3 reasons to integrate healthcare claims management

Integrating incident reporting and claims management in one system benefits healthcare claims management.

As hospitals and healthcare organizations work toward better patient care, they can begin by taking a closer look at their internal processes and technology. A reliance on disparate systems that fail to share data efficiently puts organizations at risk of falling short of the demands of modern healthcare. The Agency for Healthcare Research & Quality stated that one of the three most critical challenges facing today’s healthcare organizations in their mission to improve patient care is “establish[ing] an integrated data, analytics, and information platform, along with the necessary technical expertise, to capture a 360° view of the healthcare system.”

The healthcare claims process, too, can benefit from a single integrated healthcare risk management system. Having incident reporting and claims management functionalities working seamlessly in one platform offers three major advantages.

1. Increased efficiency and accuracy

Just as working with a single insurer is easier than working with several, integrating healthcare incident reporting and healthcare claims administration into one system can be easier than tracking each in separate systems. But unlike insurance, where receiving multiple coverages from the same insurer may not be possible, hospitals can integrate incident data and claim data with ease through healthcare risk management software like Origami Risk.

Having all data in one system adds convenience for healthcare risk managers who may have previously had to toggle between systems to follow along with the claim lifecycle—from the initial reporting of an incident to the closure of the claim. A daily reality that the article Improving Claims Management with Advanced Integration summarizes as “the need to switch between multiple software systems in order to find all the relevant information on a specific claim. It’s critical to have all pertinent data in one spot to reduce and/or eliminate this quest for data.”

Navigating between two systems also results in detrimental switch costs, the fractions of seconds that occur when moving back and forth between systems. These switch costs rapidly compound, leading to wasted time and increased errors, including misaligned data. With an integrated healthcare risk management system, healthcare risk managers no longer have to bounce between systems throughout the claim lifecycle. If an incident turns into a claim, they can monitor it or move it further along in the process without losing the original incident record.

Beyond simplifying the daily lives of healthcare risk managers, the efficiency and accuracy afforded by a single system helps manage and reduce medical malpractice lawsuits. When an adverse event occurs, staff can quickly file an incident report, complete with detailed notes and attachments. The more documentation, the better, according to the The Medical Economist article 5 strategies to reduce malpractice lawsuit threats. Steven Fox, MD, an internist and assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California, told the Medical Economist that he “advises documenting all conversations. This includes summarizing patient discussions, having patients verbalize their understanding of why something is important, explaining why any clinical alerts are dismissed and noting conversations with other providers or with family members.”

Additionally, Origami can integrate with a hospital’s existing electronic medical records (EMR) for streamlined access to any other supporting data. This information is then accessible to healthcare risk managers and lawyers who can appropriately mitigate the incident-turned-claim and any related lawsuit, respectively. Having access to the right information at the right time helps to more quickly settle suits or prevent them altogether.

2. Improved organization-wide communication and accountability

Consolidating incident reports and claims data in one system improves communication and coordination among employees and between departments. For example, a healthcare risk manager working on a claim can reference an incident report for more detail. Doing so can provide the contextual information needed to answer claim questions more thoroughly and accurately, while also preventing time wasted chasing data. Having the right information just a click away helps risk managers process claims more efficiently and spend their saved time doing higher-level work like engaging directly with claimants.

In addition to streamlining the claims process, the accessibility afforded by an integrated system can motivate employees. According to the Benefits Pro article Why more employers and insurers are turning to integrated health care, successful efforts within the healthcare benefits industry have shown that “as employees and their employers become aware of how integrated health care benefits programs can help them, interest in providing such coordination is on the rise.” In a hospital setting, a nurse who is able to report an incident and see it made into a claim experiences similar motivation.

Having all healthcare data in one system also allows for streamlined workflow automation. Origami Risk’s healthcare risk management software can trigger notifications based on any data point or combination of data points—a claim entry, changes made to claim details, or payments and reserves that exceed defined thresholds. The Benefits Pro articles states that this comprehensive view gives providers “a complete picture of employees’ health and well-being… Instead of walling these services off in a silo, they are integrated into one system, allowing for the optimized collection and sharing of key, actionable information.”

With automation ensuring the correct person is involved and made aware at the proper time in the overall healthcare claims administration process, healthcare risk managers can make a more significant contribution to the claims mitigation process earlier on, taking steps to limit or reduce the overall impact of the potential claim. Without automation or a system to trigger early involvement, critical steps in the process can be delayed or missed, thus impacting the overall claim severity.

Finally, automated workflow includes assignment process, allowing supervisors to track what staff is working on, how long claim resolution is taking, and what tasks are outstanding. Origami’s dashboard functionality displays this information in an easy-to-digest manner. (Read more about dashboard functionality below.)

 

See how Banner Health uses automation tools and online portals in Origami Risk to save time spent on administrative tasks and remove barriers for the healthcare organization’s physicians and staff.

 

3. Healthcare analytics that inform strategy and action

An integrated healthcare risk management system aggregates data from all incidents and claims. Through healthcare analytics, this aggregated data is then used for setting goals and making strategic decisions, taking the claims process to the next level. When data is fragmented in disparate systems, staff may miss key parts of the underlying story. Or, staff may spend extended time trying to compile volumes of data through unrepeatable processes. Regardless, these efforts open the door to data errors, incomplete or missing information, or outdated data sets—all of which increase the potential for missed opportunities in the risk decision making process.

When data lives in the same system, on the other hand, staff members gain a more holistic view of their role in the claims process. For example, those in healthcare claims management roles can access incident reports and trends to see what’s driving the majority of claims, providing valuable context for how the team can more efficiently process claims or better understand the circumstances of claimants.

Origami Risk’s healthcare risk management system features more than 100 report, graph, and dashboard templates. These templates can be customized to fit an organization’s specific needs, ensuring that the data being collected and analyzed is telling meaningful stories and delivering insight needed for organizational change. Examining the right data, such as leading indicators, helps accomplish this. As The data-driven risk manager points out, “Leading indicators, metrics that foretell potential risks or negative outcomes, tend to be the most actionable type of information. Rather than looking at the after effects of actions taken in the past, leading indicators predict events in the future.”

When a healthcare organization uses multiple systems for its processes, staff may also miss an opportunity to engage in root cause analysis, a crucial tool for identifying and preventing patient safety incidents. For root cause analysis to be successful, one must be able to connect the dots among various data and trends. An integrated system makes this possible.

Furthermore, an integrated system allows healthcare organizations to see if strategies they’ve implemented are truly driving change. The same reports and dashboard functionality mentioned above can be used to monitor such progress. A central repository of data, along with the built-in healthcare analytics tools required to make it meaningful, help to create the real, lasting change hospitals and healthcare systems need.

Origami Risk’s integrated healthcare risk management system makes it all possible

Origami’s flexible, secure system is the ideal platform for both healthcare incident reporting and healthcare claims management. With these two functionalities integrated, hospitals and healthcare systems will benefit from increased efficiency in managing claims, reduced manual efforts and tasks, streamlined communication, better accountability across departments, and improved healthcare analytics.

Get in touch with our healthcare risk management team today.