By Stephen Junker, Chief Information Officer, accūrō Solutions
The last 25 years have brought remarkable changes in technology. Back then, I had a state-of-the-art Nokia flip phone in my pocket. This wonderfully compact and powerful device allowed me to make phone calls and text, although the latter was a little janky. My current pocket-sized computer not only handles calls and texts, but it also enables me to also order dinner, review an Excel document, schedule an Uber, or adjust the lighting in my home, all in a few seconds. These were welcome changes that few consumers were slow to adopt.
Yet many workers’ compensation businesses remain entrenched in the flip-phone area when it comes to using fundamental technologies to run their businesses. They have been slow to adopt technologies such as software development tools, database management systems, data exchange systems, and analytic systems.
Hesitation to adopt is understandable in our industry. After all, workers’ comp insurers are in the business of analyzing risk, and adopting new technology is risky. However, some of the tools perceived as new are actually years or even decades old. For example, Application Programming Interface (API) data exchange has been around since the 1940s, maturing into web APIs in the early 2000s.
Exploring this example briefly, web APIs provide a framework to connect disparate systems directly and securely to facilitate immediate data exchange, which improves service delivery. Although APIs are not ideal in all conditions, instant exchange of claim status makes sense. Bill review systems, for example, need the current status of claims and reserves. Likewise, immediate transmission of bill review results to the claim system presents an accurate, up-to-the-minute picture of available reserves. Highly useful, yet not widely adopted.
Another likely barrier to adopting new technology is a simple misunderstanding of the tools and their use. Marketing hype urging their early adoption fueled this confusion. My favorite examples are related cousins: “predictive analytics,” “predictive modeling,” “machine learning,” and “artificial intelligence.”
These concepts are often exploited in vague marketing material, promising improved decision-making and processes with little data regarding their use or evidence of the value they provide. Their inability to deliver on early promises ultimately created distrust in them. Unfortunately, some workers’ compensation payers and other companies are missing out on their benefits.
Predictive analytics is the practice of using historical results to predict future outcomes. It becomes particularly effective when one can find simple associations or hidden key correlations. However, this is rarely simple.
Multiple data elements are used to describe the key features of a complex data object such as a claim, claimant, or medical intervention — hence the term predictive modeling. The value of each attribute of the model is given a score relative to the fitness to the decision, and all the individual scores are added to form the prediction.
References to using artificial intelligence are the most egregious because they are mostly … artificial. Much of what is called artificial intelligence is simply statistically supported decision making, sometimes with the addition of automation. To be fair, it’s difficult to say where statistical decisions end and true “artificial intelligence” begins but asking your vendors how exactly artificial intelligence is used in their solutions will provide a sense of what you’re getting.
Confusion surrounding these technologies led to technology stagnation in some organizations. Businesses could not understand how these systems would dramatically improve operations. Costs were high, implementation long, and the technology so complex that it required significant training time.
Another powerful barrier to technological advancements is the regulatory burden that comes into play when a legacy solution is well established within the security and audit sphere. In some cases, the new technology might not be allowed, or it would be heavily regulated in the workers’ comp space. New IT opportunities were discarded as too risky, or too much work.
People age with the technologies they knew when they entered the industry, despite the existence of better alternatives and access to new or newly accessible tools. The best way to combat this is to continue to hire and trust new young staff and accept their guidance in the adoption and understanding of new tools.
Having the budget and willpower to implement IT projects over multiple annual budgeting cycles is difficult, especially when professionals are tasked with showing immediate profitability and progress. Vision and leadership from executive and financial partners are necessary to add technology to a mature solution, and it must be done in a way that allows legacy solutions to remain viable.
It’s time to overcome barriers to technology adoption, and here are ways to do it:
- Don’t allow new technology or staff to become entrenched in old technology
- Always seek and evaluate better solutions
- Take time to understand what’s being offered to you – or sold to you
- Be patient when adopting new technology over long implementation cycles for long-term gain
Adopting new technology in any industry is challenging and companies need to weigh the costs and benefits before choosing it. That means having a clear understanding of the benefits it will deliver. When properly designed and implemented, newer technologies will make your business processes more efficient and your operations more profitable and vastly improve the working lives of your people.
About Stephen Junker
Steve Junker is the Chief Information Officer for accūrō Solutions and has been with the company since its inception. He has worked in the managed care industry for the past 25 years from a variety of perspectives – all specializing in practical operational technology solutions. Junker has served the industry as a CIO, software developer, client solutions architect, implementation director, and consultant in the areas of medical bill review, PPO application, analytics, document management, and payment management. Prior employers include Numeral Technology, Service First Medical, CareWorks, MCMC, Universal SmartComp, and Litigation Solutions. He is based out of Pittsburgh, PA.
About accūrō Solutions
accūrō Solutions provides complete and transparent bill processing technology and services to drive the workflow from the mailroom, through medical bill review and provider payment for companies in the property and casualty insurance industry. Built –instead of bought–in 2020, the company holds a national presence and services all fifty states. More information can be found at www.accurosolutions.com.