By Anne Levins, Director of Information Strategy, Coventry Workers’ Comp Services
With Thanksgiving only a few days away it’s the perfect time of year to reflect on the past and plan for the future. Conversations in the 2016 workers’ compensation market continue to focus on identifying data-driven solutions for early risk identification. Most companies have recognized the value of data as a strategic asset and most continue to make investments in risk-modeling. We also continue to hear about the growing volume of captured information. However, on its own, “data-as-an-asset” should be a concept challenged by the demand to demonstrate an ability to turn this information into actionable information.
Human Experience + Data Analytics = Improved Outcomes
Outcome-focused claim management relies upon data. However no data tools exist that can, on their own, drive a claim from injury to closure. Despite the fact that various levels of experience may challenge our ability to drive consistent results, we must continue to incorporate human experience into the process. Organizations need to prioritize developing their staff in the art of best practices to improve consistency and fully deliver upon the value of early risk identification. As I see it, true insight is gained from the marriage of sophisticated data analytics with the time-honed experience of clinicians and claims professionals. Both the data tools and the human experience are aimed at defining the specific intervention that will best support the needs of an injured worker as he or she works toward recovery of health and function.
Insight is critical because it helps us navigate the complexities and vagaries of an injured worker’s climb back to health. So how do you get to insight?
- Look: Start with good data. Look for a variety of information that could help inform your understanding of an injured worker’s risk for recovery.
- Compare: Examine what you know against claim types that have a history of being challenging.
- Learn: Dissect and learn from those claims that became adverse surprises to understand how to detect trouble in similar claims sooner.
The algorithms that propel the best risk model and decision-support systems hand claim professionals and clinicians what they need when they need it. Decision-support tools ensure important details aren’t missed. These systems do the most good when they unearth the less-than-apparent hints that an injured worker’s recovery is starting to tilt off course. Identifying the right people at the right time is essential.
You Have a Risk Model — Now What?
Sniffing out potential hot spots is important but in order to truly be successful a risk model and decision-support system must do more. A solid model needs to turn out detailed analyses within the proper context. That’s why a rich storehouse of historical data is so important: It helps fill in the context that then produces insight. Risk models that incorporate evidence-based medical guidelines add nuance and color. Combining what we know from history coupled with what we can glean from guidelines and best practices renders a more complete picture of how an injured worker is faring.
Too often in discussions around health care analytics there is a focus on whether a model identifies the right claims rather than whether it prompts action that supports the best outcomes. A successful risk model provides information, clearly and concisely, to help claim managers or clinicians garner additional insight that mobilizes them to act.
Check back in, after the Thanksgiving leftovers are gone, when we discuss how we must empower people to act in order to harness the full capabilities of a well-calibrated risk model that provides insight-forming context to effect change.
About Anne Levins
Anne Levins is Coventry’s Director of Information Strategy. She oversees the organizations’ information strategy efforts, and is accountable for identifying strategic initiatives related to external information delivery and outcomes measurements. Throughout her 20 year tenure in the workers’ comp managed care industry Anne has held various positions in customer service, account management, data analytics and information management.
About Coventry Workers’ Comp Services
Coventry offers workers’ compensation cost and care management solutions for employers, insurance carriers and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 30 years of industry experience, knowledge and data analytics. The company offers an integrated suite of solutions, powered by technology to enhance network development, clinical integration and operational efficiencies at the client desktop, with a focus on total claims cost.
Coventry is a WorkCompWire ad partner.
This is not a paid placement.