Are You Listening?

a White Paper
by Karen Wolfe

We believe listening to your data is the way to successfully manage claims and medical costs in Workers’ Compensation. When you listen to your data you get timely and accurate information, information that tells you what’s happening and suggests what to do. When you listen to your data, outcomes improve. 

Listen 
For instance, listen to your data to direct injured workers to the best treating doctors. The data will tell you who they are. Listen to the data to understand how severe the injury is so you know the best type and amount resources to apply.Listen to your data to tell you when claims are not progressing. 

Listen to your data continually to know how your injured workers are progressing toward return to work and to remove obstacles in their path. Listen to your cumulative data to understand what is happening in and to your organization. 

Listening help
We also believe we can help you listen. We collect data from your various sources, integrate it, and analyze it for you. This is not something you can do in your head or on your own. Attempting to do so would be overwhelming and lead nowhere. 

We also update your data continually so when the information is returned to you, it is fresh and accurate, not outdated and unreliable. 

Return information 
When we finish collecting, integrating, updating, and analyzing your data, we give it back to you in forms you can easily understand and act upon. For example, we monitor claims continually and when we notice something that you should know, we send an electronic alert. The alert is sent to the right person at the right time and with the right amount of information for action. Intervening early always leads to better results and lower costs.

Besides alerts, we also give you back information in the form of easy look-ups, searches, and reports. We give you pre-defined queries that allow you to further analyze your data and to drill down for even more intelligence. 

Easy

The best thing about listening to your data is that it’s so easy because we do the listening for you and send you information via online apps. Our online apps are easy to access and operate. Let us help you listen to your data.

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

Are You an Industry Disruptor? It Can be a Good Thing

by Karen Wolfe

The idea of an industry disruptor might be reminiscent of a classroom prankster, the one who continually distracts to keep the teacher off topic. But no. The term “industry disruptor” is being used to describe organizations with concepts or approaches that significantly impact an industry. Because of their unique presence and ingenuity, industry disruptors change the entire industry—often forever.

Industry disruptors

Think of Steve Jobs’ invention and Apple, Inc.’s implementation of the iPod. It turned the music industry on its side. Jobs could envision completely new products and new ways to use them, so he changed the music world. But the music industry was not the only business he disrupted.

Jobs did not invent the cell phone, but he changed the way cell phones are used. The “smart” iPhone profoundly changed the way we use phones. Now they are small, but powerful hand-held computers with apps that embrace almost any activity. Land lines have become almost obsolescent and old “Ma Bell” would not recognize the industry.

Moving on, Jobs also disrupted the personal computer industry with the iPad. Sales are down for laptops and portable computers because people rely on the simpler iPad for personal use, for e-reading, for movies, and for specific business adaptations. As an example, doctors’ offices now use iPads for data input into EMR’s (Electronic Medical Records). iPads and phones even capture credit cards and signatures.

Jobs could “think different”, actually using that phrase in advertising. He could envision, design, develop, and implement electronic tools that disrupt whole industries. Amazingly, the technology, through the continuous development of apps (purpose-specific applications) has allowed expansion from the original concept into every avenue of life.

Yet another, more recent disruptor is Uber. Uber has taken use of the smart phone a step further, thereby changing the way people travel from point to point in cities. Just tap your phone, and you will be picked up and driven to your destination. No money or credit card transactions are needed because that has been set up in advance on the Uber website.  

Uber has seriously disrupted the stodgy taxi industry as people find the simplicity of Uber quicker and more satisfactory. However, disruptor transition is not necessarily easy. Uber is suffering from growth stumbles and legal push-back from the taxi industry. Resistance is found in many industries.

Disruptors in Workers’ Compensation

Everyone agrees Workers’ Compensation needs updating and improving. Unfortunately, the industry is notoriously resistant to change. What would an industry disruptor create for this industry?

Legislation

Some say the big change needed is to legislate the employer opt-out option from state regulated systems. Texas and Oklahoma are the change leaders in that effort. However, a group of employers is working in other states to bring about similar legislation. If well-executed, these efforts could significantly impact the industry.

To bring about superior, sustainable change, new applications of technology will be required to monitor consistency, quality, and compliance across jurisdictions. The technology is available. Now a unique application is needed, one that everyone loves to use!

Loving technology

Loving technology is not a sentiment normally found in Workers’ Compensation. That is because most still think of technology as tedious data input and mistrust the output. Nevertheless, creative technology could boost and enhance nearly every activity in Workers’ Compensation.

The ultimate goal in any Workers’ Compensation endeavor is (should be) to optimize the medical care of injured workers at the lowest possible cost. A successful industry disruptor will apply technology in new ways, thereby positively impacting cost and outcome pathways for injured workers and their employers.

Industry disruptors

Any industry disruptor technology will encounter resistance in Workers’ Compensation. However, everyone can contribute to positive industry disruption by simply being open to change. Change might mean doing things differently. It might be willingness to learn about and adopt new technology-based approaches in business operations. It might even mean willingness to love technology.

The point is, a creative new use of technology will change the way the Workers’ Compensation world is managed going forward. Industry disruptors will make that happen.

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

 

Technology in Workers’ Comp—It’s Not Just for Documenting Anymore

by Karen Wolfe

Sweeping changes underway

Multiple articles have been published recently warning of sweeping changes impacting the Workers’ Comp industry. In an article entitled, Take Time for Technology, Steve Penman, COO at Sedgwick states, “Workers’ compensation is a data intensive system and it remains a challenge for virtually all employers. Increasing regulations, rising medical costs, and the uncertainty posed by healthcare reform continue to make this a formidable issue on all fronts. Technology is having a profound influence on the way organizations are managing their workers’ compensation programs.”[1] Yet, many organizations continue to do business as usual rather than embrace technology to understand and effectively manage through the quickly evolving business scene.

Beyond storage headaches

Payers in Workers’ Comp have long used computer technology to manage bill payments and document actions or events associated with claims. The result after many years of computerization is the vast quantity of data. However, little has been done in the industry to leverage that data to make it a viable decision support tool rather than just a storage headache. Little has been done to convert the data into a working tool that can impact claim process and outcomes.

Obama Care impact

In another recent article, Is your workers’ compensation technology platform readyfor healthcare reform? Mike Allen asks, “Is your workers’ compensation technology platform ready for healthcare reform?”[2] Allen offers a litany of initiatives taking place before our eyes in general healthcare.  He continues, “No doubt there are many opportunities to leverage the technologies implemented as part of new American medical model to improve treatment of injured workers.  What steps are you taking to make this happen?”

In yet another article entitled, Affordable Care Act of 2010 - Workers' Compensation Community, Take Heed![3] Todd Brown, EK Health's Director of Bill Review, states “The Affordable Care Act of 2010 in section 10109 gave authority to the Secretary of HEW to periodically review and determine whether or not Property and Casualty including workers’ compensation insurance should be brought up under the HIPAA umbrella. The act requires that the consideration for inclusion of Property and Causality under HIPAA be reviewed every three years.” In other words, Workers’ Comp payers may be quickly swept into the Obama Care technology surge at any time.

Heads-up!

The warnings are well-founded and clear. To manage change, the use of technology is increasingly important for the Workers’ Comp industry. Unfortunately, the industry is already significantly behind others. The Affordable Care Act (Obama Care) is driving the rush to technology in general healthcare and it will significantly impact Workers’ Comp whether or not it is formally included in the Act. Moreover, the greatest challenge to Workers’ Comp payers is not gathering more data. It is changing the way technology is applied to the data to make it a powerful tool.

New uses for technology

The use of technology must move beyond traditional computerized documentation and reporting. To their credit, some Workers’ Comp organizations have successfully applied predictive modeling techniques to the data to derive important knowledge about potential risk. But intelligence must be linked to operations through technology to make it actionable.

Integrated platforms

The major thrust in general healthcare technology in response to Obama Care is to significantly improve quality of medical care while controlling costs.  Platforms that integrate patients’ medical records from hospitals, laboratories, doctors’ offices, and ancillary providers are in place or well underway.

In Workers’ Comp, integrating the data from all sources associated with a claim is crucial. Bill review, claims, pharmacy, medical case management, and utilization review systems should be integrated at the claim level to gain the total picture of the claim at any point. In other words, documentation must continue, it must improve in accuracy, and the information must be integrated across the claim.

Decision support

Workers’ Comp data must also be re-presented to the business units for real time decision support. Claims and medical professionals should be able to access current comprehensive claim information to make decisions about best doctors and other factors pertinent to quality and cost management.

Data made a working tool

Additionally, the data in Workers’ Comp must be translated to make it a work-in-progress tool. The integrated data from all sources in Workers’ Comp should be monitored continually and concurrently using technology to identify conditions in claims that portend risk and cost. Monitoring historic and current claim data continuously and applying rules for alerts and interventions will improve quality of care and outcomes while automatically documenting the process. Such is the nature of the new technology.

Integrated claim data is monitored electronically to uncover conditions identified in predictive modeling, industry research, and gleaned from the wisdom of experienced professionals. When such conditions in a claim are identified, technology is used to automatically notify the appropriate person to intervene. Early, knowledgeable intervention avoids complexity and results in quality and improved outcomes while costs are controlled.

Better late…?

The technology imperative is urgent and clear for Workers’ Comp. “Better late than never” does not apply because the impact in underway. Never is not an option!

Ms. Wolfe is president and CEO of MedMetrics® that offers technology and analytics designed to strengthen medical and cost management methods in Workers’ Comp. MedMetrics' suite of technical services and online power apps offer payers, managed care service providers and provider networks a quick and affordable path to cutting edge technology that recharges managed care. For questions, contact karenwolfe@medmetrics.org

 

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[1] Penman, S. Take Time for Technology.  WorkCompWire  May 6, 2013 http://www.workcompwire.com/2013/05/steve-penman-take-time-for-technology/

[2] http://michaelgallen.wordpress.com/2013/05/07/is-your-workers-compensation-technology-platform-ready-for-healthcare-reform/

[3] http://www.ekhealth.com/v-2012/-june-2012/affordable-care-act-of-2010-workers-compensation-community-take-heed