By Anthony Cuva, CIO of One Call Medical
Today, workers’ compensation claims are often complicated by a number of factors, including a high volume of transactions; manual, labor-intensive business processes; delayed communications, and many other administrative hassles.
Workers’ compensation leaders realize that technology is essential to streamline operations, but applying “point solutions” will not gain significant business value, and in the end, will not result in a strategic vision for IT.
As a result, service providers are now looking to establish and utilize an enterprise-wide infrastructure to raise service levels and provide business intelligence throughout their organizations. This type of modern platform makes use of Internet-native technology as a main means to process transformation.
Here are key considerations when designing a platform for your organization, or when evaluating a platform used by service providers:
A Strategic Blueprint. Organizations should start with a blueprint that outlines IT needs and automation requirements over the next five to ten years. To start out, many organizations design an enterprise-level map of business processes to see where technology can be applied to benefit core functions. In addition, the blueprint will encompass the organization’s vision, strategy, and objectives.
It’s important to realize that not every component of the claims process should be automated or require a new IT tool. In fact, adjuster coordination is essential on complex cases, in which claims-handling expertise and personalized attention is vital to ensuring good outcomes. Instead, organizations should apply technology strategically—to automate the mundane tasks and free adjuster resources to focus on claimant communication. In this way, technology plays a vital supporting role to claims staff. For example, it can automatically notify adjusters of results from diagnostic tests or completed transportation runs for patients.
Each IT tool should deliver business value, such as increased operational efficiency, process acceleration, or more consistent application of best practices or cost savings.
Flexibility to Respond. Despite the availability of advanced technology solutions, many organizations continue to use antiquated legacy systems that lack contemporary claims-handling capabilities. Legacy systems are highly resistant to change, interconnection, and access by external parties. In fact, maintenance alone on a legacy system can consume significant IT resources and become cost-prohibitive.
A modern infrastructure, on the other hand, enables service providers to deploy new capabilities quickly. These platforms are interoperable and can easily connect to other applications in a complex multi-system environment. Modern platforms not only offer robust functionality, but also powerful configuration capabilities. As a result, organizations can continually rethink and redesign business processes to adapt to changing market and regulatory conditions. In many cases, these platforms utilize online portals to enable external stakeholders to login to access information, check on the status of transactions, and submit referrals.
A Competitive Advantage. By continually leveraging technology to optimize operations, service providers satisfy customer expectations and transform the customer experience into a key differentiator. As a result, organizations should view technology as a strategic investment to ensure service excellence and to deepen client relationships. For example, One Call Medical, Inc. (OCM) has experienced significant growth and rapid expansion. At each step, OCM’s investments in state-of-the-art technology have made it possible to ensure ease-of-doing-business with clients, handle increased volumes of referrals, and connect to new business partners.
Business Intelligence. In the past, there was no way to effectively analyze a service provider’s performance from an enterprise level. Today, data analytics help to compile meaningful business intelligence that can be easily shared and distributed to key stakeholders. In this way, organizations can ensure a high level of performance and continually develop new programs to further improve outcomes.
By utilizing targeted reports, workers’ compensation leaders can systematically build awareness of program goals and performance against these goals. Managers can use reports to identify departments with significant claims leakage, and work with departments to capture additional savings. If a department has significant issues, a manager may opt to provide specific training or adopt other leakage-capture tools. In this way, people at every level of the organization can contribute to the program’s success.
Integration and Connectivity. The workers’ compensation industry has traditionally employed various point solutions. As a result, transactions occur in silos and data resides in various databases throughout the organization. This disjointed infrastructure hinders workflow and the ability to share information. While enterprise-wide integration requires financial resources, connectivity would yield a huge return on investment. Moving forward, organizations must ensure service providers can easily connect—people, systems, and data—to create one seamless, integrated platform.
E-Commerce. In the age of the Internet and mobile technology, consumers are accustomed to 24/7 connectivity, immediate access to information, and real-time transactions. Likewise, workers’ compensation professionals are increasingly savvy and want to employ these online capabilities to the benefit of their work environments. To address this demand, OCM has established an e-commerce committee, which works with focus groups and performs market research to ensure new capabilities make the lives of claims professionals easier. The goal of this team is to deliver additional value through capabilities such as Internet portals and online self-service options.
Contingency Plans. Leaders must also anticipate unlikely scenarios and disasters that could affect their business operations. To prepare, they need a broad business continuity plan. The first step is to perform an operational impact analysis to identify and prioritize services, systems, and data functions that must stay operational. From this review, organizations can pinpoint the critical priorities that must continue uninterrupted—versus the optional services that can be restored at a later point in time. Key elements in the business continuity plan should include data backups and recovery, communications, secondary worksites, and infrastructure.
Relief for IT Resources. Many organizations are strapped in terms of IT resources. These departments often have a full plate of responsibilities and competing IT priorities. Knowing this, OCM strives to deliver IT capabilities that are easy for clients to implement. In fact, many of our tools operate on a “plug and play” basis. In this way, we provide IT value to clients without them having to secure significant time and attention from their own IT departments. Within our company, we also try to consider the “end state” of the systems we select. For example, flexibility and ease of maintenance are key factors we take into account.
Mergers & Acquisitions. In recent years, M&A activity has increased in workers’ compensation. In this climate, an enterprise platform can play a strategic role. The right infrastructure can meet the needs of various business units and ensure service levels are consistent across the company. Significant value can result from shared enterprise services. For example, when OCM acquired STOPS Enterprises, LLC and Express Dental Holdings, LLC (EDH), it began work toward a “one system” approach for invoicing, submission of electronic referrals, portal technology, and business intelligence reporting.
Reaping the Rewards
Organizations that utilize an enterprise platform can achieve service excellence and leverage business intelligence to gain a competitive advantage in the market. Actionable information gives organizations the awareness of problem areas and the insight to address them.
In workers’ compensation, OCM has operated as a leading service provider. Not surprisingly, we invested in state-of-the-art technology tools, as well as an enterprise IT platform. Our strategic blueprint has been successful because we understand our IT priorities across our enterprise and for specific business units. Having this clear understanding enables us to focus IT resources on areas that deliver the greatest value to our company, to our clients, and to the industry.
OCM has also established clear measures to monitor our return on IT investments. In the end, we know a modern enterprise platform helps to not only support day-to-day operations, but also prepare us for future growth and expansion, especially as we continue to engage in mergers and acquisitions, and the integration of additional services into our company’s portfolio.
About Anthony Cuva
Anthony Cuva is the chief information officer at One Call Medical, Inc (OCM). He has over 35 years of experience as an IT strategist and has demonstrated an ability to implement solutions in diverse technical environments as well as a proven track record in IT organizational development. He has held many key IT leadership positions over the years and has continually delivered sophisticated products and services to a wide range of audiences and clients while providing cutting-edge technical support and guidance. At OCM, Cuva leads by implementing state-of-the-art technology across all business units and his vision for integrating IT operations and services has been instrumental to the continued success of the company. He can be reached at Anthony_Cuva (at) onecallmedical.com.
About One Call Medical, Inc.
One Call Medical, Inc. (OCM) is the nation’s valued partner in delivering a suite of easy-to-use, efficient and cost-effective specialty services that help claim professionals achieve superior outcomes. OCM is committed to providing service excellence that optimizes each claim and has set the standard in innovation, quality, and dependability. When the management of every claim makes the difference to an organization’s bottom line, they turn to OCM to provide easy, fast, and effective solutions. Through OCM’s specialty diagnostic, transportation, translation, interpretation, and dental network services, our customers benefit from access to fully credentialed providers, prompt scheduling of services, and improved care. For additional information regarding One Call Medical, Inc., please visit www.onecallmedical.com.