The number of core systems an insurance risk pool uses can have a major impact on the level of service that members receive, as well as the pool’s ability to make the best use of staff resources. Constantly jumping between multiple systems and trying to coax Word and Excel into accomplishing tasks they were never designed to handle is a recipe for performance issues. This can limit a pool’s growth and the types of services it can provide.
Activities most impacted
While the inefficiency of using a patchwork of applications to handle core business functions cuts across a wide variety of routine tasks, several activities performed by risk pool staff are particularly susceptible.
Calculating loss ratios
Assembling the information necessary to calculate loss ratios often involves building multiple spreadsheets and transferring data from several sources via copy/paste. This highly inefficient process is prone to errors. According to the ECRI Institute report, Copy/Paste: Prevalence, Problems, and Best Practices, the familiarity of the copy/paste technique explains why it is used so often. “However,” the report warns, “with several windows open, information can easily be copied into the wrong location. Secondly, copy/paste accelerates propagation of inaccurate information. The ubiquitous use of copy/paste means that, once created, an error can rapidly spread.”
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As hospitals and healthcare organizations work toward better patient care, they can begin by taking a closer look at their internal processes and technology. A reliance on disparate systems that fail to share data efficiently puts organizations at risk of falling short of the demands of modern healthcare. The Agency for Healthcare Research & Quality stated that one of the three most critical challenges facing today’s healthcare organizations in their mission to improve patient care is “establish[ing] an integrated data, analytics, and information platform, along with the necessary technical expertise, to capture a 360° view of the healthcare system.”
The healthcare claims process, too, can benefit from a single integrated healthcare risk management system. Having incident reporting and claims management functionalities working seamlessly in one platform offers three major advantages.
1. Increased efficiency and accuracy
Just as working with a single insurer is easier than working with several, integrating healthcare incident reporting and healthcare claims administration into one system can be easier than tracking each in separate systems. But unlike insurance, where receiving multiple coverages from the same insurer may not be possible, hospitals can integrate incident data and claim data with ease through healthcare risk management software like Origami Risk.
Having all data in one system adds convenience for healthcare risk managers who may have previously had to toggle between systems to follow along with the claim lifecycle—from the initial reporting of an incident to the closure of the claim. A daily reality that the article Improving Claims Management with Advanced Integration summarizes as “the need to switch between multiple software systems in order to find all the relevant information on a specific claim. It’s critical to have all pertinent data in one spot to reduce and/or eliminate this quest for data.”
Navigating between two systems also results in detrimental switch costs, the fractions of seconds that occur when moving back and forth between systems. These switch costs rapidly compound, leading to wasted time and increased errors, including misaligned data. With an integrated healthcare risk management system, healthcare risk managers no longer have to bounce between systems throughout the claim lifecycle. If an incident turns into a claim, they can monitor it or move it further along in the process without losing the original incident record.
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Insurance carriers that rely on multiple-vendor application stacks to manage core functions such as policy management, billing, and claims administration may be placing limits on the strategic advantage IT departments can offer. As the number of supported vendors increases, more IT resources are forced to focus on managing application stacks rather than identifying and developing competitive technological advantages.
An Ivanti survey analyzed in The CIO’s Conundrum: Can IT Move From ‘Keep the Lights On’ to Creative Thinking? underscores the tension between maintenance and innovation. “In this survey, what became crystal clear was the counterbalancing of maintaining essential IT services with the desire to be bold and to act as a creativity dynamo.” Matthew Smith, President, Demand Generation at IDG Communications, notes that the survey results indicate that organizations “need to liberate their CIOs to think ahead of the curve rather than obsess over day-to-day operations. But today IT is all too often still regarded as a support function or information leaders are too stretched to drive competitive differentiation.”
Sandra Gittlen writes in Whittle down application sprawl, “out-of-control application stacks can jack up costs, introduce vulnerabilities, add to infrastructure complexity, jeopardize licensing and waste staffing resources.” This pulls resources toward the maintenance side of the spectrum and away from the strategic side. Glitten concludes, “IT’s value is not in supporting technology, but in understanding the business and using technology to achieve business goals.”
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Technology can play a pivotal role in improving claims management by providing adjusters, claims managers, and other stakeholders with direct, centralized access to the pertinent claims information that they need to do their jobs. As Improving claims administration with an integrated solution points out, centralizing claims data in an integrated system “that combines workflow automation tools with all of the functionality needed for end-to-end claims adjusting can be transformative.” This is especially true when the system is used to streamline claims handling processes, increase adjuster productivity, and inform decisions that contribute to swift, cost-effective claim closure.
Improving incident reporting, controlling costs, and closing claims more quickly certainly count as claim management “wins.” Yet, as Christopher Mandel points out in Next-Level Claim Strategies, there is the potential to take claims management to an even higher level.
“Just when you thought risk managers understood and had explored all the opportunities around optimizing the claims management function, next-level opportunities emerge,” he writes at the outset of the article, which examines the shared goals, motivations, and hurdles that make up the “long minimized and largely untapped synergy between casualty claims (risk management) and the benefits world.”
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Winter Storm Harper took its toll on large parts of the Midwest and Northeast, causing several deaths, hundreds of car accidents, and power outages that affected tens of thousands, according to the Weather Channel.
Extreme weather—from blizzards to hurricanes to wildfires—wreaks havoc on businesses in every region of the country, with damage having a lasting effect. In fact, according to the Insurance Institute for Business & Home Security, 40% of small businesses do not reopen after a severe weather event. This is in part due to a failure to have an actionable plan in place. As we discussed in Step up your disaster preparedness, don’t wait for the news report, organizations can get tripped up when there’s confusion over who should act and what those actions should be during a weather crisis. Without clear plans, practice, and timely alerts, critical resources may fail to execute.
Origami’s cloud-based RMIS continues to make weather preparedness a priority. With our new proximity search feature, audit functionality, and flexible data integration, you’ll be able to quickly identify major weather risks and effectively communicate how key parties can take action.
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This post was originally published on Risk Management Monitor.
Regardless of whether or not their organizations operate in states where the use of Official Disability Guidelines (ODG) has been adopted/mandated, risk managers can often leverage ODG data and the claim data from their risk management information systems (RMIS) to benchmark the medical and lost-time components of their workers compensation costs against national averages.
With its origins dating to 1995, ODG (www.mcg.com/odg) provides “unbiased, evidence-based guidelines” and analytical tools designed to “improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.”
The following are some ways risk managers can use ODG data in conjunction with their existing risk information tools to drive improvements in their workers compensation case management and achieve greater precision in loss reserve practices.
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When it comes to the ability to manage risk and losses, risk managers often face the challenges that come with claims data that is spread across multiple systems and spreadsheets. At the same time, they’re being asked to do more with less. In a previous post, we looked at ways an integrated claims management solution—one that includes multiple integration and workflow automation options—can transform claims administration processes. But you don’t have to be a self-administered organization to benefit from claims management functionality in a RMIS. The following features are just a few examples how such a solution can help you consolidate all of your organization’s claims data in a single system, streamline workflow processes, and perform analysis that contributes to more informed decision making and improved claim outcomes. … read more
“Protecting Data in Motion”, a March 2018 Risk & Insurance article, points to the fact that during the first half of 2017 alone, at least 2200 breaches—totaling over 6 billion records—were publicly disclosed. And those were the numbers prior to the reporting of the Equifax data breach.
As claims organizations improve operational efficiencies by using technology designed to eliminate paper-intensive, inefficient, and error-prone processes, it’s critical that the vendors they work with monitor and address security vulnerabilities. … read more
A recently published, comprehensive workers’ compensation benchmarking study, found that claim costs make up around 80 percent of most claims organizations’ expenses. According to the study’s authors, budget reductions and heightened scrutiny of operational expenses that come as a result mean that claims organizations should “take a close look at what claim activities and best practices drive optimal outcomes.”
Ensuring that paper-intensive, inefficient, and error-prone processes are eliminated is critical. For many claims organizations, this means scrutinizing their workers’ compensation compliance and reporting processes. More specifically, it means finding a solution that reduces the amount of time adjusters spend:
- Tracking down the correct version of state forms
- Rekeying data previously entered in the claims management system into forms
- Correcting errors that result from manual entry of claim details
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To be sure that you’re selecting the right workers’ compensation claims compliance and reporting partner, a vendor’s track record is the closest thing to a “crystal ball” that exists.
“To stay competitive in today’s marketplace, companies need complex and multi-faceted digital capabilities,” writes Rashmi Dalia in The Economist. “However, no one company can easily possess all the resources needed to develop robust technology systems, and trying to do it alone can prove difficult and costly.”
For insurers and TPAs, choosing to work with a technology partner has increasingly become a critical strategic decision. 76% of respondents to a 2017 Accenture survey agree that “competitive advantage will not be determined by their organization alone, but by the strength of the partners and ecosystems they choose.”
Identifying gaps and areas in core systems where it makes the most sense to integrate third-party technology is one part of the challenge. Equally important to finding the right technology solution is having confidence in the people behind the technology. … read more