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The MedMetrics blog provides comments and insights regarding the world of Workers’ Compensation, principally, issues that are medically-related. The blog offers viewpoints regarding issues affecting the industry written by persons who have long experience in the industry. Our intent is to offer additional fabric, perspective, and hopefully, inspiration to our readers.

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Monday, May 23, 2016

7 Reasons You Really, Really Want WC Medical Analytics

by Karen Wolfe
In a recent post, Joe Paduda stated, “The workers’ comp, and, for that matter, the entire property and casualty insurance industry, is chronically systems-poor.  While other industries view IT as a strategic asset, continually investing billions in IT, WC/P&C considers IT an expense category to be mined for pennies to add to earnings per share.”[1]

As one who has worked on the vendor IT side of the Workers’ Comp industry for decades, I know for a fact Joe is exactly right. Nevertheless, both inside and outside change is impacting the industry—compliance requirements and how IT is perceived, financed, and implemented.

Moreover, customers are demanding more usable information. So as a way of advancing the perception part of medical analytics, seven reasons are offered here to whet the appetite for analytics-informed medical management

Analytics-informed medical management means collecting, integrating, and analyzing all relevant current and historic data to gain insights that will improve performance and outcomes. The following are a few very good reasons to invest in analytics.

1.    Look forward, not backward
An unfortunate, but persistent perception of business intelligence and data analysis is that reports are for looking at the past—how many claims, the trend in slips and falls, or how much money was spent last quarter. Interesting, but not actionable.

Much greater advantage can be gained from analyzing the data to understand what is happening now in order to improve procedures going forward. Identify cost drivers and develop prompt, appropriate, and consistent actions to redirect the organization.

2.    Find meaning in your data
The industry has been diligently collecting data for years, yet little attention has been paid to what the data might reveal. Analytics looks at the data to derive meaning, suggest direction, and empower informed decision-making.

Corporate leaders are often victims of their own denial, assuming all important information is known and current processes are the best they can be. Rarely is that actually the case and analytics can be eye-opening.

3.    Deliver intelligence to those who need it
Analytics can be used to evaluate medical provider performance, for instance, and deliver the information in real time to those who are directing care. Since poorly performing providers are guaranteed to add cost and complexity to claims, analytics used in this manner will directly impact efficiency, cost, and outcome.

Similarly, information about untoward events and conditions in claims delivered to operations concurrently will add efficiency and improved outcomes.

4.    Standardize procedures
A rule-based approach can be used to monitor data and create alerts of high risk conditions and events that occur in claims. Doing so inserts credibility, consistency, and comprehensiveness into the medical management process. Moreover, when standard procedures and actions are established to respond to specific alerts, the entire process can be measured for organizational improvement, cost-savings, and outcome success.

5.    Data as a work-in-process tool
Data can be a working tool. Analytics can be structured to concurrently tag data items that portend risk and cost in claims, then alert the person who can take action. Front line workers will gain decision support information in time to intervene effectively and usually avoid irreversible damage.

6.    Discover unexpected opportunities
When analytics are employed, newly discovered information or conditions understood differently can reveal opportunities. Interventions, priorities, and procedures might be restructured, streamlined, or enhanced. New products or delivery methods may also be realized and developed.

7.    Ensure the organization’s competitive advantage
Having implemented standard and consistent methodologies, improved outcomes are demonstrated objectively for clients and prospects. Proof of value generates confidence in operations and outcomes, a much easier sell.

The forgoing seven reasons to invest in medical analytics are not by any means all-inclusive, nor are they exhaustive in their portrayal. Much more can be said and gained by implementing medical analytics. The data ingredients are available and waiting.

The general tenor in the industry is to continue business as usual, but doing so has not produced desired results. Nor will it. As Paduda points out, IT in the WC/P&C industry is exceedingly underappreciated and underfunded.

Therefore, a  little creativity may be required to obtain what is needed. Outsourcing to a company that uniquely provides Workers’ Compensation medical analytics is one approach. Fees can be sized to the organization, thereby making it affordable. Being analytics-poor is no longer an option.

Paduda, J. Who’s running your company. 05/20/2016 http://www.joepaduda.com/2016/05/whos-running-company/#sthash.LJIERvyq.dpufv

Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation, analytics-Informed medical management and technical services company. MedMetrics analyzes and scores medical provider performance and offers other online apps that link analytics to operations, thereby making them actionable. karenwolfe@medmetrics.org