A newly released study reveals that core competencies drive claims outcomes. That’s according to the 2017 Workers Compensation Benchmarking Study conducted by Rising Medical Solutions, a provider of medical cost containment and medical care management services.
The study, now in its fifth year, outlines the latest issues affecting workers’ compensation claims management.
More than 1700 claims leaders were surveyed to discern how and what high performing claims organizations – those with claims closure ratios of 101 or higher – do differently.
The free report offers workers’ compensation claims organizations a chance to improve outcomes.
“With decreasing budgets and escalating medical cost inflation, it’s critical that claims organizations know the extent to which a practice moves the needle, so they can optimally allocate resources,” said principal study researcher and author, Denise Zoe Algire.
According to the study, there are four major drivers of claims outcomes:
- Core competencies
- Medical performance management
- Talent development and retention
- Technology and data
The report revealed several differences between higher performing organizations and their lower performing peers. Here are 10:
- Higher performing organizations tend to have medical management programs in place, such as nurse/claims triage, nurse case management and utilization review.
- They are much more likely to measure best practices within core competencies than lower performing peers.
- Advocacy-based claims models continue to be used by higher performing claims organizations to drive better outcomes and as a talent strategy.
- Top performing organizations measure provider outcomes.
- Better performing organizations tend to have disability and return to work programs in place.
- Higher performing organizations have an audit or quality assurance program in place.
- They invest in staff development and training.
- Top performing organizations tend to have a formal process in place to ensure knowledge transfer.
- They are more likely to have integrated systems across multiple programs.
- Better performing organizations reveal an increased investment in IT resources to implement systems integration and workflow automation.
Additional findings include:
- Claims closure ratio declined. More than 50 percent of respondents reported a growing claim inventory.
- Rising medical costs are considered the new normal in workers’ compensation. Most survey respondents considered this to be the top factor impacting claims outcomes.
- Workers’ comp carriers are showing increasing use of predictive analytics to improve claim outcomes.
- Despite improving performance, a decline in audit programs was noted.
- Training budgets declined for both new hires and current staff in 2017.
- System integration continues to be limited.
- Pharmacy still a top priority.
A copy of the report may be requested from Rising Medical Solutions here: https://www.risingms.com/research-knowledge/workers-compensation-benchmarking-study/request-report/
Source: Rising Medical Solutions
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