker productivity, accuracy, and efficiency. Importantly, AI should never reach Workers’ Comp if more pragmatic, technology-based strategies are implemented now.
Wake-up call
Replacing Workers’ Comp professionals with Watson or its double is not feasible at this point or hopefully, ever. The possibility of replacement by the likes of Watson should not panic anyone in the Workers’ Comp industry, at least not now. Yet, it is a wake-up call to the industry.
Watson in WC
Imagine injured workers navigating the Workers’ Comp system without claims adjusters and medical case managers. Picture Watson managing claims. It could make payments without difficulty, and even review the bills effectively. Watson could also determine which claims are the most challenging and refer them to medical case management.
Stop there!
Watson as case manager
Envisioning Watson as medical case manager is a real stretch. Human interaction is central to medical case management effectiveness. Likewise, Watson delivering claim management services without dialogue with the claimant would be spotty and unpleasant at best. Accuracy and efficiency under Watson management could be nearly perfect, but claim adjusting relies heavily on human interaction. Injured workers managed by Watson would feel victimized in a heartless system. The only recourse would be to litigate. Watson might have trouble with that.
While replacing professionals with technology like Watson is going too far, it should prompt Workers’ Comp payers to actively engage current technology to improve processes and outcomes—just to keep up. Clearly, the momentum in every industry is more technology in order to gain efficiency and Workers’ Comp cannot afford to lag behind. To stay in the game, technology designed to assist workers with task-relevant knowledge and decision support that makes them more accurate, more efficient, and, yes, smarter is crucial.
Dodging Watson
Watson will replace health insurance industry administrative workers fairly easily. Essentially, bills are paid if they match the benefit plan and the treating doctor is in the PPO. However, the Workers’ Comp industry is very different from general health and much more complex. The question is how can the Workers’ comp industry optimize efficiency and productivity without discarding its professionals and alienating injured workers? The answer is to apply currently available predictive analytics technology to make WC professionals smarter, more accurate, and highly efficient. Of course, that also spells profitability for the organization.
Knowledge assistance
Apply predictive analytics to understand
historic data and the cost drivers inherent in it. Monitor the data
continuously to identify risk conditions as they occur. Create apps that inform
claims reps of conditions and events in claims that need attention in real time
so action is early and proactive.
Assist claims reps by providing
information for decision support such as the probable ultimate medical reserve
amount for a claim. Time and effort is saved, while accuracy and efficiency is gained.
Rather than laboring with decisions such as adjusting reserves, a timely and
accurate projection is presented, thereby optimizing efficiency.
Similarly, relevant information should
be available for medical case managers so they can avoid searching for claim information
and status. Timely alerts and shared information promote collaboration and
integration of efforts between claims and case management decision-makers in
the organization. Watson is thwarted.
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
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