When developing effective claims programs for workers’ comp, a finely tuned user researchprocess is a crucial tool in ensuring that stakeholders across the board all benefit from the solutions that are implemented.
Stereotypes and assumptions surrounding the wants and needs of injured workers, claims professionals, payers, and other stakeholders stand in the way of effective solution building. Only a true understanding of their experience in the workers’ comp system can highlight negative interactions or gaps that serve as a barrier to positive claims outcomes.
Healthesystems recognizes the importance of an evidence-based, structured approach to identifying the needs, challenges and preferences of different stakeholders as they navigate the workers’ comp system, which is why our user research program regularly inserts research capabilities throughout our innovation pipeline. The insights we gather from these initiatives help inform the development of new solutions and the improvement of existing solutions, to better serve our clients and the workers’ comp insurance market.
We currently have multiple in-depth research initiatives underway, including a continued and concerted focus on the patient experience – the detailed findings of which we make available to our customers. Here we share three high-level findings that identify areas where the industry can improve patient experience and program outcomes.
According to our findings, 50% of patients experienced a delay in reporting their injuries. This occurred for a variety of reasons, including:
- Fear of negative consequences for reporting an injury
- Stigma around workers’ comp patients across various stakeholders
- Plans for self-care
- Lack of direction from employers and insurers
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.
"It’s a lot of paperwork to fill out while being in pain. 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:
- Empathy training for HR and managers who may be involved in the management of injured employees, to reduce feelings of hostility that injured workers may experience – real or perceived
- Tools to streamline the intake experience and reduce injured worker burden, such as paperless first fill forms
- Access to centralized resources, such as an assistance hub or help desk chat
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:
- Being examined in unusual, non-medical settings
- Receiving incorrect medical records/documents/documentation
- Being sent to the wrong type of provider
- Unprofessional or even discriminatory behavior
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.
"My case manager wasn’t returning my calls. 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.
This article was originally published on WorkCompWire in October 2020. For more insights from Healthesystems, visit our RxInformer journal online.