By Doug Markham, Chief Operating Officer, Wisedocs
Timely decision making is a crucial part of any job, but in the workers’ compensation industry these decisions carry extra weight. According to former US Secretary of Labour Thomas E. Perez, “When workers are hurt, a robust workers’ compensation program can make the difference between poverty and recovery.” With medical expenses making up 60% of workers’ compensation costs and documents relating to these expenses numbering into the thousands, delays caused by a manual workflow have a human cost.
For workers who are injured, ill, or otherwise unable to do their jobs, long processing times keep them from accessing appropriate care. This is a cost to both the worker, the employer, and the many professionals involved in handling the claim. These delays are nothing new: 2009 article in the New York Times brought the issue to the public eye, suggesting that each time an insurer rejected a medical procedure for an injured worker, it took 3-4 months to settle the case. During this time, the worker’s recovery was slowed or impaired, making them significantly less likely to return to (or be productive at) their job. In 75% of cases, the original procedure was ultimately done as planned, however with this backlog now resulting in a cost to nearly everyone involved.
More than a decade later, the workers’ compensation industry has reached a new stage. Technological innovations are creating improvements across the entire workflow, as evidenced by case studies across large workers’ compensation organizations (WCOs). Innovations in artificial intelligence and machine learning make it easier to handle and triage cases, expedite decision making by claims processors, and improve strategies for claims management as a whole. This allows providers to keep pace with changing post-pandemic conditions, as well as decreasing employer costs by at least 20% across numerous jurisdictions.
Innovation is driving improvement (and there’s more to come)
Few can argue with the role technology has played in the shift towards more efficient workers’ compensation claims processing—and the advent of artificial intelligence means human/machine interactions are more effective than ever before. The unstructured documents that insurance or medical claims require (such as accident reports, hospital records, or medical evaluations) are no longer something knowledgeable workers must tackle alone. Instead, there are machine learning models spanning natural language processing (NLP), Optical character recognition (OCR), and the advanced Intelligent Character Recognition (ICR) technologies exist to help experts make better use of their time by sorting, organizing, and digitizing these docs.
AI-powered software platforms and tools can now recognize handwritten documents and paper notes and convert them to digital information. Now, unstructured paperwork that used to require human input to sort, record, and organize can now be done automatically—in a fraction of the time. This automated reduction of pages, elimination of duplicates, and removing non essential pages from the process allows knowledgeable workers to focus on what’s truly important and increases the speed and accuracy of claims management, all while lowering costs.
Since 80% of global healthcare documents are unstructured, this is a necessary goal. As AI technologies develop, they’ve become established in both the workers’ compensation space and the broader healthcare environment. Information from medical examinations or handwritten reports can now be digitized and extracted accurately: allowing administrators to gain insight, search, scan, and process results faster than a human could ever do.
These technologies don’t replace the human expert or the clinical role. Instead, they allow workers to spend more of their time on decision making, complex cases, or clinical insight, leaving the manual portion of the workload to technology tools. The power of these technologies can be harnessed to create vast improvements across the entire workflow—so as innovation continues, there’s more improvement to come.
Innovation is key to the insurance ecosystem as much as to the care and cost outcomes to the claimant
When medical, legal, or insurance experts spend more of their day processing claims instead of sorting through documents, they not only improve their effectiveness at reviewing claims documents, they also make sure more injured workers get access to care. The 3-4 month processing time laid out in 2009 has been reduced in almost all cases, although there’s still plenty of room to grow.
With so much of the healthcare system bogged down with manual processes and unstructured data, digitization represents an opportunity for major change. Embracing innovation means everybody wins: injured workers are rehabilitated faster, employers pay fewer costs overall, and organizations offer improved levels of care. As more and more organizations in the workers’ compensation space embrace this mentality, better outcomes emerge for everyone at the table.
About Doug Markham
Doug Markham is the Chief Operating Officer at Wisedocs. Doug is a healthcare and managed care industry veteran with over 25 years’ experience. Formerly of the IMA Group, he has worked with insurance carriers, TPAs, and government agencies nationwide.
Wisedocs is the medical record review machine learning software for insurance carriers, healthcare providers, laws firms, and TPAs. We serve the auto, liability, disability, workers’ compensation, tort law, and similar markets. Wisedocs provides an easy-to-integrate solution for improved accuracy and speed to deliver improved outcomes in the medical claims process.