Among the key differentiators identified, higher performing claims organizations are more likely to:
- Link key performance indicators (KPIs) to desired claim outcomes
- Employ claims decision support tools – such as workflow automation, advanced analytics, and predictive modeling – and use them more frequently throughout the claim lifecycle
- Leverage numerous data sources to develop analytics, like Evidence-Based Medicine (EBM)
- Utilize an employee-centric, advocacy-based service model to improve claim outcomes as well as talent retention
- Engage sooner in emerging and/or particularly challenging industry areas, such as adopting value-based care models and implementing formal knowledge transfer programs
- Use pharmacy metrics as a measure of provider quality/outcomes
- Link provider quality/outcome measures to provider contracts & Letters of Agreement
The study's direction continues to be guided by its expert Advisory Council and driven by a collaborative investigation with claims organizations. "We've heard from the claims community about difficulties identifying which best practices actually move the needle because industry data is often limited or unavailable," says Rachel Fikes, Vice President and Study Program Director at Rising Medical Solutions. "Providing quantitative, primary data to substantiate various methods in claims management was the next logical step in the study's evolution."
"By using the industry benchmark of claims closure ratio, which is applicable to all payer sizes and types, we were able to contrast how and what higher performing organizations are doing compared to industry peers," says principal study researcher, Denise Zoe Algire. "With so many competing priorities and complexities in claims management, the 2016 study provides a roadmap identifying where organizations should allocate resources to drive better outcomes."
As in previous years, the 2016 Study Report is available to all without cost or obligation as a contribution to the workers' compensation community. A copy may be requested from Rising Medical Solutions here.
About the Workers' Compensation Benchmarking Study
The Workers' Compensation Benchmarking Study is a national research program examining the complex forces impacting claims management in workers' compensation today. The study's mission is to advocate for the advancement of claims management by providing both quantitative and qualitative research that allows organizations to evaluate priorities, hurdles and strategies amongst their peers. Conceived and directed by Rising Medical Solutions, the ongoing program is a collaboration of industry executives representing diverse organizational perspectives, including the Study's Principal Researcher and Advisory Council:
- Gale Vogler, Director, Managed Care, Acuity Insurance
- Denise Zoe Algire, Director of Managed Care & Disability, Corporate Risk, Albertsons Companies
- Raymond Jacobsen, Managing Director, AON Benfield
- Rich Cangiolosi, Vice President, Western Region, Cannon Cochran Management Services Inc. (CCMSI)
- Pamela Highsmith-Johnson, RN, BSN, CCM, Director, Case Management, CNA
- Cathy Vines, Director, Healthcare Cost Containment Strategy, CopperPoint Mutual Insurance
- Daniel T. Holden, Manager, Corporate Risk & Insurance, Daimler Trucks North America LLC
- Kelly Kuri, Claims Manager, Frank Winston Crum Insurance
- Marcos Iglesias, M.D., Vice President, Medical Director, The Hartford
- Tom Stark, Technical Director, Workers' Compensation, Nationwide Insurance
- Trecia Sigle, Associate Vice President, Workers' Compensation Claims, Nationwide Insurance
- Tom McCauley, Owner & Consultant, Networks by Design
- David Price, President, POMCO Risk Management
- Laura Crowe, Risk Management Director, Presbyterian Healthcare Services
- Mark Walls, Vice President, Communications & Strategic Analysis, Safety National
- Darrell Brown, Chief Claims Officer, Sedgwick
- John Smolk, Principal Manager, Workers' Compensation, Southern California Edison
- Joe McLaughlin, Senior Vice President, Sales & Marketing, TRISTAR Insurance Group
- Linda Butler, Manager, Workers' Compensation, Walt Disney World Resort
- Kyle Cato, Workers' Compensation & Safety Manager, Williams-Sonoma, Inc.
- Tim Mondon, Senior Vice President, Bill Review, Zenith Insurance
About Rising Medical Solutions
Rising Medical Solutions is a national medical-financial solutions firm that provides medical cost containment and medical care management services to the workers' compensation, auto, liability and group health markets.
Media Contact: Rachel Fikes: email@example.com / 312.224.5893
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SOURCE Rising Medical Solutions