During our time at RIMS 2014, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “4 For 14” series, focused on what to look for this year and in the future! Rachel Fikes, VP of Marketing, Rising Medical Solutions and Denise Algire, Principal Researcher for the Workers’ Compensation Benchmarking Study answered the questions from the viewpoint of the Study, which surveyed claims leaders nationwide about their daily operational challenges:
1. What do you believe will be most significant development in the Worker’s Comp industry in 2014?
Consolidation – this issue is occurring in the industry in a variety of ways. Hospitals across the US are merging and purchasing physician practices at a faster pace than they have in decades. The consolidation is not generating cost savings. In fact, it’s doing just the opposite. As more provider practices become part of hospital organizations, the cost to deliver their services has increased. Additionally, as the marketplace of vendors continues to consolidate with more to come – service and value degradation becomes a real concern for the industry. On both of these fronts, measuring provider quality and outcomes as well as vendor performance becomes that much more important. The 2013 Workers’ Compensation Benchmarking Study revealed that very few claims organizations are using performance/outcome metrics for providers or vendors partners. This is an area of opportunity that’s becoming increasingly important given the consolidation trends.
2. What is the top issue/problem you and your organization are currently grappling with?
A top issue claims organizations reported in the Study revolved around talent development and retention. It is a fundamental issue that resounded repeatedly in the Study. With so many interdependencies that affect claims performance, many organizations are grappling with arming the right talent with the right training, tools, incentives and road maps.
3. Looking out 5 years, beyond obvious trends, what do you think one big change in the Workers’ Comp industry will be?
Treatment guidelines will become more prevalent, particularly around narcotics. With this, there is opportunity for the industry to increase their use of evidence-based guidelines as a means to gauge operational and provider performance. Currently, 17% of Study respondents report that they utilize claim outcome measures based on treatment guidelines and 20% report measuring average narcotic use as a means of measuring provider performance.
4. What is one thing you’d like to promote?
The confidential survey process for the 2014 Study will begin in about a month and many WorkCompWire readers will be asked to participate. With the industry’s continued engagement and survey participation, the 2014 results will uncover pressing issues and build upon the meaningful benchmark data the industry can use.
About Denise Zoe Algire, MBA, RN, COHN-S/CM, FAAOHN
Denise serves as the independent Principal Researcher and study report author for the 2013 and 2014 Workers’ Compensation Benchmarking Study. She is board certified in occupational and environmental health and is a fellow of the American Association of Occupational & Environmental Health Nurses. Bringing more than 18 years of industry experience, her expertise includes insurance operations, medical management, enterprise risk management and healthcare practice management.
About Rachel Fikes
As Program Director Rachel leads the project and communication management efforts for the Workers’ Compensation Benchmarking Study, a study conceived and published by Rising Medical Solutions. She works in conjunction with the study’s independent Researcher and Advisory Council on program execution and industry outreach initiatives. At Rising, she directs the company’s marketing and communications. With 10 years in the workers’ compensation space and 17 years in the marketing field, her previous experience includes roles in the information technology industry.