As one of the latest Women to Watch awardees, MedRisk’s founder and CEO has a lot to say about how care impacts cost — and it might surprise you what she thinks it means for the future of the workers’ comp industry.

Tell me a little bit about your history and the origins of MedRisk. Where did this all start?

I was working on the provider side and going to business school for my graduate degree, and I had this idea for a paradigm shift that would transform workers’ comp. The very beginnings of the MedRisk concept was what I ended up presenting in a thesis for one of the classes. It got a D-. I almost failed the class entirely and I will never forget what my professor told me. He said, “Good idea, but you’ll never get it off the ground.”

It would have been so easy to give up. To think that almost failing a graduate-level business class at Wharton meant that I’d surely fail at business. Instead, I took it to my employer. They didn’t like it either, so I pitched it to a client and they said there was no way providers would ever participate. But each time, I took a hard look at their actual objections and pain points and revised my idea based on that feedback.

What we finally figured out was if we could get buy-in, if we could get someone to commit, we might have a chance. What I really needed to ask was, “Will you buy if I build it?” and the answer was a “yes.” I got a small business loan by leveraging the house and the husband, gathered 7 bright, capable, fun and smart people, and sat at the kitchen table with the baby on my hip until we made it happen.

How has the philosophy that inspired you to start MedRisk played out over the years?

The core philosophy is really around making a difference, doing the right thing and living each day with utmost integrity. That’s how we guide ourselves and provide exceptional service to our customers and partners. In a more practical sense, MedRisk was built on a strong clinical foundation with the belief that if you use the right clinical expertise to help decision making and processing, the result benefits everyone. And we’ve found that to be true over and over again. It’s why we have committed to building an international scientific advisory board. It doesn’t make us money, it takes money, but we believe in the power of research to better ourselves and the industry as a whole, and so we make a commitment to fostering it.

MedRisk is known for finding innovative solutions for the workers’ comp community. What is happening in the industry and can you give me a peek at what solutions the company is working on?

The funny thing about innovation is that it is really just continually asking how can we do it better. We don’t sit on our laurels at MedRisk; we learn from the international community, and we learn from other service sectors. We fully analyze what works really well elsewhere and see how it can be adjusted and applied to make our processes, our services and our industry more streamlined, more efficient and, ultimately, more effective.

There are three areas in particular that we’re focused on right now: medical cost containment, psychosocial issues, and telehealth. What we’ve asked is “how do we take what exists today and make it better?”

With medical cost containment, for example, we looked at some of the common pain points of the current system and built our NexGen Advantage to eliminate the weaknesses and achieve a more streamlined, more efficient result with payment integrity. We looked at the goal, which is to get the right amount of money to the right providers to do the right services, and what we quickly realized was the layered approach of the current system just isn’t cutting it. It is linear and inflexible and incentives are not always aligned. Our answer has been to design a solution that uses data analytics, includes custom clinical oversight, assesses the best savings strategy available (rather than simply offering the next one in line), and is fully transparent.

The concept of telehealth seems to get very mixed reviews within the industry, but you’ve IDed it as something MedRisk is focusing on. What are your thoughts?

Yes, there are a lot of voices saying “Telehealth as an idea is great, but it’s too far out or it will never get off the ground.” Sound familiar? The good news is there is already wide adoption in the group health space. (Adoption meaning “my carrier offers it and I’ve signed up through a third-party group.”) And I’m a firm believer that workers’ comp medicine can learn from what is happening in group health. But here’s the problem: It’s not widely utilized. There is a delta between availability and usage.

I think, number one, it’s hard for patients to wrap their heads around and trust telehealth when they need to see a doctor. While there is consensus that telehealth for PT wouldn’t likely face the same challenge from the end users, we would still need to think out how to solve this problem for the wider workers’ comp space. But the opportunities for transformation are clear. Insurance Thought Leadership recently published an article about telehealth and increasing utilization was listed as a top strategy for insurance organizations in the United States.

Secondly, most organizations considering telehealth in the workers’ compensation industry are focused on the front-end triage process–which is important since you have to have the gating criteria–but it falls off the tracks there. You’re only using telehealth tech to deliver the triage through the nurse, you’re not changing the landscape. We need to follow through with a telehealth system that includes doctors and virtual clinics that “get it” and who are willing to implement it systemically. It needs to include not just triage, but maybe a virtual visit, virtual PT, etc. downstream. Of course, there are questions that need to be answered and vetted every step of the way: is telehealth enough at this juncture or does the patient need to go to the clinic? Bottom line: the solution needs a fully integrated approach.

This is where we’re putting our energy. Into the system that supports the process of decision making and hand offs.

MedRisk’s growth has been in the news recently. What’s driving it? And what should we expect to see from the organization in the coming years?

I’d like to say it’s because we’re constantly innovating, but innovation is only one part of the equation. We have a long history of exceeding our customers’ expectations and we’ve been laser focused on building and nurturing those relationships. So, what is really driving our growth right now is:

• #1: Superior customer service: Ensuring we’re executing what is important really well. We’ve had a spectacular year bringing on new customers and growing the existing base within our current customers. It’s one thing to sell “our product,” but user adoption is more important and that means the adjusters, case managers, employers, doctors, providers. We don’t treat what we do as a commodity. Building, maintaining and working on those relationships is of the utmost importance to us as a company.
• #2:  Exceptional operational excellence: In an industry that outsources regularly, we believe that one of the best ways to take care of our customers, providers and patients is to invest in our employees and take care of them, too. We want team members that believe in what they do. Team members packing their own lunches and coming to work with each other every day. Team members passionate about what they do and invested in the good work of MedRisk.

It’s never been about the widget at MedRisk; it’s about people. And that approach pays back ten-fold, allowing us to grow our current book of business, to plan for services related to eventual needs and opportunities, and to explore how to make a positive impact on the industry as a whole.