Sponsored: myMatrixx

Big Data Can Drive Better Outcomes for Workers’ Comp. This Platform Proves It.

Aggregating patient, prescriber and prescription data provides a more comprehensive view of a claim, and allows payers to make better decisions for injured workers.
By: | November 2, 2018 • 6 min read

Have you ever considered the many ways that data sharing has shaped the convenience and efficiency of modern life? Every time you make a payment via your digital wallet app, you share your personal financial information with that platform in order to make a quick and cashless transaction. If you switch mobile providers, you can keep your number, contacts, photos, music and the rest of your data. Information collected via your wearable fitness device can provide your doctor with a more granular view of your health.

Businesses are harnessing this power to drive internal efficiencies as well.

According to a recent business intelligence market survey by Dresner Advisory Services, data discovery, data mining/advanced algorithms and integration with operational processes are among the top initiatives driving adoption of business intelligence today, all with the goal of “making better decisions, improving operational efficiencies, growing revenues and increasing the competitive advantage.”

Despite the benefits offered by Big Data analytics, the workers’ compensation industry has been slow to adopt the technologies that enable data sharing at a level that provides actionable insights.

“Technology-based solutions have become simpler for organizations to acquire, configure and deploy. We rely now more than ever on the versatility, power and scale of our silicon-based workforce,” said Cliff Belliveau, myMatrixx Vice President, Business Intelligence.

“Digital transformation only occurs when we accept this reality, and workers’ compensation should be no different. Data is the currency we can use to construct innovation when quantity, quality and timeliness are optimized.”

Collecting and sharing patient data throughout the lifecycle of a claim can create opportunities to redirect care, resulting in improved patient safety and cost savings.

Digital Innovation Opportunities

Cliff Belliveau, myMatrixx Vice President, Business Intelligence

Disjointed communication between providers, patients and claim managers present a common claim barrier in workers’ comp. Lack of communication can result in duplication of care, unmonitored prescribing, or simply the continuance of a care plan that isn’t working. Centralizing intervention and pharmacy data in one location allows every stakeholder to see a patient’s care history and track progress.

For that to happen, multiple provider and vendor data platforms must be able to talk to each other.

“Interoperability is required to gain an analytical view of the patient’s claim lifecycle,” Belliveau said.

A best in class data analytics platform can pull together patient medical history — including non-pharmacy events like surgery or other therapies — along with prescription data and prescriber data to build a comprehensive view of a claim.

“If a client electronically submits surgery event data, we can cross-apply that data with pharmacy utilization throughout the life of a claim. Next, we overlay any applicable clinical interventions. The result is a transparent chronology of medical, intervention and key pharmacy utilization metrics such as Morphine Equivalent Dose, opioid utilization, dangerous drug combinations, etc.,” Belliveau said.

“This unique view enables our team of clinicians to determine additional intervention plans or recommendations to our clients. It’s important to understand if our clinical intervention methodologies are improving outcomes, and if not, can we analyze the data to find a better solution.”

Aggregated data could, for example, indicate that a patient is seeing a provider who has a history of prescribing high dosages of opioids. Predictive modeling algorithms could, based on a patient’s history, indicate if that patient is at increased risk for addiction. Information pulled from national drug registers could help to track cost per script to identify cheaper and safer alternatives.

Of course, aggregating data from disparate health care providers poses unique challenges.

Patient confidentiality, liability risks and cost are key reasons why centralized data sharing doesn’t exist universally within workers’ compensation or healthcare in general. Additionally, the question of who owns healthcare data fuels ongoing debates.

But, said Belliveau, “At myMatrixx, we are optimistic about the future surrounding data sharing.”

“I like to think of data as a perishable food that must be consumed sooner rather than later,” he said. “Moving to an industry-wide data sharing model will enable many more solutions that satisfy our appetite for the information we need to drive innovation while protecting injured workers.”

A Consultative, Customized Approach to Data Analytics

With the creation of its myDataSense platform, myMatrixx is leading the charge in building business intelligence programs specific to workers’ compensation. Within that platform, the Clinical Analytics Results Engine (CARE) program drills down specifically to pharmacy utilization patterns.

“The platform provides ongoing pharmacovigilance to continuously assess the risk versus benefit of drug therapy. It’s visibility into the effectiveness of interventions that’s so far unprecedented,” Belliveau said.

Clients have the ability to set custom thresholds around prescribing patterns, “high-risk” patients or other factors. If a threshold is crossed, the program will automatically send an electronic alert. Reports and interactive dashboards can also be adjusted to focus on whatever outcomes or targets matter most to a client.

“We work in a consultative manner with our clients to ensure we are maximizing the value of data by delivering customized data products and visual analytics,” Belliveau said. “What makes these products unique is that they have been tailor-made for the workers’ compensation domain.”

According to Belliveau, myMatrixx utilizes these platforms internally to track performance outcomes. In other words, “we eat our own cooking.”

Solutions with the ability to aggregate data, analyze it based on customizable parameters and generate action items are exactly what workers’ comp payers need to make better decisions for their injured workers.

“When we share data and integrate systems, we enable a robust and diverse set of data-driven solutions,” Belliveau said. “It’s in our best interest as leaders in workers’ comp to drive innovation in what can be considered a relatively small industry that bares the responsibility of impacting the lives of so many people. As an organization that plays a critical role in the life cycle of an injured worker’s claim, we are eager to push these ideas forward while delivering utility value.”

To learn more, visit https://www.mymatrixx.com/pbm-solutions/mydatasense/.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with myMatrixx. The editorial staff of Risk & Insurance had no role in its preparation.




myMatrixx is a full-service pharmacy and ancillary medical benefits management company focusing on the “Customer Experience.”

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]