In TPAs and automation, part 1: Humanizing customer service, we looked at ways in which the use of features available in integrated claims management software—automation tools, push-reporting, and online portals—can help improve the level of service provided to clients and claimants. The automation and self-service features of a claims management software solution also have roles to play in another business-critical area for TPAs and organizations self-administering claims: recruiting, hiring, and retaining top talent.
Challenges to hiring and keeping qualified claims professionals
As is the case across most industries, a combination of baby boomers reaching retirement age and a strong economy continues to make it difficult for businesses in the property/casualty insurance industry to find qualified candidates. According to the Insurance Journal article Insurance Industry Facing Competitive Labor Market, the industry’s unemployment rate of 1.7% is even lower than the reported national average of 3.9%. Even so, the article points to the fact that, as of its April 2019 publication date, the “need for technology, claims and sales/marketing staff is expected to grow the greatest in the next 12 months.”
Beyond the challenge of finding qualified candidates to fill open claims department positions is the issue of employee retention. A 2018 CompData Survey shows that total turnover among organizations in the insurance industry stood at 12.8%. Although lower than the average for all industries (19.3%), this rate has trended upward in recent years.
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Workplace burnout has become so common across industries that, as of May 2019, the World Health Organization (WHO) recognizes it as an occupational phenomenon in its International Classification of Diseases Handbook.
In the healthcare industry, burnout is a reality and is described by those on the front line in alarming terms. According to a NEJM Catalyst survey Immunization Against Burnout, “83% of respondents — who are clinicians, clinical leaders, and health care executives — call physician burnout a ‘serious’ or ‘moderate’ problem in their organizations.” Based on survey results like these, a report titled A Crisis in Health Care: A Call to Action on Physician Burnout called physician burnout “a public health crisis.”
Burnout has reached crisis level for many reasons, including its prevalence and its effect on staff turnover. But it’s had unexpected consequences for patient care, as well. A JAMA Internal Medicine study concluded that physician burnout doubled the odds of an adverse patient safety event. According to the report, this includes “unsafe care, unprofessional behaviors, and low patient satisfaction.”
In the first part of a two-part series, we examine the main drivers of hospital staff burnout, its far-reaching consequences for healthcare organizations and patients, and how the right technology can play a key role in reducing its widespread nature.
Understanding burnout and its consequences
The WHO officially defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- feelings of energy depletion or exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
- reduced professional efficacy.”
Burnout affects clinicians on an individual level, delivering the mental and physical exhaustion mentioned above. Far from being only a staff issue, burnout has profound effects on hospitals and patients.
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When does maintaining an up-to-date library of workers’ compensation state forms become too great of a bureaucratic burden for your claims adjusters or administrative staff? The most straightforward response is this: The more states in which your organization handles workers’ comp claims, the greater the challenge of staying on top of form revisions and additions.
Time and resources could certainly be allocated to more important activities. In the International Risk Management Institute, Inc. (IRMI) article Workers Compensation Bureaucracy Drives Costs, Mark Walls and Kimberly George cite training and education as two such examples:
One of the goals of workers compensation regulations is to ensure that injured workers are paid benefits in a timely manner at the correct rate and that they have access to appropriate medical treatment,” write Walls and George. “There was a time when payers had offices located in most states with adjusters handling only that state. Now, with most payers utilizing multistate adjusters, payers must be constantly training and educating their adjusters to ensure that they understand all of the nuisances of the different states that they handle.
For organizations looking to reduce the bureaucratic burdens their adjusters face, Origami Compliance offers a secure, API-based solution that integrates with any claims management system to provide immediate access to a single-source, up-to-date library of state and federal workers’ comp claim forms. Without leaving the claims system, an adjuster can quickly find the right form based on state or category. And when that form is selected, form fields automatically populate with claim data and a PDF version is generated.
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In November 2018, Baylor St. Luke’s Medical Center in Houston made two medical errors, the second of which lead to the death of a 75-year-old patient. After an investigation by the Houston Chronicle and ProPublica, the Centers for Medicare and Medicaid Services issued a report in early 2019 that outlined a pattern of blood labeling errors at the hospital. A ProPublica article on the report states:
Dr. Ashish Jha, an expert in hospital quality, reviewed the government’s findings and said it appeared St. Luke’s was struggling to meet basic care standards. The labeling mistakes, he said, seemed indicative of ‘a broader systemic problem.’… St. Luke’s appeared to miss warning signs in the months prior to the deadly mistake, according to the government report.
The “broader systemic problem” Dr. Jha mentions is, unfortunately, not unique to St. Luke’s. Many hospitals and healthcare systems face organization-wide, process-related issues, especially in a modern healthcare landscape that’s rife with change. Mergers, multiple technology platforms, and changing healthcare policies, to name just a few, contribute to widespread miscommunication and a lack of transparency. This, in turn, jeopardizes the overall quality of care within these organizations.
Hospitals can stem the scope of these issues by implementing a healthcare enterprise risk management (ERM) program. Healthcare ERM establishes a standardized framework for identifying risk across an organization, encourages cross-departmental collaboration, and shifts hospitals from a reactive clinical risk program to a proactive holistic risk management program. A straightforward process, along with the right technology that leverages healthcare analytics, can help to make this shift effective.
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It seems as if everywhere you turn, someone’s referencing AI. “Artificial intelligence is essential for business,” states a news article. “AI is the only way forward,” insists a colleague. And the scariest of all: “If you don’t implement AI quickly, you’ll be left in your competitors’ dust.” The constant refrain of AI, AI, AI can leave you feeling like your organization has lost the race before it has even entered it.
The truth is, AI is changing the world at a remarkable pace. And, eventually, nearly every industry and business will benefit from it. “Whether you work in retail, banking, transport or the public sector, AI will be an integral part of the way you do business in the future as it has huge potential to improve decision-making, increase efficiency and power new ways of working,” states the article How to Get Your Business AI-Ready.
But that doesn’t mean AI is the best solution for your organization right now. Implementing AI takes a massive commitment in the form of time, resources, and money. It requires a critical mass of data and properly trained staff. By prematurely jumping into a high-profile AI program, you risk ignoring the valuable tools already available and stalling other strategic projects underway. Instead, a more practical approach—one that uses software scaled to your operations—will move the most important metrics now, while developing an analytics culture that will make AI more feasible down the road.
AI has become a buzzword. What exactly does it mean?
In its prolific use, the meaning of artificial intelligence has become skewed. Some have come to view it as a magical solution capable of instantly transforming business all on its own. Others equate it with automation. Neither of these is true, however. AI requires much preparation and strategy (more on that later), and where automation follows pre-programmed rules, AI involves machine learning. AI is designed to mimic human thinking by making predictions and adjusting its processes based on new data insights. In this way, AI is quite different from many previous technological revolutions, during which technology took over specific, static roles within processes.
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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.
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A Risk & Insurance article recently stated that the souls of employees everywhere are saying, “Treat me like a human.” This applies to your claimants, as well. You’ve likely already considered many of the ways you can provide them better service, but you may have yet to tap into one of the keys to humanizing the claims process: automation.
The word is everywhere, as pervasive as the technology it’s infiltrating. Automation can bring to mind processes that are cold, robotic, and removed. So, considering software with automation functionalities may raise some hesitations. Will automation put distance between us and our clients? Will processes become mechanical and impersonal? How will this affect our service reputation and brand?
As the article Automation and AI: Miracle Tool or Hostile Takeover points out, automation “is neither the one answer nor a dangerous technology to be shunned. It’s another tool available to your organization, and every tool must be used effectively and for the right problem.”
Automation, when done properly, can bring more heart and soul into the work you do. Many manual processes consist of time-sucking drudgery. They leave you vulnerable to error and service headaches. They can become ingrained within your organization, forcing you to treat every claim or client the exact same way, despite variables, because deviating requires even more work. By using automation strategically, you’ll be able to deliver service to your claimants that’s more personal than ever. With a risk management information system (RMIS) that includes built-in automation, you can make humanizing the claims process a reality.
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Whether you’re an organization whose business is handling claims for others or one that administers its own claims, claimants are your customers. Viewing claimants through this lens will help focus your efforts on strengthening relationships and delivering better support. You also have the opportunity to go a step further and establish your reputation as truly customer-first. How? Through a straightforward branding exercise.
Before dismissing branding as something far removed from the claims world and better left to marketing and advertising executives, consider that every customer interaction further establishes an organization’s brand. Your reputation for customer service — however good or bad — is out there. You can continue with the status quo, or you can take control and push the narrative.
“Think about it,” says the Insurance Thought Leadership article 3.5 Ways to Deliver Happiness in Claims. “The claimant is going through your process during a time of grief, hardship and huge loss. Your process should not add to the stress. Your process should be easy. It should work to deliver a little happiness for them during this time. You want your beneficiaries to tell stories to their friends, family or other loved ones about how seamless your process was.”
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When choosing a risk management information system (RMIS) or making a RMIS switch, the process of assessing systems sometimes feels like comparing apples to apples. As important as the big functionalities are, organizations would do well to look at the more granular details—details that, however simple they may seem, address their organization’s very specific needs, while also saving time and preventing mental fatigue.
As a Risk Management Monitor article says, “An effective relationship starts with knowing the specific requirements of your enterprise and setting relevant priorities” and then checking how closely your RMIS provider can match them.
Why the little things matter
The workforce today puts in longer hours, more days a week than ever before. But employees aren’t spending all of that time tackling more projects and setting more goals, as one might expect. The 2018 survey Companies Are Overlooking a Primary Area for Growth and Efficiency: Their Managers found that 36% of company managers spend 3 to 4 hours per day on administrative tasks. An employee who spends an hour manually entering data or emailing colleagues about upcoming tasks is using time that could be better spent on more valuable activities like interacting with clients and improving product offerings.
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It’s not exactly a secret: Regardless of size or industry, every organization stands to benefit from using automation technology to cut down on repetitive, time-consuming administrative tasks. More than simply speeding up a process or getting people to work faster, automating administrative tasks yields value by freeing up employees to focus on the aspects of their job that really matter and provide value.
Automation is wonderful. Except when it isn’t.
As covered in Behind the Hype of Robotic Process Automation (RPA), businesses can run into issues by rushing to reduce costs and improve productivity through automating processes without first evaluating their effectiveness and necessity. The benefits of automating repeatable, administrative tasks can also be lost if automation technology is too difficult to use. The result? Time that could be used performing more high-value activities winds up spent managing software.
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