By Stephanie Arkelian, Director of Product Management, Healthesystems
The role of the claims professional is truly front and center. They are on the front line of claims management, and serve as the central point of communication between the injured worker and all other stakeholders.
I understand this well, not only from our conversations and research initiatives here at Healthesystems focusing on the claims professional experience, but because I used to be in that role.
Before I stepped into the role of product manager, developing solutions to meet today’s workers’ comp challenges, I was that adjuster out there trying to manage hundreds of claims. And I faced the very same challenges that I’m today focused on solving – challenges that these professionals are often still facing today. Working with disparate systems. Working with a multitude of vendors. Trying to coordinate all these services for the injured worker. It can become very complex and very confusing very quickly.
It is this front-and-center aspect of their role that positions claims professionals as key stakeholders in minimizing information gaps that can negatively affect patient outcomes. But only if they are empowered with the technology to effectively do so.
There are a lot of efficiencies to be gained using technology to streamline and simplify the process of managing an injured worker’s medical care. With the technology we have available today, it is possible for a claims examiner to view and manage activity for multiple ancillary medical products, services and vendors all in one place – whether it’s a referral for physical therapy services, or a ride to the doctor via Lyft. This visibility means that a claims examiner has a more complete picture of claims activity – and it’s a game changer.
Being able to centralize services minimizes gaps in coordination of care. Take the case where an injured worker is running late to a scheduled service, or transportation to an appointment is delayed. It’s critical to have insight into the bigger picture of all the moving pieces so that all the parties can be notified. The claims professional is empowered to properly manage that service disruption to potentially avoid a missed appointment, and any downstream issues that may come from that. In the short-term that may mean rescheduled appointments. In the long-term, disruptions to care can lead to bigger-picture consequences, such as delayed return-to-work or additional indemnity.
With this type of infrastructure in place, the sky is the limit in terms of what types of services and data streams can be connected. Imagine an experience where a prescription refill pattern identifies a candidate for a urine drug screen, and then automates a referral for this service based on pre-defined business rules. This type of automation helps efficiently connect the dots between claims risk and mitigative actions, while also freeing up the claims professional’s time to tackle other responsibilities.
Not only does easy access to complete information save time and money, it also avoids some of the added pitfalls of siloed systems, such as data inconsistency. For example, one system might use the “pay date” field for a transaction to indicate the date of payment receipt, whereas another system, or organization, might treat that same data field as the date they paid someone else.
It’s just one small example. But any time a single data field is being used to communicate two different things entirely, it can create upstream and downstream issues. If there is not awareness of the inconsistencies, issues will arise with reporting timeliness and cause communication challenges.
In addition to the gains that centralization can bring to the claims professional and claims process, there is also the injured worker to consider. Incomplete or incorrect information can delay care or cause claim stakeholders to reach conclusions that impact the patient in a negative way. In a best-case scenario, the injured worker becomes frustrated. In other cases, we may see this result in legal action.
Unfortunately, what we often see with a lack of access to timely information is a negative ripple effect. This is why the application of holistic insight and management across the multitude of workers’ comp services is key in managing the injured worker’s care.
About Stephanie Arkelian
Stephanie Arkelian, Director of Product Management at Healthesystems, is an award-winning workers’ comp professional who is focused on innovative, strategic, and transformational opportunities and partnerships to deliver services and features that solve age-old problems and improve stakeholder experiences within the industry. Stephanie has 11 years of experience in the industry and got her start as an adjuster working with injured workers, which has allowed her to excel at building solutions that make a difference because she understands first-hand the pitfalls, gaps and inefficiencies within the process of managing work comp claims. She is passionate about making the adjuster and injured worker journeys easier by working closely with industry stakeholders and applying user research to inform solutions that solve everyday problems with the user’s voice driving the design. She has delivered many solutions in her current role, including delivering an industry leading physical medicine, ride share, and diagnostics program that incorporates the top vendor partners in the nation and is used by multiple insurance companies in the industry.
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company’s comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, physical medicine, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems visit www.healthesystems.com.
Healthesystems is a WorkCompWire ad partner.
This is NOT a paid placement.