New 2016 Workers’ Compensation Benchmarking Study Identifies Differentiators of Higher Performing Claims Organizations

Rising Medical Solutions
Nov 16, 2016, 12:04 ET

CHICAGO, Nov. 16, 2016 /PRNewswire/ — For the first time in its four year history, the annual Workers’ Compensation Benchmarking Study identifies which claims best practices are generating better outcomes. Findings from the just published 2016 study reflect results from a nationwide survey of 492 claims leaders who report on methods that drive success in their organizations.

To date, nearly 1,200 claims leaders representing diverse payer organizations have participated in the study’s quantitative surveys and qualitative focus group research. The 2016 study builds on the prior years’ intelligence to provide a clear, convincing, and data-backed profile of the higher performing claims organization.

Among the key differentiators identified, higher performing claims organizations are more likely to:

Link key performance indicators (KPIs) to desired claim outcomes
Employ claims decision support tools – such as workflow automation, advanced analytics, and predictive modeling – and use them more frequently throughout the claim lifecycle
Leverage numerous data sources to develop analytics, like Evidence-Based Medicine (EBM)
Utilize an employee-centric, advocacy-based service model to improve claim outcomes as well as talent retention
Engage sooner in emerging and/or particularly challenging industry areas, such as adopting value-based care models and implementing formal knowledge transfer programs
Use pharmacy metrics as a measure of provider quality/outcomes
Link provider quality/outcome measures to provider contracts & Letters of Agreement
The study’s direction continues to be guided by its expert Advisory Council and driven by a collaborative investigation with claims organizations. “We’ve heard from the claims community about difficulties identifying which best practices actually move the needle because industry data is often limited or unavailable,” says Rachel Fikes, Vice President and Study Program Director at Rising Medical Solutions. “Providing quantitative, primary data to substantiate various methods in claims management was the next logical step in the study’s evolution.”

“By using the industry benchmark of claims closure ratio, which is applicable to all payer sizes and types, we were able to contrast how and what higher performing organizations are doing compared to industry peers,” says principal study researcher, Denise Zoe Algire. “With so many competing priorities and complexities in claims management, the 2016 study provides a roadmap identifying where organizations should allocate resources to drive better outcomes.”

As in previous years, the 2016 Study Report is available to all without cost or obligation as a contribution to the workers’ compensation community.