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 Daryl Corr, President of Healthesystems had to say:
What do you believe will be the most significant development in the workers’ comp industry in 2015?
From a medical cost management perspective, the continued adoption and focus on the use of evidence-based medicine in workers’ comp is very positive. More states are adopting medical guidelines that adhere to or are derived from sources such as ACOEM and ODG. To date, eight states have implemented a closed formulary, with other implementations being considered or underway. Most recently, Tennessee voted to adopt ODG guidelines for the formulary they are working to implement. This is very empowering for payers and medical cost managers. These larger initiatives will increase the visibility of well-defined criteria that are used to inform care decisions. The key will be how effectively the industry can leverage the framework of legislation to better manage and implement this into the care delivery process. It’s important that we remain mindful that state guidelines and formularies alone are not the complete answer. Meaningful intervention at the prescriber and patient levels is crucial to supporting these larger initiatives.
What is the top challenge you and your organization are currently working on this year?
You know, it comes down to the age-old adage of time. We’ve been very focused on continuing to expand our predictive modeling capabilities. We currently have models based on rigorous predictive analytics that are demonstrating significant impacts on how we can help our customers better manage care. For example, we can look at a case and estimate the probability that a patient will experience a specific risk event within their first 90 days of treatment. This means we can more effectively identify the most opportune or critical situations where proactive intervention is necessary. That being said, true predictive modeling – which shouldn’t be confused with ad-hoc analytics – is a complex and meticulous process. We have a multitude of additional powerful models that we expect will have a major impact on how treatment is managed. The challenge is quickly moving them through the necessary development process so our customers can begin taking advantage of them.
Looking out five years, beyond obvious trends, what do you think one big change in the workers’ comp industry will be?
Earlier I touched on the ability to meaningfully leverage the growing broad application of evidence-based guidelines. Over the next 5 years the industry will continually evolve and consistently leverage evidence-based guidelines in the care delivery process. A lot of this has to do with data – what kind of data, how and when it’s collected, and most importantly, how it can be meaningfully applied and shared to guide clinical decision-making. As we continue to refine how data are captured and analyzed, we increase our ability to drive more right-time clinical decisions throughout the care continuum. In many ways, we are already doing this. However, there is still a lot of opportunity to improve what the industry historically has been performing using a retrospective process. In order to truly impact outcomes, payers must have the information they need upfront to make evidence-based care decisions that can preempt drivers of claim duration, cost and risk, rather than simply reacting to them.
What is the one thing you’d like to promote?
The recent rollout of our physical medicine program represents a significant expansion of our ancillary benefits management platform. I believe the comprehensive environment we’ve built for managing pharmacy and ancillary services has always been unique to the industry. We provide an infrastructure and service that doesn’t exist elsewhere – one that allows for true management of performance-based networks. We provide detailed, objective measures that help payers more effectively manage the various ancillary services and determine whether patient care is being delivered optimally. This includes leveraging medical data that historically was either unstructured or lacked the necessary detail – for example, buried in physician notes or not codified – and facilitating their integration into the overall analysis. Our goal is to provide our customers with the most complete and detailed information to enable decisions that will drive quality of care and control costs. The beauty of our model is how we marry those data in a comprehensive environment that can manage a claim across all levels of the cost containment spectrum. It has truly taken medical management to the next level.
Disclosure:
Healthesystems is a WorkCompWire Ad Partner.
This is not a paid placement.