A Healthy Disrespect for the Impossible

by Karen Wolfe

When people are extraordinarily successful, examining their characteristics, values, and attitudes can be instructive. The rest of us can learn from them and possibly adopt some of them to advance our own goals. Larry Page, co-founder of Google is an example of one who has achieved exceptional heights. Peering into his thought process can be enlightening.
 

Page says, “Have a healthy disrespect for the Impossible”. While the statement may not be original with him, it does reflect his world view.

Disrespect the impossible

To conceive and develop the Google concept and then the massive company, its young founders had to have a very healthy disrespect for the impossible. Others besmirched the idea of collecting all the information in the world and then making it available to everyone in the world. Not only was it a bold idea, it was thought by most to be ridiculous and impossible. But Larry Page and Sergey Brin had a very healthy disrespect for the impossible. They made it happen.

The concept of disrespecting the impossible could be entertained by those of us in the Workers’ Compensation industry. True, few of us are likely to reach the pinnacle level of Larry and Sergey, but we can borrow some of their bold thinking to get past the assumptions and barriers that keep us from achieving more.

Everyone agrees Workers’ Compensation as an industry needs a healthy nudge to try new things. The industry is known for its resistance to change. Refer to the article, “Are You an Industry Disruptor? It can be a good thing.”[1] Maybe the way to change the industry, to be an industry disruptor, is to begin with an attitude of disrespecting the impossible.

The impossible in WC

Many people in general, including those in the Workers’ Compensation industry focus on why something cannot be done. Reasons for this notion are many, but probably cultural tradition plays a role. Creativity and inventiveness are not expected or appreciated. Too often, the best way to keep a job in corporations is to keep your head down and avoid being noticed. Spearheading a new idea is risky.

Stonewalling new ideas or doing things differently or adopting new technology in an organization thwarts creative thought and certainly diverts progress. I was once told we have a very good product, but to incorporate it would mean doing things differently in the organization. So the answer is automatically no!

Check assumptions

We all know the old saying about the word ass-u-me. It actually packs some truth. To avoid the trap, check assumptions for veracity. Incorrect assumptions can be highly self-limiting.

Problem-solve

Begin the process of problem-solving with new thinking—disrespect the impossible. What could be done if the perceived barriers did not exist? What could be accomplished if new methods were invented and implemented?

Tenacity

Probably the most important ingredient for achievement in any context is tenacity. It’s easy to quit when the barriers seem daunting. Tenacity combined with a disrespect for the impossible might be the unbeatable formula.

Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation medical analytics and technology services company. MedMetrics analyzes the data and offers online apps that super-charge medical management by linking analytics to operations, thereby making them actionable. karenwolfe@medmetrics.org

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[1] http://medmetrics.blogspot.com/2014/12/are-you-industry-disruptor-it-can-be.html
 

Early Intervention Drives Better Outcomes, But is Not Really Pursued

by Karen Wolfe

Early intervention drives better outcomes. It’s a statement that garners little resistance. Everyone agrees when a problem is found early, the solution is easier. Thwarting a problem early in its course produces better results. Yet few systems are in place to guarantee early intervention into problematic Workers’ Compensation claims.

Early intervention is a fine idea, but not always pursued. Work flows and systems in the industry are not typically designed to target the goal. To be effective, early intervention requires identifying the claims needing attention as soon as possible in their course, then mobilizing action procedures.

Predictive modeling

One effort to identify claims early that is widely acclaimed in the industry is predictive modeling. Elaborate analysis of the data using advanced mathematical methods is used to identify new claims that will likely become problematic. Regardless of the sophistication of the math, finding those claims remains a guessing game. Not every future problematic claim will be tagged. Likewise, claims that do not meet the modeling criteria, yet migrate anyway, will not be recognized. Predictive modeling can be helpful but it is imperfect and costly.

Containerizing human responses

Containerizing human conditions and responses is possible to a point. However, predicting human behavior is imperfect at best. Moreover, a second step is necessary: consistently intervening in the identified problematic claims. Once the troublesome claims are detected, certain action steps must follow.

Data monitoring

A more practical methodology for identifying costly claims is to monitor the data on a concurrent basis to uncover dicey conditions in them.

Rather than predicting which claims will be risky, the conditions that portend risk and cost in claims are isolated and then identified in claims as they occur.

Technology is used to find the claims that bear those conditions whenever they occur throughout the course of the claim. All claims are monitored, so none are missed. No guesswork is involved.

Step two

The data monitoring approach is powerful, but as with predictive modeling, that is true only when the next step is taken. Organizations that undertake a process for identifying risky claims early stand to lose the entire benefit unless they also structure procedures for intervention. The appropriate persons must be notified about problematic claims immediately and those persons must act to carry out the recommended procedures.

Whether the alert recipients are claims adjusters, medical case managers, or someone else, they must follow intervention procedures for best results. Using the data monitoring approach, each condition that is sought in the data should be associated with a prescribed intervention procedure.

Standardized interventions

Follow up procedures should be specific so that analyses can be made of their effects. For instance, when the condition identified in a claim is the third prescription for a Schedule II drug, the system might be set to alert the medical director. A standard method of intervention or approach for intervening with the treating doctor is followed.

Another example of a problem is extended medical treatment past a designated point for low back strain. The alert is sent to the claims adjuster whose procedure is to engage a medical case manager to investigate. The investigation procedure is standardized.

Examples of how this works are unlimited, but the important thing is that intervention procedures are analyzed in advance and clearly stated so the actions are consistent across the organization and going forward, regardless of who actually carries out the intervention. Obviously, details of actions may be variable, but the general course should be followed.

Measuring results
The plight of medical case management has long been that results could not be measured. Consequently, medical case management as a strategy has been undervalued.

Categorize interventions

Moreover, medical case management could not be measured because interventions are delivered by individuals, even though usually professional nurses, each is different. However, intervention tactics can be categorized so outcomes can be calculated. The benefit of using a standardized approach is that outcomes can be compared and measured by the cause condition and intervention employed.

Automated referral

Claims adjusters sometimes fail to refer to medical case management for a variety of reasons. When early intervention procedures are standardized, the referral is automatically made by the system, thereby eliminating the burden of referral for claims adjusters. Efficiency is good.

Summary

Simply stated, early intervention is more effective than late intervention. The problems have not yet morphed into catastrophe and are usually easier to solve. Moreover, systems and procedures should be established to automate problem claim identification and follow up procedures. Best results can be pinpointed and continued. Lesser results can be modified. The upward spiral of quality improvement is continuous.

Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation medical analytics and technology services company. MedMetrics offers online apps that super-charge medical management by linking analytics to operations, thereby making them actionable. karenwolfe@medmetrics.org