Top 5 Reasons to Integrate Managed Care and Workers Compensation Claims Management

Transcription

1 Top 5 Reasons to Integrate Managed Care and Workers Compensation Claims Management Presented by JJ Schmidt, Senior Vice President Managed Care Jeffrey R. Einhorn, Chief Executive Officer NonProfits United Listen to a recording of the webinar by clicking here. MAY

2 Integrated Claim Solutions Continuous Changes In Claims Technology and Data We have increased the access to information Speed to response has increased Demand for response times continues to shrink Storage of data and claim history continues grow Communication expectations fast is never fast enough Medical Information There is an increasing emphasis on medical spend Medical spend is driving more of the total spend of claims There is a greater complexity of the combinations of medical equipment and medications

3 Integrated Claim Solutions Workforce the changes to the claim workforce continue to happen New resources have different experiences and expectations in terms of work environments Aging workforce and reductions in tenure Expectations as a customer are greater Employer policies Data security expectations continue to increase Greater focus on the employee and experience Wellness programs to impact co-morbidity conditions One stop concept for issue resolution

4 Integrated Claim Solutions Definitions for our discussion Bundled versus Integrated Vendor Management Common Strategy Managing all of the vendor s processes to make your one process work What does this all mean to you?

5 Integrated Claim Solutions - Data Fast and Consistent Access to Data Multiple Systems most organizations have separate systems points for Claims Case Management Medical Bill Review PPO Reporting How does all of this data get integrated into one place where it is easy to manage Consistent Use of Data Terminology Different systems or organizations may label or mark the same thing with different terms or data structures

6 Integrated Claim Solutions - Data Transfer of Data Between Organization Security How many times is important data passed back and forth between external organizations Who is given access to get in to systems How are access rights controlled or managed when multiple organizations are involved with different controls or HR policies Storage Is there one place that is the ultimate record How are the varied systems and organization interfaced or updated with changes Reporting How easy is it to get one consolidated report that presents results in a consistent and concise 6 6

7 Integrated Claim Solutions - Analytics Predictive Analytics How easily can you combine data and processes from different organizations to implement analytics models Is the data exchange frequent and timely How are accountability and outcomes measured to show efficacy Integration of Resources to Manage Problem Claims Can resources connect easily How do they collaborate and create a common strategy How do they resolve conflict and escalate issues

8 Integrated Claim Solutions - Analytics Strategically determine resource allocation and assignment Are the philosophies of the organizations aligned How are the matching of resources completed Who is managing this process? Medical Resources Are there similar tools and access What are the clinical protocols and guidelines Provider outcomes Direction of care

9 Integrated Claim Solutions Unified Team Integrated approach and strategies Do separate organization have the same approach to managing claims as they do on medical management Common processes Common standard operating procedures developed over time Best practices for claim administration Organizational philosophy and corporate culture

10 Integrated Claim Solutions Unified Team Real time processing, data access and interactions Can adjusters and case managers see the same things Do they need to wait for data exchanges to make decisions If yes can this be creating unwanted delays or extra work steps to work around technology limitations Alignment in Outcomes and Metrics Is everyone tracking the same thing Do the organizations have a history of tracking the same results

11 Integrated Claim Solutions Transparency Fully transparent for all services Greater insight and oversight of program related fees Elimination of hidden costs or mark ups Transparency and disclosure Reduced friction costs that can be passed on in savings

12 Integrated Claim Solutions Better Control Management of all internal vendor issues Logistics of managing process and connectivity of process issues on all external parties Coordination of vendors working together Vendors may not be used to working together or have aligned interests What is the true picture of what is happening? Finger pointing and not working together. Time There could be additional time issues added in to account for the multiple parties which could delay care or activity on the claim Costs What might seem less expensive might cost more because of the increased administrative time managing the program

13 Integrated Claim Solutions Case Study Discussion with York client Jeffrey R. Einhorn Chief Executive Officer NonProfits United

14 Questions? 14

15 About Our Presenters JJ Schmidt JJ Schmidt is Senior Vice President of WellComp, the managed care division of York Risk Services Group, Inc. Mr. Schmidt oversees TeamComp, York s approach to managing workers compensation claims that combines sophisticated data analytics, medical and claims expertise and adaptive technology to improve claims outcomes and lower costs. He is responsible for developing the algorithms that drive TeamComp as well as identifying emerging trends and future cost drivers. Mr. Schmidt has over 20 years of industry experience; prior to joining York in 2014 he held multiple high level positions in managed care and vendor management with several national managed care organizations. He earned a Bachelor of Arts degree from The Catholic University of America and a Masters of Business Administration from St. Thomas University. He is currently a Ph.D. candidate at Florida International University. 15

16 About Our Presenters Jeffrey R. Einhorn Jeffrey R. Einhorn has 39 years experience in the insurance industry working for small and national brokers. For the past 16 years he has been an associate with Wasserman & Associates. He is currently Chair of the United Cerebral Palsy Foundation of Sacramento, and has served on that board for the past twenty years. He has also served on the United Cerebral Palsy National board and is the recipient of the Ethel L. Hausman volunteer of the year award. He has also served on the Alta California Regional Center Board, the Sacramento Mobility Coalition as its chair. He is the Vice President of the Sacramento Country Day Booster Club, and serves as a member of the California Automobile Assigned Risk Plan. Jeff has been involved for over twenty years in the developmental disability field and as Chair of the UCPA Sacramento Foundation was instrumental in establishing the ACE, Autism Center of Excellence program at Sacramento State College. He lives in Sacramento with his wife Jane and their son Matthew. 16