”If data is the currency of the new digital economy, then organizations
that know how to monetize data will generate the highest returns. They will
make better decisions that lower costs, grow customer loyalty, and increase
revenues.”[1]
Over the past twenty-five years, the Workers’ Comp industry has
collected vast amounts of data. Moreover, organizations within the industry
have easy access to their most valuable asset: their data. Their challenge now
is to monetize the data and profit from it.
Experts say medical costs now amount to 60% of claim costs in Workers’
Comp. If true, organizations should be charging ahead to find ways to optimize
medical loss management and monetize their data for profit.
Data integration
The first step toward monetizing medical data is to integrate data from
disparate data silos. All bill review, claims system, pharmacy (PBM) and other
relevant data should be integrated at the claim level to gain a full picture of
individual claims. Once integrated, predictive analytics methodologies are
applied to covert the data to usable information.
Past is prologue
What happened in the past is a good indicator of what will occur in the
future when similar conditions appear. Organizational culture, protocol, and
individual preferences are consistent influencers. Consequently, data gathered
from other organizations may offer inaccurate results.
Analyze historic data using predictive analytics to discover conditions
that are cost drivers or cost accelerators. Uncover trends. What conditions or
combinations initiate or perpetuate high cost situations? Where are the gaps in
timing in operational flow? What actions encourage positive or negative claim
resolution? Finally, the information must be made actionable.
Inform stakeholders
Portray the predictive analytics-informed information for claim
stakeholders in timely, informative notifications when risk situations occur.
An example of this is a diagnosis of a comorbidity such as diabetes appearing
in the data long after the date of loss. Predictive analytics has determined
the comorbidity of diabetes adds complexity and cost to claims, therefore an
alert is generated and key Information is conveyed to appropriate persons.
Probable ultimate medical costs
Based on predictive analytics, the probable ultimate medical costs for
the claim are portrayed for the claims rep along with other key information
regarding the claim in question. The claims rep adjusts medical reserves
accordingly and moves on. Time is saved and accuracy is optimized.
At the same time, the predictive analytics-informed system automatically notifies the nurse case manager based on the organization’s
referral protocol. The claims rep is informed of the referral but is not
required to take action.
Similar claim information is presented to the nurse case manager for
quick review, thereby integrating and coordinating claims and nurse case
management initiatives.
Monetize medical management
Data is made intelligent and can be monetized through predictive
analytics combined with a timely information delivery system. Searching for
decision-support information takes time and is inefficient. Manually entering
data is time-consuming, annoying, and often inaccurate. On the other hand,
intelligent information delivered appropriately is monetized as claim
stakeholders make informed decisions quickly, effortlessly, and accurately
without need for data gathering and data entry.
Projected probable ultimate claim cost with comprehensive supportive
information displayed for claims reps does not require data search or data
entry. Even less-experienced adjusters are accurate and efficient. Accuracy and
efficiency is optimized, productivity is increased, and profitability follows.
Moreover, early intervention through timely alerts allows for action before further
damage is incurred.
Medical loss management is also monetized by the ability to objectively
measure claim cost savings. Having projected the ultimate medical costs for a
claim, quantifiable cost savings are available at claim closure due to
coordinated medical management initiatives. Monetization is realized through
client satisfaction, customer loyalty, and client retention. Moreover, the
story is proof of value serving the organization’s strategic competitive
advantage.
Intelligent medical management
Organizations that monetize their data have greater returns, including
return on investment. The intelligent medical management system is monetized
internally and externally, thereby paying for itself. Such statements are
familiar as sales platitudes, but with intelligent medical management, positive
results are objectively measured. Savings are greater than the cost.
[1] Eckerson, W. How to Monetize Data: Strategies for
Creating Data-Driven Applications. Eckerson-How-to-monetize-data.pdf Zoomdata.
March, 2016.
Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation, predictive analytics-informed medical loss management and technical services company. MedMetrics offers intelligent medical management systems that link analytics to operations, thereby making insights actionable and the results measureable. karenwolfe@medmetrics.org
