December 16, 2017

Effective Health Systems’ President Introduces Big Data Strategies at AMCOMP 2016

Los Angeles, CA – James Schlueter, President, Effective Health Systems recently presented evidence to suggest that Big Data affords not only significant strides in workflow automation, but also a noticeable lift in job satisfaction among claims professionals. Results reported include the elimination of a wide range of mechanical processes adjusters grapple with daily; double to triple the standard industry performance metrics for medical networks, utilization review, ancillary network penetration, and automated bill validation; and a big drop in complaints.

At the invitation of The American Society of Workers Comp Professionals Schlueter was joined by the VP and National Medical Director from a major insurance carrier, whose firm uses Effective Health Systems to help automate its workflow. Both presenters offered their remarks at the organization’s annual meeting in Las Vegas April 14 & 15, 2016. The theme of the conference, according to Board Member Marty Ovens, was “Rethinking Workers Compensation,” a look at key trends affecting the development of the workers’ comp industry.

Schlueter, of Effective Health Systems, led a session on Emerging Data Trends In Workers’ Comp Claims Management, in which he made the surprising case that automation need not displace claims professionals, but rather restore their primacy. He explained, “Over the past twenty years claims management has shifted away from a process that involved highly personal engagements between an injured worker and a claims administer. Today, claims management has become far more mechanical, focused largely on forms, processes and costs.” Schlueter further explained, “The industry has failed to keep up with the changing technologies necessary to effectively manage data and elevate the value of its human capital.”

“The result, is form over substance, processes over outcomes, and cost over value. These biases have undermined the success of claims organizations and made it hard to attract and retain new blood, as Boomers retire. Millennials see claims management as a twentieth-century factory job. Meanwhile, lack of transparency and inaccessibility of critical data make it difficult to measure meaningful performance outcomes of medical and service providers.”

“Business leaders get this,” says Schlueter. “They recognize that claims outcomes aren’t improving, and that claims organizations aren’t in alignment with their business objectives.” Schlueter exhorts his industry to adapt, or else. “History has shown many times over that an industry that doesn’t evolve with its market will be left behind as the market responds to the growing demand.”

Schlueter said, “What we need to do is simple. Automate what can be automated and create a work environment that offers front-line managers a sense of autonomy, mastery and purpose. The goal is to create time and space so claims professionals can do what they do best; rather than simply grinding out routine forms and processes day after day. Our numbers suggest real progress on this front.”

Schlueter’s co-presenter, a client of Effective Health Systems, picked up on Schlueter’s introduction and used examples to show how the carrier’s investment in workflow automation strategies has come to mean greater compliance with regulatory requirements and best practices, improved transparency and more accessible data in the claims management process. As the Vice President & Medical Director reported, “We have removed the burden of the myriad of tasks that technology does better from our claims team. As a result, we are now better able to identify trends in data that were previously either non-existent or inaccessible. And, in the process we have elevated the jobs of our claims professionals.”

“There was some early concern by the claims team about giving up control these routine tasks. However, they soon realized that automation of the routine mechanical functions allows them far more time to work on the issues that are more rewarding and can truly drive a claim to closure. Automation has made our claims management roles much more satisfying and creates an environment that’s attractive to the younger professional.”

“In addition,” the Vice President & Medical Director reported, “automation has given us better data on what is occurring in real-time within the claims process. It allows us to apply best practices and big data more responsively to specific claims management issues. Consequently, we are better aligned with the objectives of our clients and injured workers are getting better care and returned to productivity with less disruption in their lives. Quite simply, everyone wins.”

Source: Effective Health Systems

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