By Jason Beans, CEO, Rising Medical Solutions
Helping injured employees get back to productive life is an enormous and critical job. Unfortunately, it is a job that is too often focused on administrative tasks instead of high value efforts that positively impact an employee’s life. According to Rising Medical Solutions’ annual Workers’ Compensation Benchmarking Study, over one quarter of frontline claims professionals report that administrative work comprises more than 40% of their time, while nearly another quarter say it takes up 30 to 40% of their time.
This needs to change. Any opportunity to streamline workflow processes and free up time for frontline staff to deliver compassion and value—such as communicating with, empowering, and motivating injured employees—can have a direct impact on a payer’s bottom line while also improving work fulfillment for claims professionals and, most importantly, outcomes for employees. That IS the job.
In my previous Partner Post (titled “The Amazon Effect”), I discussed the benefits of a digital marketplace platform for claims payers at a program and organizational level. In this post, I’d like to focus on the benefits of a digital marketplace for frontline claims professionals, particularly on lessening the administrative friction caused by portal fatigue.
Decreasing Portals to Increase Efficiency
Workers’ compensation payers rely on a multitude of partners and software applications to support injured employee recovery, streamline claims management, and enhance productivity. However, the growing number of web-based tools and portals frontline staff need to access regularly—each with its unique login credentials, interface, features, and reporting—often leaves claims professionals feeling overwhelmed and fatigued.
One area where portal fatigue is especially prevalent is in the management of ancillary care services, where dozens of organizations specialize in a specific niche of the care management process. According to NCCI’s 2023 State of the Line Report, ancillary care services represent approximately 20% of total medical costs. Unlike medical provider visits, however, ancillary services tend to be higher volume and frequently require far more administrative coordination and time for claims professionals.
While it’s a best practice for payers to use a mosaic of ancillary providers to optimize results across geographies, reducing the number of portals will decrease staff training and data entry, increase program compliance and productivity, and provide assurance that the best provider is selected for the requirements of every referral. Much like Amazon created a consolidated interface to bring buyers and sellers together, an ancillary marketplace with a single portal can eliminate a lot of extra busy work for claims professionals.
Think about how frustrating it is for you to enter your same contact information at new websites when shopping there for the first time. Now imagine a claims professional entering the same contact and claim information for EACH injured employee, over and over again. A claims professional must do that. If they are handling over 100 files at a time, and there are 6 to 10 partner portals they must use, that is hundreds to thousands of redundant entries per month that can be minimized with a single partner and single integration.
A single portal is also much more secure. Each additional portal is another potential security failure point, including staff becoming lax with passwords. Ensuring security practices are being followed by all vendor partners and all claims professionals on an ever increasing number of portals is a daunting task with devastating consequences for non-compliance.
Building a Marketplace: One Portal, Single Integration, 100+ Best-of-Breed Partners.
Several years ago, Rising Medical Solutions (Rising) began building a marketplace to connect claims professionals directly with regional and national ancillary service providers. Today, the digital marketplace solution consolidates the entire managed care workflow into a single platform, eliminating multi-portal access needs and siloed program visibility.
As noted in my previous post, the marketplace concept is akin to Amazon’s retail shopping model that revolutionized the way consumers shop. Instead of shoppers having to visit individual websites to find the products they need, and manually comparing service attributes amongst other providers, Amazon created an ecosystem of suppliers and a codified way to utilize those suppliers through one simple interface. They have now become a one-stop shop for buyers, providing new standards for selection, pricing options, delivery speed, and self-service simplicity.
Embracing that same concept, Rising’s VISION™ Marketplace offers access to services provided by Rising or one of our best-in-class partners, including case management, utilization review, independent medical evaluations, Medicare compliance, settlement support, physical therapy, durable medical equipment, diagnostic imaging, transportation, translation, vocational rehabilitation, and home health services.
How it Works: A Connected Solution Delivering Value Across the Continuum of Care
A single portal to submit and manage all ancillary referrals is just the tip of the iceberg. Behind the scenes of VISION™ Marketplace, a single integration enables referral forms to auto-populate with accurate claims data. If medical documentation or claim file notes are needed, the documents can be automatically assembled without users having to upload the information.
The claims professional can simply choose their preferred network partner, or their request can be dynamically matched to the best supplier based on many factors, including cost, location, availability, and past performance. This process eliminates the guesswork for claims professionals and provides a higher level of assurance that the referral will be fulfilled by an ancillary supplier that best matches the individual care scenario.
Throughout the referral process, progress is managed in a single location – eliminating portal fatigue that frustrates employees, impedes productivity, and hinders higher-value activities. In an exceedingly fragmented health system, VISION™ Marketplace consolidates care into a seamless delivery model, streamlining essential functions, from communications regarding referral status, to payments, to analytics.
Importantly, VISION™ Marketplace provides seamless access to an entire ecosystem of service providers and gives payers the flexibility to choose who they want to work with or to let the system determine the best match. The improved efficiency delivers an easier way for claims professionals to manage ancillary healthcare services and frees up their time to focus on core tasks, such as supporting injured employees on their road to recovery.
About Jason Beans
Jason is CEO and Founder of Rising Medical Solutions. With more than 30 years of industry experience, Jason is a nationally recognized expert in medical efficiency and medical economics, and serves on several Boards of Directors in the insurance and managed care industries. He has dedicated his career to developing and delivering medical management services, as well as creating technology platforms and analytic tools to enhance program performance. Jason has a Finance degree from Boston College and a Master’s degree from MIT’s Entrepreneurial Master’s Program. He is also an inductee into the Chicago Entrepreneurship Hall of Fame.
About Rising Medical Solutions
Rising Medical Solutions is a national managed care firm that provides medical cost containment and medical care management services to the workers’ compensation, auto, liability, and group health markets. Rising also directs and publishes the annual Workers’ Compensation Benchmarking Study, a national research program examining the complex forces impacting claims management in workers’ compensation today.
This is a sponsored post from WorkCompWire marketing partner Rising Medical Solutions.