Chicago, IL – Since the Workers’ Compensation Benchmarking Study launched in 2013, claims leaders have consistently ranked medical management as the core competency most critical to claim outcomes. With medical costs representing more than 60 percent of claims costs in many jurisdictions, the study’s Advisory Council recommended the 2018 study further investigate how high performing claims payers are surmounting this top industry challenge.
“Five years of data shows the claims community ideologically agrees on what’s most critical to successful claims resolution,” says Rachel Fikes, Vice President and Study Program Director at Rising Medical Solutions. “However, the data does not show that medical performance management is a critical industry priority, in practice” she says. “It’s important that we don’t become desensitized to the persistent medical challenges that have become the ‘new norm.’ We must continue to pursue and deploy viable strategies on the frontlines.”
The sixth annual study draws upon first-person, focus group research for its 2018 Report, with over 40 industry executives examining forefront topics. These topics were chosen based on data results from the five prior annual studies, and include:
- Focusing on a Triple Aim model to improve claim outcomes
- Employing a medical concierge model and moving away from discount methodologies
- Integrating behavioral health into programs
- Using predictive and prescriptive modeling to effectively manage treatment and interventions
- Enabling employee self-reporting
- Leveraging technology to enhance employee resilience and recovery
- Incorporating employee wellness and patient-centered outcomes
- Enhancing employer education around employee advocacy and communication
- Utilizing universal provider scorecards and publishing results
- Measuring provider outcomes by using existing benchmarking data and tools more effectively
- Leveraging value-based payment and Accountable Care Organization models
The 2018 focus group participants include a national cross-section of self-insured employers, national and regional carriers, state funds, third party administrators, brokerages, and industry consultancies. Participants were segmented into two focus groups of 1) claims leaders, and 2) clinicians / managed care leaders. This segmentation allowed the study to identify commonalities in the groups’ medical management priorities and approaches, as well as variances to expose gaps that may need to be bridged to improve outcomes.
To date, more than 1,800 claims leaders nationwide have contributed their collective intelligence to the study’s research. Their insights have helped build a robust profile of the successful claims organization and established a mature benchmarking tool by which to measure industry advancement.
As in prior years, the 2018 Report will be available to all without cost or obligation as a contribution to the workers’ compensation industry.
Request here: 2018 Workers’ Compensation Benchmarking Study