During our time at RIMS 2015, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “RIMS Review” series, focused on what to look for this year and in the future! Here’s what Art Lynch, CEO of Coventry Workers’ Comp Services had to say:
What do you believe will be the most significant development in the Worker’s Comp industry in 2015?
If I had to pick one thing it would have to be how the states, employers and their payers along with the medical community attempt to manage the growth of pharmacy utilization and costs. If we look at the 2015 legislative sessions to date, greater than 60% of all work comp-related reform measures touched the explicit regulation of mounting pharmacy concerns, including: opioid utilization, compounds, prescriber dispensing, treatment guidelines, cost containment, closed formularies. I also think that continued transparency around total pharmacy experience (regardless of dispensing source) for the safety of each injured worker and for effective program management will become more prevalent as employers and payers expect this as the norm.
What is the top challenge you and your organization are currently working on this year?
Continued expansion of our market-leading data warehouse is our top challenge and our focus this year. At Coventry we have the industry’s broadest suite of Managed Care services, each designed to complement the next to support the full claim process and drive optimal outcomes. Ensuring these products and services ‘talk’ to each other in a seamless and efficient way is a significant challenge. For example in light of the mounting risks related to pharmacy management (noted above), we’ve dedicated considerable time and resource to aggregate all pharmacy activity from our PBM, Bill Review and Clinical systems to close the loops among them and make certain appropriate and safe prescribing is in fact occurring. Additionally, through our Global inSight® risk model, built in the data warehouse, claims are immediately identified when risk is emerging and advanced into our integrated clinical continuum from NT24 (Nurse Triage) through to Case Management and any other clinical ancillary management needed (UR,IME, DME, PT, PBM). The data warehouse has also created a platform for business intelligence tools for our customers providing enterprise level, on-demand access to key performance indicators (KPIs) for each Coventry product, with the ability to drill down to see what’s driving the results. Building and growing our data warehouse to support these efforts allows us to focus on the injured worker holistically – harnessing the power of the data for risk identification, decision support and outcome analysis.
Looking out 5 years, beyond obvious trends, what do you think one big change in the Workers’ Comp industry will be?
When I think of how much the past five years have changed it’s a bit daunting to project how much could change by 2020. I think organizations in the Workers’ Comp industry will begin to aspire to excellence in their focus on the customer experience as critical for competitive differentiation, customer retention and growth. As a result, we will begin to see increased investment into systems and processes that recognize individual client communication and interaction preferences and will strive to deliver a more personalized customer experience. I also believe we will finally see major advances in the use of technology to solve for prevalent issues within the Work Comp world. With the growing concern regarding access limits for primary care providers given the projected shortages, I believe we will see not only increased use of Physicians Assistants and Nurse Practitioners but also virtual Physician access through telemedicine technology. Consider the use of video conferencing to assess initial injuries or better yet apps that connect injured workers with Providers available to assess their injuries immediately. Seems possible… and could become the norm.
What is one thing you’d like to promote?
Healthcare … true health-focused care, is about the individual and their doctor, it’s about access and quality. Access and quality in occupational healthcare is about getting injured workers to doctors and hospitals that can make them better. If we do access and quality right we take a huge leap toward controlling the cost of care. And we have to prioritize just that way… focus on each individual, ensure access to quality care and then cost management will naturally follow. The focus in workers compensation has been the inverse. A critical shift in focus in workers compensation is to bring the injured worker, the individual, the patient to the center of managing their own recovery, as well as their own health. For too long the focus has been on ‘injury management’ with standardized practices that failed to consider the individual. To better service the injured worker and achieve the best outcomes, Coventry has moved away from a model that promotes passive patient compliance to one of active patient engagement. Patient engagement must be built on a foundation of trust. Once you have trust, you can educate patients about what they can do to enhance their recovery—and make them partners in the process.
CoventryWCS is a WorkCompWire Ad Partner.
This is not a paid placement.