How to Use ODG Data to Improve Workers Comp Case Management

This post was originally published on Risk Management Monitor.

Regardless of whether or not their organizations operate in states where the use of Official Disability Guidelines (ODG) has been adopted/mandated, risk managers can often leverage ODG data and the claim data from their risk management information systems (RMIS) to benchmark the medical and lost-time components of their workers compensation costs against national averages.

With its origins dating to 1995, ODG (www.mcg.com/odg) provides “unbiased, evidence-based guidelines” and analytical tools designed to “improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.”

The following are some ways risk managers can use ODG data in conjunction with their existing risk information tools to drive improvements in their workers compensation case management and achieve greater precision in loss reserve practices.

  1. Examine the data. ODG has a wealth of data that can be used to benchmark estimated incurred financials and return to work (RTW) best practices by job class, state, injury diagnoses, and numerous other confounding factors (e.g., obesity, diabetes, etc.). You can benchmark guidelines against both current and historical workers compensation claims to identify potential issues and opportunities for individual case management or program improvement. To evaluate trends, you need to capture and analyze detailed data on historical losses (a core capability of RMIS technology). Meanwhile, improving decision-making on open cases calls for the ability to track individual financial and treatment developments on a real-time basis. That is where your RMIS or claims administration platform combined with data streaming from your TPA or carrier can be keys to success.

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About the Author

Jeff Enzinger is an experienced sales executive with more than 10 years in commercial software sales and 5 years managing implementations of RMIS projects involving Carrier/TPA data conversions. Jeff’s focus at Origami Risk is to help customers find ways to leverage RMIS to drive value in their Risk Management and Safety organizations.

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