7 Reasons to Invest in Medical Analytics

As many other industries have shown, being analytics-poor in workers' comp is no longer an option.

In a recent post, Joe Paduda stated, “The workers’ comp, and, for that matter, the entire property and casualty insurance industry, is chronically systems-poor.  While other industries view IT as a strategic asset, continually investing billions in IT, WC/P&C considers IT an expense category to be mined for pennies to add to earnings per share.” As one who has worked on the vendor IT side of the workers’ comp industry for decades, I know for a fact that he is exactly right. Nevertheless, both inside and outside change is affecting the industry—compliance requirements and how IT is perceived, financed and implemented. Moreover, customers are demanding more usable information. So as a way of advancing the perception part of medical analytics, seven reasons are offered here to whet the appetite for analytics-informed medical management See also: How Work Comp Can Outdo Group Health Analytics-informed medical management means collecting, integrating and analyzing all relevant current and historical data to gain insights that will improve performance and outcomes. The following are a few very good reasons to invest in analytics. You can: 1. Look forward, not backward An unfortunate, but persistent perception of business intelligence and data analysis is that reports are for looking at the past—how many claims, the trend in slips and falls, or how much money was spent last quarter. Interesting, but not actionable. Much greater advantage can be gained from analyzing the data to understand what is happening now to improve procedures going forward. Identify cost drivers and develop prompt, appropriate and consistent actions to redirect the organization. 2. Find meaning in your data The industry has been diligently collecting data for years, yet little attention has been paid to what the data might reveal. Analytics looks at the data to derive meaning, suggest direction and empower informed decision-making. Corporate leaders are often victims of their own denial, assuming all important information is known and current processes are the best they can be. Rarely is that actually the case, and analytics can be eye-opening. 3. Deliver intelligence to those who need it Analytics can be used to evaluate medical provider performance, for instance, and deliver the information in real time to those who are directing care. Because poorly performing providers are guaranteed to add cost and complexity to claims, analytics used in this manner will directly improve efficiency, cost and outcome. Similarly, information about untoward events and conditions in claims delivered to operations concurrently will add efficiency and improved outcomes. 4. Standardize procedures A rule-based approach can be used to monitor data and create alerts of high-risk conditions and events that occur in claims. Doing so inserts credibility, consistency and comprehensiveness into the medical management process. Moreover, when standard procedures and actions are established to respond to specific alerts, the entire process can be measured for organizational improvement, cost-savings, and outcome success. 5. Use data as a work-in-process tool Data can be a working tool. Analytics can be structured to concurrently tag data items that portend risk and cost in claims, then alert the person who can take action. Front-line workers will gain decision support information in time to intervene effectively and usually avoid irreversible damage. See also: Data Is Your Best Weapon in Work Comp 6. Discover unexpected opportunities When analytics are employed, newly discovered information or conditions understood differently can reveal opportunities. Interventions, priorities, and procedures might be restructured, streamlined or enhanced. New products or delivery methods may also be realized and developed. 7. Ensure the organization’s competitive advantage With standard and consistent methodologies, improved outcomes are demonstrated objectively for clients and prospects. Proof of value generates confidence in operations and outcomes, a much easier sell. The forgoing seven reasons to invest in medical analytics are not by any means exhaustive. Much more can be gained by implementing medical analytics. The data ingredients are available and waiting. The general tenor in the industry is to continue business as usual, but doing so has not produced desired results. Nor will it. As Paduda points out, IT in the WC/P&C industry is exceedingly underappreciated and underfunded. Therefore, a  little creativity may be required to obtain what is needed. Outsourcing to a company that uniquely provides workers’ compensation medical analytics is one approach. Fees can be sized to the organization, thereby making it affordable. Being analytics-poor is no longer an option.

Karen Wolfe

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Karen Wolfe

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 unique expertise.


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