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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An abundance of data accumulates in the claims management process. And while that data relays critical facts about each claim, that’s not the only insight it can provide. Data, no matter how seemingly unimportant, has the power to unleash valuable insight into your overall claims strategy. As the article Effective Data Discovery Can Be A Difference Maker For A Company’s Long-Term Success says, “Data that you may not even take into consideration can end up giving your company great insight after using proper analytics and data discovery techniques to make sense of it.” The failure to engage in data analytics means your organization may miss out on potentially rich data that sparks innovative strategy.
Benchmarking is one of the most powerful forms of data analytics. Used to measure competitor success and find areas for your organization to improve, benchmarking thrives on an abundance of data. With the right risk management information system (RMIS), you’ll not only be able to seamlessly collect troves of essential data, but also use benchmarking and other data analytics tools to extract meaning from it.
How does benchmarking make your data meaningful?
Data analytics can improve claim outcomes and, in some cases, help to prevent future claims by identifying trends and outliers that may otherwise go unnoticed. Benchmarking, specifically, involves comparing your data and performance against the industry’s best, which helps identify opportunities for improvement and establish long-term goals.
For example, risk managers, insurers, TPAs, and others who work with workers’ comp claims benefit from the annual Workers’ Compensation Benchmarking Study, conducted by Rising Medical Solutions. The study goes beyond merely reporting how claims payers are conducting business and outlines “how organizations turn the challenges identified in the prior studies into solutions and action.” The report’s mission is “to advance claims management in the industry by providing quantitative and qualitative research that identifies what high performing claims payers are doing differently than their peers.”
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Technology can play a pivotal role in improving claims management by providing adjusters, claims managers, and other stakeholders with direct, centralized access to the pertinent claims information that they need to do their jobs. As Improving claims administration with an integrated solution points out, centralizing claims data in an integrated system “that combines workflow automation tools with all of the functionality needed for end-to-end claims adjusting can be transformative.” This is especially true when the system is used to streamline claims handling processes, increase adjuster productivity, and inform decisions that contribute to swift, cost-effective claim closure.
Improving incident reporting, controlling costs, and closing claims more quickly certainly count as claim management “wins.” Yet, as Christopher Mandel points out in Next-Level Claim Strategies, there is the potential to take claims management to an even higher level.
“Just when you thought risk managers understood and had explored all the opportunities around optimizing the claims management function, next-level opportunities emerge,” he writes at the outset of the article, which examines the shared goals, motivations, and hurdles that make up the “long minimized and largely untapped synergy between casualty claims (risk management) and the benefits world.”
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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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Data Breach Today offers predictions in What’s Ahead for Health Data Privacy, Security in 2019? While the article focuses primarily on health data, a few key trends apply more broadly and are likely to resonate with all types of organizations.
Prediction: Disruption from regulatory changes is likely
Rebecca Herold, author of 19 books on information security and CEO of The Privacy Professor consultancy, begins the list of predictions by examining the potential for agency updates to HIPAA. “Based on continued pressure from local, state and federal government agencies, law enforcement, researchers and others to ease the sharing of patient and mental health data by removing the need to obtain patient consent, I expect to see OCR issue proposed HIPAA updates,” she notes.
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One of the Claims Journal’s most popular articles of 2018 covered the Altus report that investigated the possibility of Amazon entering the claims management sector. The fact that Amazon tried to poach employees from Lemonade and recruit for a new product manager position certainly provided enough circumstantial evidence to fire up the rumor mill.
The report highlights some of the advantages Amazon brings to the table. The customer-facing infrastructure — from Alexa and Echo devices to an online juggernaut offering an expansive consumer marketplace and digital media center — is unlike anything currently in the insurance space. In addition, Amazon Home Services, which offers on-demand repairs and potential assistance with installing large replacement goods; its array of supported smart home devices; and its direct access to customer purchase history make the company poised to completely transform the claims management process.
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“Suppose each time you ran low on an item in your kitchen—olive oil, bananas, napkins—your instinctive response was to drop everything and race to the store. How much time would you lose? How much money would you squander on gas? What would happen to your productivity?”
That’s the hypothetical scenario that Ron Friedman, a psychologist and author of The Best Place to Work: The Art and Science of Creating an Extraordinary Workplace, introduces in a Harvard Business Review article examining the “cognitive price” of interrupting a task that requires dedicated focus.
“We all recognize the inefficiency of this approach,” writes Friedman. “And yet surprisingly, we often work in ways that are equally wasteful.” … read more