According to our findings, 50% of patients experienced a delay in reporting their injuries. This occurred for a variety of reasons, including:
Approximately 25% of patients faced complications with receiving initial paperwork or being asked to deliver intake information via a channel they did not have access to, such as the need to scan or print documents.
Having someone do it for you over the telephone
would take the load off.”
Delayed intake leads to delays in care, which can impede recovery, lengthen return to work, and increase claims-related costs. Assisting patients upfront during the intake process through a combination of streamlined processes and enhanced support can ultimately benefit claim outcomes down the line. Examples include:
When analyzing the patient journey, we found that the greatest number of challenging touchpoints were reported in respect to initial medical exams.
Similar to the daunting challenges of the intake process, a patient’s first in-person experience with a medical professional within the workers’ comp system can make or break their faith in the management of their care, setting the tone for the course of the claim and recovery.
Among patients who had initial exams, 60% reported a negative provider experience. Examples of negative experiences include:
To compound the issue, patients often lack the communication channels to report problems such as these, and they may not be aware of potential options to change providers. Negative provider experiences increase the likelihood the patient will continue down a suboptimal path of care or pursue litigation, either of which are associated with increased claims costs.
Patients felt so strongly about this subject that 88% supported process-related resources that included provider background checks. Going further, industry leaders also voiced a desire for such resources, as it is likely they would improve overall program performance.
Overall, we found that patients require guidance at various steps of a claim, but instead of going to stakeholders within the claims system, such as an adjuster or nurse case manager, 75% of patients reported that they utilized family, friends, other injured workers, or their own research to answer questions related to their care and the claims process.
When asked why, patients noted that they faced difficulty getting information they needed from the individuals working on their claim.
I later found out that the original case manager
wasn’t on the case anymore, and I had not
been notified.”
While these breakdowns may sometimes be the failure of an individual, they can often be gaps in the system itself. Claims management solutions have historically not been designed to keep patients informed. By providing patients with channels to ask questions and seek guidance, many problems that arise throughout the lifecycle of a claim and often go undetected can be uncovered earlier.
Furthermore, when it comes to opening channels of communication for patients, success relies upon understanding which channels patients may prefer. For example, approximately 94% of patients reported using their cell phones often, with 70% of those participants utilizing text and/or email as the top two features on their phones. In fact, nearly 60% of patient participants utilized telehealth at some point, demonstrating the ability to embrace other technology solutions.
Catering communication channels to the behaviors and preferences of the user will be an important consideration to help drive uptake of these tools that will facilitate the desired outcomes.
