How Having Clarity Over Ancillary Benefits Data Improves Claims and Outcomes for Injured Workers
Ancillary benefit programs may be just one piece of the workers’ compensation puzzle, but they can have significant cost and duration implications if not managed well.
Lara Heal, senior director of managed care for MEMIC, a private mutual workers’ compensation insurance company, knows the value of having a solid dashboard tool.
“Having transparency into our total program so that we can understand where our physical therapy and radiology spend is going is one piece of it,” Heal said. “But the quality of care and the outcome that injured worker receives is equally, if not more, important. At MEMIC, our ultimate goal is for our injured worker to get back to work and back to a productive lifestyle. That’s all part of our mission to make workers’ comp better – for everyone.”
As MEMIC’s medical cost containment partner, CorVel prioritizes helping Heal’s team pinpoint meaningful data that can be used by everyone from the claims handler to the executive. With modular analysis capability, CorVel’s dashboard is designed to help senior leaders like Heal save valuable time and customize views so that each level of her organization can understand what story the claims data is telling.
CorVel’s ancillary benefits dashboard provides a clear picture of total program spend, utilization patterns, and jurisdictional considerations that affect the delivery of care for injured workers.
“When we review program results using the dashboard, it’s not confusing, and we can trust what the data is telling us. It’s critical that there is an efficient way to use this information that makes sense for the business need,” Heal said.
Navigating Managed Care, State by State
A large part of managing ancillary benefit spend comes down to how clearly claims handlers can spot opportunities to re-channel claims in-network.
“The job of a claim handler is so complex,” Heal said. And having clear data that illustrates differences in patient outcomes helps claim handlers have confidence in the significance of guiding patients toward network providers who can deliver care swiftly and effectively.
“Giving managers the tool to really focus in on utilizing our networks benefits the injured worker, as well as our bottom line,” Heal said.
“The spend is one piece of it, but it’s the quality of care and the outcome that the injured worker is receiving that’s most important,” Heal said. “If they’re waiting too long to get a diagnostic test done and their treatment’s being delayed, recovery will also be delayed. This is why utilizing a network of high-quality physical therapy or radiology providers who can get our injured worker an appointment quickly is important.”
The ancillary benefits dashboard allows MEMIC to illustrate the impact of both prospective and retrospective approaches to network utilization throughout their service territory. Sarah Scott, CorVel’s vice president of network services explained: “Prospective management is when the claims adjuster refers into their ancillary program at the time treatment is ordered. It allows for impact to both treatment utilization and spend per visit resulting in overall reduction in costs and improved outcomes.
“Retrospective management impacts medical cost after the treatment has been rendered, resulting in overall reduction in cost,” Scott added. “So, if the claims handler misses a referral or they receive the claim after treatment was initiated, we can capture a network discount for the client.”
Heal’s team has been able to use the dashboard to establish benchmarks that reflect the nuances of MEMIC’s multi-state ancillary benefit program. “We know there are jurisdictional differences, and we know what those are,” she said.
“Having the ability to drill down by state of jurisdiction, from Maine to Florida and beyond, enables us to identify opportunities, target our strategies and better manage our ancillary program.”
CorVel’s dashboard provides a mechanism to identify alternative network providers. “Some states allow for greater control of medical care,” Scott said. “Having the ability to identify claims treating out of network allows the carrier to take action. Additionally, providing an alternative in-network provider within 5 miles makes the dashboard a really powerful tool.”
Metrics Over Anecdotes
Along the path to finding the most expedient means of recovery for injured workers, it’s easy to lose sight of how well programs like ancillary benefits are being utilized.
“It was important when we were selecting our ancillary benefit partners that we had transparency and visibility into those programs,” Heal said. “Without the ability to easily obtain and review our data, it is difficult to develop strategies to improve outcomes. We see it as a significant aspect of what makes MEMIC different.”
At CorVel, the goal has been to make the ancillary benefits dashboard into a tool that supports carrier clients like MEMIC in identifying opportunities and crafting strategies toward improvement. “The challenge,” Scott said, “is to make these dashboards actionable for our clients.
“Program utilization is the number one KPI we measure on the MEMIC program, drilling into the percentage of their medical spend channeled through their prospective and retrospective ancillary programs,” Scott said. “We establish targets for their team to work toward and utilize the dashboard to report their progress and program impact back to them.”
“Prior to the dashboard, we had this information, but it was difficult to interpret multiple reports from multiple sources and pull it together in order to take appropriate action,” Heal said.
Ultimately, to support injured workers on their path to recovery, using data is a powerful way to improve care and outcomes.
“When you don’t have good, actionable data and you’re relying on anecdotal information, it just doesn’t work,” Heal said.
For more information, visit www.corvel.com.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with CorVel. The editorial staff of Risk & Insurance had no role in its preparation.