In 2022, claims process automation was the number one beneficial initiative for workers’ comp organizations. This is one of many statistics revealed in the fifth annual Workers’ Comp Industry Insights Survey. Healthesystems conducted the survey of 500 industry stakeholders in collaboration with Risk & Insurance® magazine at the National Comp conference and online through November 11, 2022.
The survey continues to expose important insights about the challenges, successes, innovations, and evolving needs in workers’ comp medical care. Chief among this year’s findings is an increased focus on technology to improve the claims experience.
More than ever, it is important for the workers’ comp industry to deliver a more consumer-driven experience that meets the needs and expectations of today’s users – both front-line claims staff and injured workers. Technology such as mobile capabilities, workflow automation, and intuitive user interfaces can go a long way in improving the digital experience for all parties and delivering tools that help users take action with less effort.
Automation Is Key for Adjusters
Largely due to a talent shortage in the insurance industry, workers’ comp leaders have made technological initiatives a priority in the last year. Organizations are turning to solutions such as claims process automation, virtual and mobile technologies, system integration and data sharing, and analytics to improve operational efficiency and enhance services.
Sixty-seven percent of survey participants indicated they want better technological solutions to support front-line claims staff. The need for automation, in particular, has increased year over year, with 68 percent of participants noting it as a number one priority in 2023 versus 48 percent in 2022. “Automation is a huge part of our plan for the next two years,” said one survey participant.
While claims examiners have a wide range of different knowledge sets, they may need more in-depth expertise to make claim decisions, especially in unique or complex cases. That’s where workflow automation comes in. By incorporating evidence-based medicine and advanced logic, it can provide the right-time clinical guidance examiners need to make intelligent decisions, and if necessary, route claims to the most qualified individuals.
Organizations are also placing a stronger emphasis on technical solutions in medical care management where clinical decision support, information sharing between payers and providers, and the use of analytics to identify opportunities for clinical intervention have grown in importance.
Improving the Injured Worker Experience
As beneficial as technology is for the insurance adjuster, it can be just as beneficial for the injured worker – when executed properly. In most cases, the easier it is for injured workers to receive appropriate and effective treatment, the more likely it is that they will recover and return to work in a timely manner. This makes an injured worker’s experience with workers’ comp systems especially important.
For the past three years, survey participants have identified the injured worker’s unfamiliarity with these systems as the number one barrier to recovery. And each year, the percentage of respondents who agree this is the case has increased, growing from 50 percent in 2020 to 66 percent in 2022.
Consequently, 66 percent of claims professionals said they struggle to obtain information from injured workers. One survey participant noted, “You know the last thing an injured employee wants is a one-size-fits-all phone call with a script or a form letter. The fact pattern can be identical for the injury, but the individual themselves can be much different.“
Industry stakeholders are betting on technology to facilitate a smoother journey for injured workers – and they’re right to do so. Studies show that injured workers largely prefer using text and email, rather than more outdated forms of communication, to consume information and get their questions answered. And sixty-five percent of survey respondents said the most valuable use of analytics and artificial intelligence is to personalize the injured worker experience.
Other Major Findings
In addition to prioritizing technology and improving the injured worker experience, this year’s survey revealed several other trends. These include a strong focus on healthcare industry dynamics, managing comorbidities as a growing priority, and a low incidence of pharmacy drug concerns.
The top two industry challenges cited by participants in this year’s survey were healthcare provider/service shortages and medical price inflation. Managing comorbidities was the number one medical program priority, with 57 percent of respondents saying comorbidities is a barrier to recovery. Medical care access and costs were also top of mind this year. Finally, unlike in years past when the industry was contending with the ubiquitous use of opioids, pharmacy program priorities have shifted to more subtle and diverse concerns.
For more detail on these insights, read the 2023 Workers’ Comp Industry Insights Survey Report.
Partner Post:
This is a sponsored post from WorkCompWire marketing partner Healthesystems.