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3 Ways Automation Benefits Key Stakeholders in Workers’ Comp Claims

3 weeks ago

3 Ways Automation Benefits Key Stakeholders in Workers’ Comp Claims

This article originally appeared in Risk & Insurance

In workers’ compensation, speed matters. The faster an injured worker gets connected to care, the sooner healing can begin. Historically, though, health care is riddled with barriers that hamper expediency.

Think about the last time you made a medical appointment.

Did you put off making the call, only to be met with an onerous phone tree when you finally did? Did you have to wait a month for your doctor’s next availability? How long did you wait in the office before you were seen?

These roadblocks become more problematic in the context of the workers’ comp system, which involves many more stakeholders and layers of approval. When done manually, referrals, authorizations and basic communication all represent opportunities for delay, which only impedes recovery.

Fortunately, advances in technology can help the workers’ comp industry minimize or even eliminate these barriers. Automation is helping to reduce stress for injured workers, enable providers to deliver care more efficiently, and free up care coordinators to get injured workers the care they need, when they need it.

“To deliver quality care when it’s needed with scale and consistency, you have to be willing to look at your process and automate those steps that can be managed with data and technology,” said Will Smith, Chief Commercial Officer, One Call.

Here are three ways automation creates a better experience for injured workers, providers and payers:

1) Automated Texts Create More Effective Communication with Injured Workers

A lot of information needs to be collected and communicated in the hours after an injury. Once an injury is reported and triaged, the worker needs to know who will be treating them, the time and place of the appointment, and how to get there.

Perhaps even more importantly, they’ll need an explanation of what to expect in the days and weeks ahead.

Exchanging information via phone calls, however, is error-prone, inefficient and rife with opportunities for delay. Injured workers may mishear or simply forget key pieces of information, and follow-up calls could be ensnared in a game of phone tag.

Automated text messaging, on the other hand, offers several advantages.

“Texting is comfortable, familiar and flexible. It doesn’t require an injured worker to take time out of their day to answer a phone call. And all of the information is on their phone for reference later if needed,” Smith said.

One Call’s text messaging platform sends out scheduled reminders 24 to 48 hours in advance of an upcoming medical, physical therapy, diagnostic, transportation or language appointment. To confirm, recipients simply text back ‘Y’ for yes or ‘N’ for no. This quick and simple communication goes a long way in reducing missed appointments.

“For transportation and language alone, we received a nearly 50% response rate — up from 20% with manual, telephonic communication — and confirmed more than 86% of appointments,” Smith said.

2) Integrated Data-Sharing Platforms Reduce Burden on Providers

The delivery of care in workers’ comp may be centered on the patient and provider, but multiple stakeholders are involved in care decisions, including the TPA, employer and insurer.

“We have to make our connection with our provider network as seamless as possible. We cannot expedite care for the injured worker or expedite feedback to the insurance company or TPA if we can’t quickly obtain information from our own network,” Smith said.

“Automation allows for a seamless, low-touch way to connect with our providers and collect high-quality data for all stakeholders.”

Software that connects with a provider’s system through an API interface enables quick communication and data sharing without requiring the provider to transfer the data through some other channel.

“We utilize software called ‘Provider Flow’ to connect more efficiently with our network regarding scheduling and referral authorization, and to collect clinical notes from their appointments with injured workers. Whatever information we need is there for us to grab, or it gets pushed to us. Providers no longer have to fax documents to us or transmit data via a separate portal,” Smith said.

“It speeds up the process, which means we’re able to determine next steps more quickly, and providers are able to spend more time on patient care.”

3) Automated Administration Enables Focus on Service Delivery

Discussions of automation often incite criticism that losing the human touch will damage relationships, not to mention cost jobs.

Neither fear is justified. Converting time-intensive administrative tasks from manual to automated processes enables people to spend their energy on patient-focused, value-added efforts. These include getting to know customers’ unique priorities and idiosyncrasies.

“When you understand details like the type of communication cadence that particular case manager prefers, or what information they want to receive electronically versus a phone call, you can move things forward much more quickly,” Smith said.

“The depth of conversation is entirely different. You can talk about specific adjusters, specific patients, and specific outcomes when you know your customer very well.”

That’s only possible when care coordinators and claim intermediaries are able to fully leverage their industry knowledge and clinical expertise, without tedious paperwork demanding their attention.

“Anytime you can remove a non-value-added process from the equation and allow people to bring their skills, expertise and creativity to bear, you get a better outcome,” Smith said.

“With automation, you enable people to think at a higher level and actually anticipate problems and communicate far more proactively and effectively.”

Automation as a Strategy, Not a Buzzword

In addition to creating a smoother customer experience, faster care and better outcomes, automation also supports the ingestion of clean, actionable data that is integral to strategic decision making.

One Call’s automated management system, for example, can collect and analyze clinical data much more easily thanks to connectivity with providers’ electronic health records.

“Anytime you’re taking information and then transposing it into another system, the error rate increases. When we can take data directly from the source, we know it has more integrity,” Smith said.

The same is true for data collected from insurance carriers, also facilitated by automated communication platforms.

“If we’re getting clean data from the payer and the provider, we can go right to analytics and benchmarking. This lets us know if our goals are aligned with our customers, and if we’re moving the needle on things like wait time for injured workers,” Smith said.

Though many entities in workers’ comp are realizing the benefits of automating key processes, One Call’s approach is a bit different in that it is directed by a multi-disciplinary team of Lean Six Sigma-certified, customer experience, and provider interoperability professionals who work together to develop these solutions.

“Their whole focus is to identify processes, breakdowns, inefficiencies — things that should and could be automated – and determining the downstream impact,” Smith said. This highlights a key point on the effectiveness of automation in workers’ comp—it only works if the time and energy saved translate to increased focus on patient care.

“For us, automation is more than a buzzword; it’s a strategy centered around getting each injured worker what they need to get back on that path of recovery,” Smith said.

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