Now in its fifth year, Rising Medical Solutions’ Workers’ Compensation Benchmarking Study reprises its 2014 survey questions to measure industrywide advancement in claims management these past three years. The study also continues its potent method of validating how and what higher performers are doing differently than lower performing peers to reveal a more robust profile of the successful claims organization. Findings from the just published 2017 study reflect the responses of 572 claims leaders reporting on their organizations’ operational priorities, challenges, and strategies.
To date, more than 1,700 claims leaders representing diverse payers nationwide have participated in the study’s quantitative surveys and qualitative focus group research. The 2017 study builds on the industry’s collective intelligence to provide a mature benchmarking tool, identify if emerging areas are becoming new industry norms, and expand on practices generating better claim outcomes.
Since 2014, industry shifts indicated by respondent data include:
- Measuring best practices in top-three ranked core competencies is up
- Investment in training and development is declining, while claims talent crisis intensifies
- Work from home options and other flexible arrangements for claims staff are on the rise
- Technology budgets are down, while leveraging predictive analytics grows
- Use of evidence-based, outcome data is improving
- Narcotic utilization measurement increases, though not at a rate consistent with the industry’s opioid reduction emphasis
- Measure core competency performance in real-time, improving service levels
- Adopt and evaluate advocacy-based claims model with employee-centric metrics, focusing beyond cost containment
- Revamp injured worker communications, emphasizing empathy and engagement
- Integrate technology systems across multiple programs, removing innovation barriers
- Employ a data warehouse, capitalizing on big data and claims intelligence
- Gauge provider quality and outcomes, including a much more robust metric set
- Use risk / reward strategies with medical management vendors, driving performance
The study’s direction continues to be guided by its expert Advisory Council and driven by a collaborative investigation with claims organizations. “For five years, the claims community has generously and liberally shared both their successes and struggles, allowing the entire industry to benefit from the resulting best practice guide,” says Rachel Fikes, Vice President and Study Program Director at Rising Medical Solutions. “This year’s report not only benchmarks data trends from prior study reports, it also distinguishes the level of differentiation between high and lower performers – be it modest, moderate, or major – for various best practices.”
“With decreasing budgets and escalating medical cost inflation, it’s critical that claims organizations know the extent to which a practice moves the needle, so they can optimally allocate resources,” says principal study researcher, Denise Zoe Algire
As in previous years, the 2017 Study Report is available to all without cost or obligation as a contribution to the workers’ compensation community.