Karen Wolfe is founder, president and CEO of MedMetrics. She has been working in software design, development, data management and analysis specifically for the workers’ compensation industry for nearly 25 years. Wolfe’s background in healthcare, combined with her business and technology acumen, has resulted in a unique and focused expertise. She has consistently worked from an entrepreneurial perspective, thereby maximizing her ability to create innovative technology products.
MedMetrics is an Internet-based workers’ compensation analytics company. MedMetrics offers a suite of technical services and online software apps to workers’ compensation payers, managed care service providers and networks. MedMetrics apps are designed to be quick and affordable pathways to powerfully recharge cost-control initiatives. They include provider performance analysis and ranking, predictive intelligence profiling, injury severity predictive score and “Ask-the-Data” query library. Wolfe, via MedMetrics, translates her medical, workers’ compensation industry and technology knowledge to clients through applied business tools that strengthen claim and medical management processes, resulting in measureable cost control.
Philosophically, Wolfe believes managed care in workers’ compensation has failed, evidenced by the steady increase in claim cost and complexity. She believes understanding and analyzing the data is necessary to revitalizing managed care and the industry. The data must be gathered, integrated and analyzed to gain critical business intelligence, but, even more importantly, it must be linked to operations in the form of easy-to-use, actionable software tools. Such tools offer decision-support, operational efficiency, cost control and optimized claim outcomes.
Wolfe has a bachelor of science degree in nursing from the University of Oregon, and a master of arts and a master of business administration from St. Mary’s College of California. She has published scores of articles and a book titled Information Technology Made Easy and Understandable, a Guide for Health Care Managers, OEM Press, 2002.
Everyone knows the bulk of workers’ comp costs now are medical. Claims reps and nurse case managers handle injured workers and their medical costs with utmost care. Anecdotes show that their work saves time and money. The problem is that concrete evidence of their value has been elusive—until now. How can costs avoided and time […]
USA Today recently published a story about ProPublica, a nonprofit news organization that has developed a metric to score surgeons’ performance, comparing them with their peers. The study is intended as a tool for consumers, but it has generated concern among surgeons, who feel they are being treated unfairly. What the article neglects to mention […]
Traditionally, in workers’ comp, nurse case management (NCM) services have been widely espoused yet misunderstood and underutilized. The reasons for underutilization are many. Tension between NCM and claims adjusters is one. Even though overburdened, adjusters often overlook the opportunity to refer to NCM. Also to blame is the NCM process itself. In spite of professional certification […]
Fact Significant dollars can be saved by getting injured workers to the best doctor. Evidence supporting this fact is the mounting Workers' Comp industry research clearly stating treatment by well-informed and well-intentioned medical doctors results in lower costs and better outcomes. Belaboring A Point As repeatedly stated in this series, many doctors in networks are […]
Data monitoring means applying technology and analytics to gain real-time intelligence and decision support in claims management. Moreover, data monitoring is the way to link analytics to operations, thereby making them actionable. Nearly everyone in Workers’ Comp is trying their hand at analytics now. The problem is that organizations that have implemented analytics do not […]
No doubt you have seen the ad for Angie’s List. A good-looking male doctor is pictured with the caption, “He has been nothing but focused, dedicated and concerned about my health and well-being.” If searching for a contractor or hair dresser, this might be a good start. But searching this way for doctors? Absurd! Finding […]
It's a safe bet that claims will not have a happy ending if the treating physician has a history of being associated with poor claim outcomes. In fact, physicians rated poorly in analytic studies based on past performance are 100% predictive of high costs and inferior outcomes in future claims where they are involved. The […]