By Nina Smith, Executive Vice President and General Manager, Mitchell Casualty Solutions Group
Technology is transforming the way we live, work and play—and the workers’ compensation industry is no exception. As an industry, we are beginning to understand how to harness technology and look at big data sets in very specific ways that allow us to solve complex problems. Here are three ways that I anticipate workers’ compensation insurers will leverage technology and data in 2017 to help them make more informed decisions around claims and deliver better outcomes to their customers.
1. Enhanced access to data will be embedded in claims workflows
The nature of work is undergoing a dramatic transformation. Technology is unburdening us of the need for traditional employment models. In fact, Intuit predicts that a full 43 percent of the workforce will be contingent by 2020. Further, McKinsey predicts that 25 percent of the insurance workforce, including many experienced adjusters, will retire by 2018. To compensate for the loss of industry and institutional knowledge, more workers’ compensation insurers will be looking to technology to fill the void. Going forward, the most powerful claims workflow solutions will be those that deliver embedded, data-driven, decision-support tools at key points throughout the claims lifecycle. Embedded analytics will help both contingent workers and adjusters who have more recently entered the workforce make accurate and informed decisions around claims.
2. Detailed provider analytics will help insurers get claimants on the road to recovery.
In workers’ compensation, the ultimate goal is to ensure the injured party is properly treated and healed and can resume normal activities—getting back to work among them. As the industry moves away from the fee-for-service model and toward a value-based care model that focuses on patient results, provider analytics will allow insurers and their customers to identify care providers and treatment patterns that are most likely to have positive results. By streamlining provider records so that a single provider is not represented in a given database multiple times, insurance companies can score provider care and better leverage discounts. Conversely, provider analytics will help insurers identify providers and treatment patterns that are less successful, recognize patterns between providers and attorneys, and even identify and flag bills from ‘bad actors’.
3. Advanced technology and data will help insurance companies better protect claimants from opioid abuse.
Opioid abuse had reached epidemic proportions—every 19 minutes, someone in the U.S. dies of an opioid overdose. And workers’ compensation payers, who collectively spent more than $1.54 billion on opioids in 2015, have a lot at stake. As workers’ compensation insurers seek ways to protect their customers from developing dependencies, redirect treatment where appropriate, and rein in associated costs, they are again turning to technology. Provider analytics plays an important role in identifying over-prescribing, but that is by no means the only tool available. Pharmacy benefits management solutions with integrated bill review can provide formulary controls and risk monitoring to all prescriptions, including physician-dispensed opioids. If high-risk prescribing behavior is identified through bill review, then regardless of where the drugs are dispensed, appropriate intervention can be made much earlier in the claim.
It’s an exciting time in workers’ compensation—technology is bringing about significant change, but with that change comes opportunity. These are just a few of the ways that workers’ compensation insurers can leverage better technology and the abundance of data being created to work more efficiently, reduce costs, identify and address fraud—and most importantly, deliver better outcomes to their customers.
About Nina Smith
Nina Smith is Executive Vice President and General Manager of Mitchell International’s Casualty Solutions. In this position, Nina leads the Company’s Auto Casualty Solutions and Workers’ Compensation Solutions divisions, overseeing an organization dedicated to bringing process improvement, greater efficiencies, and lower costs to customers while pioneering new standards and benchmarks in the casualty market. As a passionate, customer-centric business executive, Nina brings to Mitchell over 25 years of focused leadership in bringing client satisfaction and operational excellence to the technology sector.
Prior to joining Mitchell, Nina served as a Division President of Sage Software North America, a leader in business management solutions. Nina also served in multiple roles at Xerox Corporation where she rose from Product Marketing Manager to Vice President/General Manager, ultimately serving as Chief Marketing Officer. Nina holds a Bachelor of Arts, Management, from the University of Redlands.
Headquartered in San Diego, California, Mitchell International, Inc., delivers smart technology solutions that simplify and accelerate claims handling and repair processes, driving more accurate, consistent and cost-effective resolutions. Mitchell integrates deep industry expertise into its workflow solutions, providing unparalleled access to data, advanced analytics and decision support tools. Mitchell’s comprehensive solution portfolio and robust SaaS infrastructure connect its customers in ways that enable tens of millions of electronic transactions to be processed each month for more than 300 insurance companies, over 30,000 collision repair facilities and countless other Property & Casualty industry supply partners across the Americas and Europe. For more information, please visit http://www.mitchell.com.