Here’s a hot take: claims management is a team sport, but for far too long, the players haven’t been able to huddle up. While claims administrators, networks, and providers each have access to troves of data, they have lacked a way to share insights in real time. The result has been incomplete passes, fumbles, and missed opportunities to identify risks early or improve outcomes.
Sports have long shown what becomes possible when teams work as units informed by data and insights. Today’s sports teams lean on big data and advanced analytics to better study their competitors and fine-tune their techniques and game plans. Need to predict the movement of the basketball team you’re up against? Data-tracking cameras at all angles of the court capture each player’s moves. Want to know how often a batter avoids being struck out at the plate? Studying the on-base percentage can help.
While training is key to performance improvement, data provides insights that create winning strategies and better decisions on the field. Feats that were once considered inconceivable or purely by chance become not only achievable but also routine thanks to collaboration and innovation.
In the world of claims, organizations will agree that there is one goal — optimizing patient outcomes. So, how can collaboration and innovation come to play to achieve winning results?
Leveraging new innovations
Claims outcomes are driven by several independent and dependent factors. These include independent factors such as the patient’s age, body part, nature/cause of injury, and psychosocial factors, along with dependent factors like treatment pathways and claim handling. It’s often observed that 20% of the claim drive 80% of overall cost. However, many of these claims actually start out simple but become severe and costly due to mismanagement and poor claim handling. Moreover, siloed approaches to treatment hinder the fast action required to manage these claims better.
Today, a new generation of digital technologies is changing the game for claims management. APIs and web services are the new cleats allowing seamless data-sharing at last. Predictive AI models are the coaching staff, trained to spot patterns and call the right plays. Customizable digital platforms are state-of-the-art stadiums, enabling collaboration when and where stakeholders need it most.
With physical therapy at the forefront of treatment, it’s only right that organizations use insights from physical therapy other than the actual treatment process. Today, AI-augmented clinical solutions can help in multiple ways.
Keeping in mind that not all patients are not the same, it’s important to assess each person for both physical and psychosocial factors that may affect their recovery. Physical therapists are well positioned to perform initial screenings and to monitor the development of any factors over the course of the claim.
They typically see the patient early in the claim and they have more one-on-one time with the injured employee than any other stakeholder. Frequent, continued involvement with the patient’s functional restoration gives physical therapists more opportunities to uncover hidden psychosocial factors, such as fear, anger, or unhappiness with their employer that may impact recovery.
When potential barriers to recovery uncovered by the therapist are fed into AI models trained on data sets and transformed into predictive insights, payers can detect which claims could veer off track. And when high-severity claims and possible setbacks are detected early on, appropriate resources can be assigned.
As treatment begins, AI models now also leverage enhanced digital and clinical solutions to monitor, measure, and provide actionable insights quickly so stakeholders can make better informed decisions. These insights along with direct, constant communication among all those involved in the claim, help identify additional opportunities to impact treatment and further drive improved claim outcomes.
This process also doesn’t stop once a patient has successfully recovered and returned to work. Data gathered from a closed claim can be compiled and used to benchmark against historical data and established clinical guidelines to fine-tune insights, potentially identify larger trends, and ultimately, improve the overall claim process and experience for the future.
Playing the long game
Sports have shown how far connected, data-driven teams can push the boundaries of achievement. Now, the world of claims is beginning to leverage its value. Instead of various stakeholders working in separate claims silos, the future of claims is a connected ecosystem where all parties work together as a team.
Emerging technologies are equipping providers, claims administrators, and managed networks to share meaningful insights instantaneously, identify complex cases ahead of time, determine optimal interventions, track progress, and achieve the outcomes that matter most to each client and patient. And the results are a homerun — reduced adjuster workload, reduced lost-time claim duration, improved financial outcomes, and the ability to focus on the 20% of claims driving 80% of the cost.
The truth is, in sports and claims, players can still win games, but it’s the combined power of data and collaboration that puts them in the best position to win championships.
Creating a Winning PT Program Through Data and Collaboration. WorkersCompensation.com, https://www.workerscompensation.com/expert-analysis/creating-a-winning-pt-program-through-data-and-collaboration/.
