In February, Dan Reynolds, the editor in chief of Risk & Insurance, caught up with Alex Benson, the CEO of Bardavon. What follows is a transcript of that conversation, edited for length and clarity.

Risk & Insurance: You’re coming up on a year as CEO, correct?

Alex Benson: Yes, it’s been a year and a few months now since I stepped into the role. Time flies, you know.

R&I: As you look ahead, what business opportunities do you think the team can take advantage of?

AB: I see a lot of opportunities with medium-sized carriers and TPAs, the kind of organizations that, whether through actual vertical integration or partnership, are managing multiple aspects of the claim adjudication and managed care program. They might have in-house or super-integrated contract nurse case management, bill review, and the things you’d expect.

The key thing is they’re employing their adjusters, they really care, and they have the owner’s mentality and autonomy over their program. As a mid-sized company, the outcomes we can drive and control, and the way we’ve improved the business over the past couple of years to be an aligned partner with those folks—I see a ton of opportunity there. And importantly, our company is now able to pass on a greater level of cost-savings than before for these partners.

Looking back four to eight quarters, we’ve seen progress in the mid-market TPA and carrier segment, it’s a good niche and fit for Bardavon. What gets me really excited is supporting carriers that write hard work—hard jobs, highly distributed workforces, high surgical mix—that’s where I see our company really getting its legs, being great on that hard-to-manage and complex work.

To be great at this you need a little bit of grit and must over-index on high-touch customer service and case oversight. That is what we’re all about.

R&I: You mentioned adjusters. The general impression we have is that adjusters work hard and are under a lot of pressure. They could probably use help wherever they can get it. What’s your view on that?

AB: Completely agree. There are a couple familiar quips in our line of business: “Take a referral on a napkin” and “No noise on the desk.” That’s what we aspire to.

So, give us the least invasive customer experience possible, and hopefully the adjuster only hears back from us when most appropriate, or to punctuate a great outcome at the end of the case. The question is, can we deliver that experience?

I tell the team it’s more like “as little noise as reasonably possible on the desk.” I’m realistic and pragmatic—there will always be some two-way conversation, and quality two-way dialogue is how we gain trust and prove we’re doing a great job. I have such an appreciation for the role of adjusters. They’re air traffic control, literally managing hundreds of open files at a time. In many ways, their work is impossible, they’re always spinning plates.

That’s where I talk about over-indexing on customer service. A huge part of our job is to do the best we can to not drive them crazy with email fatigue and noise.

R&I: Sometimes people think they’re helping you when they’re giving you more work.

AB: Exactly. Most of our company works on teams that make these cases real—from placement of PT/OT to fulfillment of the billing at the end, with important things happening around provider engagement, placement, and case progression in the middle. That’s where the majority of our Associates focus their day-to-day.

We just did our first Net Promoter survey last year. We’re determined to be the best customer service company in the industry, which is about anticipating needs and not driving people crazy with too much communication. That’s more of an art—it’s not as easy as it sounds.

From a true differentiation perspective, we think we’re onto something with our clinical program when it comes to impacting overall case duration through our injured worker engagement program that we’ve integrated into our PT/OT scheduling. No one else is really doing this today.

But at the end of the day it is pretty simple, the most important customer persona we work with is the blended role of those at the desk—adjusters and nurse case managers, period. If we make their lives better, all the stuff about market segments, sales and growth should work out.

Business Challenges

R&I: As a business leader, what are your obstacles or challenges? What do you need to overcome to get where you need to go?

AB: For us, there’s been a bit of reflection—appreciating who we are, what we do, who values it. At the end of the day, the service we provide is well commoditized. There’s an expectation around what a unit of PT should cost, there’s a buying motion, people know how they want to pay for it. There are multiple companies that look like us, and from a “can you charge for value” perspective, there’s a pricing structure anchored by a fee schedule.

An internal opportunity has been really appreciating the business we’ve built, who we are, how we’re perceived and valued by the industry and market, and then figuring out where we can do the most good. The earlier version of Bardavon was looking to be a change agent, the more seasoned version of our company is much more focused on meeting the market and industry “where it’s at”.

Making it more external, we are a mature business. We’ve been around for 10+ years, we work nationally. Generally speaking, people know us, but we’re not one of the two or three big national guys. And depending on when or how you got to know Bardavon, your historical perception of the company could be very…let’s say variable…

So, an opportunity for Bardavon is simply telling our new story, far and wide. We believe great people drive great outcomes, not proprietary software. Similar to what I put on LinkedIn last summer when we completed a brand refresh – the new Bardavon is unapologetically looking to support only the workers’ compensation industry, related to all things physical rehabilitation. We are happy where our feet are. And we believe the secret sauce is anticipating the need of the adjuster and loving up the cases in our stewardship with as much oversight as possible, via a purpose-built and exceptional national network of physical rehabilitation providers. If we do those two things well, cases progress, stakeholders are happy and the financial, operational and clinical outcomes will naturally come.

There is a good chance that people know Bardavon, at least to some degree, and have a historical perception of the company.

Technology and Innovation

R&I: There’s so much going on with technology across industries. Where in your work are you seeing technological innovation gain traction?

AB: I’ll start with the external market. It’s not rocket science, but still super important—the API integration work with claims management systems, vendor-to-vendor integrations, and the ability to create and deliver a more seamless claims experience via contemporary API integrations.

We live in ancillary land, so whether it’s self-insured, self-administered employer, TPA, or carrier, that system-to-system ability to stitch together a partner ecosystem through lightweight but good open FHIR-based API integration can help work faster and better. While API connectivity isn’t necessarily as exciting as GenAI, it does make claims management easier and more efficient.

While it comes with the technology adoption curve for end users being willing to use portals instead of phone calls or emails, once you get past that, we’ve seen incredible net efficiencies. We can do our work faster, which is good because we’re hired to work fast—schedule quick, start cases, maximize what’s been authorized. We can reduce intake times by 50% when we can get something read/write entered through an API directed at the desk versus adjusters having to throw it over the fence to us.

That’s an area where we see a lot of focus, and we’re prioritizing our roadmap to “bet on the come” integrations with good partner companies. I view this all as an investment in customer service.

The second area is patient engagement and the proliferation of digital health programs. Everyone’s head goes to apps—exercise apps, nutrition apps, the Apple Watch potentially saving your life because it knows something bad happened.

We are huge believers in injured worker engagement, and the positive impact it creates for all stakeholders, and ultimately on the claim file. In lieu of an app, or a heavier technology, we’ve created a very lightweight text-based engagement program, as part of our PT scheduling service. There is no app—it’s just a scalable, sophisticated texting apparatus that our clinical team runs. It’s hands on keyboards firing stuff off, not clinicians thumbing out texts on iPhones. There’s a centralized technology behind it, but it presents on the phone with injured workers via normal SMS text and calls back to real numbers and real humans—all licensed PTs and OTs.

R&I: It’s got almost a simplistic look to it in terms of how it’s consumed, right?

AB: 100%. It’s just texting. We bundle up some good workers’ comp 101 content via links that the injured workers can click and it renders in their mobile browser. It’s a bit condition-specific—upper extremity, lower extremity, and so forth. We add PROs (patient-reported outcomes).

It’s not a Trojan horse for some larger tech play at all. It’s just simple. Injured workers don’t have to download anything or register for an app. The big “aha” is that people will text.

In our line of business, we live in the world of visit compliance and adherence for physical therapy. Companies like ours schedule the first visit and then try to keep tabs through visit 10, 20—it could go on a long time if it’s a surgical episode. We’re creating this loop of communication with someone who is the most involved in their PT journey, the injured worker.

The texting program (we call it Recovery+) makes us more informed. We find out all kinds of stuff—”Hey, I’m going to skip my appointment,” “My DME’s not working well for me.” It’s general case information, half administrative, half clinical. It lets us do the next right thing on the case, which gets back to the adjusters and nurses. Our job is to do the next logical thing to help the case progress.

R&I: You mentioned speed, which as a general rule in workers’ comp, the quicker we get to things, the less time an injured worker is sitting on something, the better the outcome for the plan.

AB: 100%. I’ve been talking about “faster is better” with our team (harkening back to those old AT&T commercials), but what does faster mean? It means we schedule the initial eval as quickly as humanly possible from receipt of referral and ensure that visit happens quickly. It all means that the faster the road to rehabilitation happens, the better—literally for all stakeholders.

When somebody’s post-surgical and sitting around for two or three weeks to get into PT, that’s a horrible starting point. There’s a real cost containment and dollars-and-cents nature to our business and market but faster is a clinically good thing. It’s the first domino getting knocked down so everybody can do their work.

R&I: It’s not reckless, it’s medically necessary.

AB: Exactly.

We were on a customer call this morning going through examples from our clinical engagement program. The texting becomes very lightweight coaching from our licensed PTs. There was a great example: hand surgery, minor surgical episode. For good reasons, PT was going to start two weeks post-surgical. A splint had been sent to the injured worker.

Our campaign—our texting engagement—had kicked off because we’d scheduled, and these coaches got introduced. Seamless baton handoff. The injured worker was super conversational, completely engaged, had questions about the splint, didn’t know how to put it on.

Is it Bardavon’s job, the PT in the clinical program of a PT/OT Network, to help figure out how to form a splint? Probably not, but this is the stuff that gets me excited. Our coach said, “Hey, it’s just texting. Shoot me some photos of the splint. Show me how you’re wearing it. You’re wearing it wrong.” So we walk them through it—it’s real touch.

R&I: That’s a personal touch.

AB: Yes, it’s all just very…real. They’re happy, that person’s engaged. Their PT’s not starting for two weeks, but our coaches check in with them along the way, make sure they go to their first appointment, and then you have a good, happy outcome.

Touchless Claims

R&I: Your team uses the phrase “touchless claim.” Does that mean less noise on the desk? Help me understand.

AB: We’ve used it as a bit of an internal mantra. From the adjuster and nurse perspective, once they give a claim to us, they should feel like that claim is touchless to them. We are just in report-back mode and should only have to guide them back to it should they need to do some necessary work, whether it’s a compliance issue or whatever.

The spirit of it is taking the burden off the desk and putting it onto us. We’ve done things that aren’t earth-shattering but very logical operationally. The clinicians we have through the texting program give us a backstop and more visibility. We’ve added staff that interplays with them around case administration, visit and end-note follow-up and collection—adding in some very rigorous monitoring to what we were already managing.

The spirit is really running the claims management process of the file for the adjuster for the time that we’re lucky enough to be engaged in the case.

Industry Leaders

R&I: Are there leaders in the industry that you admire or think are worth paying attention to?

AB: This is a hard question, because there are too many to name and do justice by.

I think risk sharing—the idea of taking the legacy risk transfer model and putting a value lens on physical medicine—is pretty novel and cool. Specifically, what Paradigm has done taking a value-based approach (like value-based care in traditional commercial healthcare) around pay-for-performance and quality…really betting on themselves to get to a good, mutually agreed-upon clinical and financial outcome.

I saw a phenomenal session at National last year with the New Mexico State Fund and Eastern Alliance doing this through Paradigm’s HERO MSK program. Seeing these leaders lean in on surgical episodes, saying they’re going to basically go at risk and work toward a quality outcome, is ahead of the curve.

This isn’t an appeal that the industry needs to change the economics of how the market runs—not at all. But collectively, companies like ours have a lot of data that informs how cases could and should look. We should have a good sense of what the cost is to get a job done and how to manage quality.

Looking at our segment (PT/OT), there’s no doubt that the team at MedRisk has built a phenomenal business and are in the middle of taking a big swing…through mutual friends and colleagues I feel like I know Streamline better than I actually do (lol), but I have a lot of respect for how their business shows up in the market.

At more of an individual level – gosh, too many to name. I think Dr. Claire Muselman does a wonderful job spotlighting important topics (like empathy) and professionals within our industry. One of our client’s, who I won’t name, but knows who she is – she’s so forward thinking in how her company’s program is organized…many can learn from her. Dr. Adam Seidner at the Hartford, publishing and speaking on important topics (another great NWCDC session by the way) and many more.

A final thought on this question, collectively, the work the Alliance of Women in Workers’ Compensation is doing is just so impressive and great. One of our senior leaders is an ambassador and it’s been a joy to watch her do some much good through her platform with the AWWC.

Patient Advocacy

R&I: What does patient advocacy mean to Bardavon and your culture and staff members?

AB: That’s a great question. We talk about empathy and engagement mattering. Part of our “why” is that empathy and engagement are important. It’s not that workers’ comp doesn’t have it, but it’s definitely an opportunity—there could be more of it.

For us, you really see this through our clinicians. Our clinical leader Jen Henry and her team have really become the voice of the patient, the voice of the injured worker. Not on our behalf or theirs, but we’ve created a world where we can communicate an aggregate perspective of the injured workers back to the claims managers and divisional leaders during stewardship meetings when they review program effectiveness.

The engagement through our texting program averages 50% engagement as measured by two-way dialogue—humans really talking with our coaches. That’s our company target. It means we have a chance to do the next right thing one-and-a-half times on every case we manage, which gets us excited.

Through that program, we drop links to content and patient-reported outcomes. We also do CSAT (customer satisfaction) surveys at the end, asking them to rank about 10 things along their journey—happiness with the overall experience, their adjuster, NCM, treating PT. We get verbatims too, and we do pretty well—15-30% response rate, better than industry average.

It means the world to us, not that we’re looking to become the voice of the injured worker—that’s not our job. We believe we’re going to help create a better claim and clinical outcome if we engage directly with them. We can provide a real indicator of satisfaction on what the workers’ comp experience was, along with verbatims of how that person felt through the journey.

When we launched this program a year ago, the industry veterans on my team were nervous. They thought, “What if adjusters don’t like it? What if nurses don’t like it?” There was a real fear that by engaging with the injured worker, we’d accidentally stumble upon other issues. “Oh, they say they’re depressed and anxious now. Now we’ve created a biopsychosocial claim that didn’t exist before, and it’s your fault, Bardavon.”

Thirteen months into this program being live, there have been zero issues. Empathy and just being there for someone, the injured workers just knowing it’s easier to get hold of whoever this person is on the other end of the phone—that’s what patient advocacy means to us. I’ve told the clinical team, “Your job is to be the chief ‘connect the dots’ officers.”

Our clinical team wasn’t hired new—they were doing other work and toggled their workloads to take this on. I’ve asked them, “Do you feel like you’re working below your licensure? You’re fielding a text message from someone that says, ‘I’m not going to PT today.'” But they don’t see it that way. One coach said, “We are trained to spend time with people. We are all practicing PTs at one time.” And we don’t charge more for the coaching, it’s just part of what you get with Bardavon PT/OT scheduling. It is our gift back to the industry, offering that engagement and empathy at no additional cost to the claim file.

Closing Thoughts

R&I: Was there anything you were thinking about in preparing to talk to us that you didn’t get a chance to express?

AB: I mentioned in passing that we’d done our first Net Promoter Score survey. We kicked the tires as a company for almost two years on whether we should do something like this, because adjusters are really busy and you’re putting one more email in somebody’s inbox, risking bothering people.

Ultimately, our NPS score was good, but that’s not the point. The point would be just listen to your constituents and seek out feedback on both your services, but what really matters to your end users early and often. As an industry, I think we sometimes take listening for granted, again, a reality in a commodity marketplace. So my closing thought would simply be 1) ask for feedback, 2) listen and 3) embrace what you hear back – it’s a gift that can guide your strategies and company priorities. &