By James A. Schlueter, President, Effective Health Systems
In workers’ Compensation, adjusters are the equivalent of the football quarterback. The goal of the adjuster is to move a claim forward by effectively returning the injured worker to productive lifestyle following a work-related injury or illness. The adjuster needs to direct the injured worker to get the right care at the right time and at a reasonable cost; while avoiding many obstacles along the way.
In the workers’ compensation system, there are many opportunities for secondary gains that generate conflicting goals and objectives in the management process. Consider that the frequency of workers’ compensation claims has declined by over 55% in recent years. And yet, medical costs have more than tripled. Some point to an increase in claim severity to explain medical costs increasing three-fold. But, that explanation is just too quick and convenient. Think about it. A system that was competent enough to reduce claims frequency by more than half, stands by and allows the remaining injuries to become so severe that the gross cost, on less than half the volume, more than triples the previous gross cost? However you cut it, there’s more to this story.
Managing a workers’ compensation claim used to be a process of managing disability and indemnity. Today, workers’ compensation is about managing a complex medical process. The market has seen the evolution of many expensive and specialized medical services and the management process has become highly technical, specialized and regulated. There’s big money in this game and all the players have become very sophisticated. The field is rich with opportunities for secondary gains for those so inclined, and the competition for resources is fierce. Unfortunately, the claims management technologies of the 90’s and early 2000’s were simply not created to manage the complexity of this new game.
Attempts to respond to the above issues have been blunted by efforts that have been fragmented, single focused, and often as not, driven by portal technologies created by self-interested vendors. These endeavors have lacked integration and operational simplicity. Not only have the failed to truly grab hold of the issues, they have made the process far more complex and opaque. For adjusters, the game has become more like international diplomacy. In order to get from A to B, you have to talk with X, who communicates with Z, who tells B what Z thinks A wants B to do.
Like football quarterbacks, adjusters have several supportive resources available to them to help move a claim. But, they are handicapped with too many routine tasks and decisions that create too many delays to effectively move the claim forward. Without solid communication and coordination of resources to ensure effective command and control of the field, the best plans unravel; and the quarterback gets sacked.
The need for communication and coordination between the various players has never been greater. The process has never been so complicated and task intensive as it is today. Subsequently, those seeking the secondary gains available in workers’ compensation find many opportunities slip behind the adjuster’s line and sack the play. Bottom-line, claims slip out of the adjuster’s control and the whole process begins to splinter; all due to a lack of effective command and control.
Our BaseLine platform’s OLTP and OLAP technologies establish a robust command and control system to a claims organization that is missing today. As a result, with BaseLine, it is much harder to sack the workers comp quarterback.
About James A. Schlueter
James A. Schlueter is the Founder and President of Effective Health Systems. He has over 30 years working within the healthcare industry, most of which has been engaged in the workers’ compensation area. He has developed many innovative programs and strategies designed to bring greater management efficiencies and effectiveness to the industry. His primary focus today is on product and business development.
About Effective Health Systems, Inc.
At Effective Health Systems, we do things that help professionals do their jobs better. Our primary offering is a technology we call BaseLine. It is aimed at improving the process of claims management in workers’ compensation.
BaseLine is a Platform as a Service (PaaS) that delivers interoperability between multiple technologies, databases and human workflows. As a web-based service, BaseLine leverages and enhances the value of a client’s existing investments in technologies, people and vendors.
BaseLine communicates with client’s existing systems through a series of interdependent managers that incorporate On-Line Transaction Programing (OLTP) and On-Line Analytics Programing (OLAP) designed to automate, manage and audit complex processes and systems.