By Ron Skrocki, Senior Vice President, Product Management and Development, Genex Services
In a system with roots reaching back more than 100 years, change doesn’t come easy in workers’ comp. It isn’t sparked by a revolutionary movement designed to shake the heart of the system, but is evolutionary, involving a lot of incremental improvements, some more significant than others.
This incrementalism is also the norm at the employer or payer level within the system. I work for a provider of medical, disability and cost-management services in workers’ comp, serving a highly committed and knowledgeable customer base that is typically careful and cautious relative to change. It’s rare when I run into clients who want to wipe the slate clean and completely reinvent their approach, but that doesn’t mean they want their programs to stagnate. In fact, the most successful workers’ compensation programs, in my experience, are those that are deeply informed, if not fundamentally based, on risk-driven design powered by continuous data analytics.
Making Change Happen
Workers’ compensation is structured in its design, with regulatory fiefdoms making it difficult to make real change across a large swath of claims. You may be able to change in a few places or one place, but not all.
With every program diagnostic, you’re hoping to identify clear opportunities for improvement. The reality is you not only need to identify and confirm these areas but also provoke the subsequent identification (or discovery) of the “improvement path.” Companies that do this best are collaborative and transparent with clients, showing them the how, what, when and where of the recommended metrics and letting them self-drive the evaluation where possible.
Meaningful data and analysis is critical for all players in workers’ comp. Analytics can support identifying high-risk claims, the best medical providers as well as the most-effective treatment protocols. It can be leveraged to improve process and workflow design to better align effort with impact. Individual adjuster and case manager performance can be measured and ultimately improved through smart data capture and analytic tools as well. The solution isn’t data analytics alone, of course. The involvement (ideally ownership) of and by subject matter experts is vital both in the design of the measurements and tools as well as the translation of their results to produce tactical and strategic change toward better outcomes.
A big part of this is helping the various parties understand the whole process better. Through analytics, we provide visibility into the entire process, the role of each of the constituents, the trends and outcomes, and from there we find ways to improve. This feedback helps us determine how claims, managed care and medical professionals perform in service of the injured worker. If designed correctly and with strong organizational support, these findings can be leveraged to improve everything from safety programs and prevention strategies to complex claim handling.
Walk the Talk
Ultimately, to affect change positively, key constituents must first consider if there is a real opportunity for meaningful improvement and a viable path to its success. They must also be willing to tolerate the risks associated with the change.
The best medical management “systems” don’t just use data to focus on the external measurements of success. Additionally, they align internal performance metrics and tools to the external in a way that integrates how they “walk” with how they “talk” to those they serve.
About Ron Skrocki
Ron Skrocki is Senior Vice President, Product Management and Development, where he is responsible for product strategy, compliance, and the analytics practice for Genex Services. He and his group collaborate closely with Genex customers, outside regulators, internal operations, and technology staff to ensure service quality, regulatory compliance, and continuous outcome improvement.
Prior to joining Genex in 2004, Mr. Skrocki held national level leadership positions in information technology, operations, sales, account and product management. He has more than 25 years of managed care industry experience across these multiple disciplines.
After graduating from Philadelphia University with a bachelor’s degree in business management, Mr. Skrocki earned a master’s degree in computer science from Villanova University.
About Genex Services, LLC
Genex Services is the trusted provider of managed care services enabling workers’ compensation payers and risk managers to transform their bottom lines. Genex is a managed care leader with more than 2,900 employees and 47 service locations throughout North America. The company serves 381 of the Fortune 500 companies as well as the top workers’ compensation and disability carriers and third-party administrators in the U.S. In addition, Genex is the only company that delivers high-quality clinical services enhanced by intelligent systems and 360-degree data analysis. The company consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems.
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