August 4, 2021

In Claims Management, Centralized Data Means Empowered Decisions

This article was originally published by WorkCompWire. featuring Healthe’s Director of Product Management, Stephanie Arkelian, in their Leaders Speak forum.

The role of the claims professional is truly front and center. They are on the front line of claims management, and serve as the central point of communication between the injured worker and all other stakeholders.

I understand this well, not only from our conversations and research initiatives here at Healthesystems focusing on the claims professional experience, but because I used to be in that role.

Before I stepped into the role of product manager, developing solutions to meet today’s workers’ comp challenges, I was that adjuster out there trying to manage hundreds of claims. And I faced the very same challenges that I’m today focused on solving – challenges that these professionals are often still facing today. Working with disparate systems. Working with a multitude of vendors. Trying to coordinate all these services for the injured worker. It can become very complex and very confusing very quickly.

It is this front-and-center aspect of their role that positions claims professionals as key stakeholders in minimizing information gaps that can negatively affect patient outcomes. But only if they are empowered with the technology to effectively do so.

There are a lot of efficiencies to be gained using technology to streamline and simplify the process of managing an injured worker’s medical care. With the technology we have available today, it is possible for a claims examiner to view and manage activity for multiple ancillary medical products, services and vendors all in one place – whether it’s a referral for physical therapy services, or a ride to the doctor via Lyft. This visibility means that a claims examiner has a more complete picture of claims activity – and it’s a game changer.

Being able to centralize services minimizes gaps in coordination of care. Take the case where an injured worker is running late to a scheduled service, or transportation to an appointment is delayed. It’s critical to have insight into the bigger picture of all the moving pieces so that all the parties can be notified. The claims professional is empowered to properly manage that service disruption to potentially avoid a missed appointment, and any downstream issues that may come from that. In the short-term that may mean rescheduled appointments. In the long-term, disruptions to care can lead to bigger-picture consequences, such as delayed return-to-work or additional indemnity.

With this type of infrastructure in place, the sky is the limit in terms of what types of services and data streams can be connected. Imagine an experience where a prescription refill pattern identifies a candidate for a urine drug screen, and then automates a referral for this service based on pre-defined business rules. This type of automation helps efficiently connect the dots between claims risk and mitigative actions, while also freeing up the claims professional’s time to tackle other responsibilities.

Not only does easy access to complete information save time and money, it also avoids some of the added pitfalls of siloed systems, such as data inconsistency. For example, one system might use the “pay date” field for a transaction to indicate the date of payment receipt, whereas another system, or organization, might treat that same data field as the date they paid someone else.

It’s just one small example. But any time a single data field is being used to communicate two different things entirely, it can create upstream and downstream issues. If there is not awareness of the inconsistencies, issues will arise with reporting timeliness and cause communication challenges.

In addition to the gains that centralization can bring to the claims professional and claims process, there is also the injured worker to consider. Incomplete or incorrect information can delay care or cause claim stakeholders to reach conclusions that impact the patient in a negative way. In a best-case scenario, the injured worker becomes frustrated. In other cases, we may see this result in legal action.

Unfortunately, what we often see with a lack of access to timely information is a negative ripple effect. This is why the application of holistic insight and management across the multitude of workers’ comp services is key in managing the injured worker’s care.

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