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 Delphia Frisch, Executive Vice President/COO of GENEX Services had to say:
What do you believe will be the most significant development in the Worker’s Comp industry in 2015?
As always, it’s hard to identify just one single element, but there are a few interesting trends that workers’ compensation experts predict could influence the 2015 landscape.
Today’s more robust workplace and economy will likely translate to younger, less experienced workers entering the workforce. Injury frequency is typically higher with a less experienced worker. And as a result, we might experience a national incidence level that ceases to decelerate at its historical annual rate, or perhaps even slightly increases.
Experts also suggest that 2015 might see medical inflation start to creep back up due to historical cost/fee patterns as well as some possible downstream implications to the Affordable Care Act (access and utilization).
What is the top challenge you and your organization are currently working on this year?
One of the challenges we continue to face is accurately forecasting tomorrow’s work comp medical trends from an outcomes, utilization and spend perspective. GENEX has some of the most advanced analytic capabilities in the industry. We invest greatly in resources dedicated to translating trend and experience data into actionable strategy. Then, along that execution continuum, we also have to make sure that we convert the data insights into program recommendations. For example, better educating and training our case management workforce to translate the value proposition our analytics provides into every claim, for every customer, that we manage.
Looking out 5 years, beyond obvious trends, what do you think one big change in the Workers’ Comp industry will be?
From a work comp managed care perspective, as noted earlier: The ACA and its impact on access and cost of care. Let’s face it, there are approximately 16 million more healthcare recipients1 now insured for medical care. That may place an inordinate strain on our nation’s medical resources. Some also project the unintended consequence of ACA cost shifting to work comp. Time will tell…
Another issue on the horizon will be the need to do a better job addressing the comorbidities of injured workers. Our aging workforce will bring hypertension, obesity, diabetes, heart disease and a multitude of other chronic conditions. You start with an injury and then find out there are additional chronic medical issues that should be considered as they impact recovery and resolution of the compensable injuries. That’s also another area where I think the industry’s case managers can play such an important role. Case managers engage with the worker, obtain insights into certain conditions and then ensure that other members of the work comp team have relevant information considered for recovery and RTW plans/goals.
What is one thing you’d like to promote?
Certainly the importance of early intervention and analytics; our data analysis continues to show us how important that is to the success of a program. GENEX recently published a white paper – based on our own book of business – noting a return-to-work rate can drop by close to 20 percentage points when delaying case management for a year. Conversely, claims that utilize case management within the first nine months of the injury are twice as likely to achieve a successful RTW as those that are referred three years after the incident. Clearly not every claim needs case management intervention. However, for certain types of injures, as well as complex claims, there must be agreed upon early intervention parameters, based on benchmarks and data, to help educate and guide adjusters on when and where to bring in case managers. These guidelines must be consistently utilized and updated to ensure case managers are optimally resourced for timely outcomes and resolutions.