Measuring quality performance in the Workers’ Compensation managed care arena has long been problematic. Medical networks measure discounts as savings from fee schedule while bill review companies measure reductions from the billed amount. Both means of measuring savings are difficult to justify and sustain over time. Still, savings from medical case management interventions and initiatives are the most challenging to calculate and prove. But not impossible.
Everyone wants to see how their peers are doing, but obtaining that information is tricky. “I‘d love to see your data, but I will not share mine”, is a common sentiment. To avoid that conundrum, a non-affiliated third-party must do the analysis. The third-party must be without connections or obligations that compromise the operation or its participant’s anonymity.
Proof of Value
Benchmarking is a powerful tool that demonstrates or proves the organization’s performance compared to others. Clients and senior management want to know if they are getting the best results. Benchmarking provides a measure of the value of the services and products purchased. Moreover, benchmarking is a powerful means of retaining clients and influencing prospects.
When benchmarking results show less than positive results for the organization, benchmarking reveals exactly where improvement is needed. It calibrates quality accurately, objectively, and without requiring additional effort or resources of the organization. Medical management performance is calculated and visible, thereby highlighting areas of excellence along with those operations that need improvement. Moreover, by refreshing the data at regular intervals, repeated benchmarking provides an excellent, ongoing quality assurance monitoring program for the organization.
Regardless of the benchmarking goal, specific factors representing medical management process and outcome must be isolated in the data. Peer performance is then compared specifically, accurately, and anonymously.
Data elements in the participant data must be selected for analysis, collected and measured against the same data elements in the third-party database. For example, Workers’ Compensation medical benchmarking data elements would include overall medical costs, indemnity costs, and return to work factors. Process analysis requires such data elements as time from the date of loss to claim closure, among others, while adjustments for diagnostic severity should be made.
Benchmarking medical management practices for Workers' Compensation is state-specific. Because of jurisdictional variability and state fee schedules, comparing more broadly will generate inaccurate and misleading results.