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The gambling capital of the world seems like an appropriate place for workers’ compensation professionals to come together and wager on the best ways to reign in worker injuries and the adverse impact they can have on their businesses.

Thousands of these folks have descended upon Las Vegas this week for the Workers’ Compensation and Disability Conference, where buzz-worthy topics include:
  • How predictive analytics can detect problematic claims early on and the value of early detection
  • How to minimize the misuse of doctors, medical testing, prescriptions and time off work with medical management and return-to-work best practices
  • How to reduce claims’ severity through reviewing claims and managing programs

Just last week, in advance of the conference, Rising Medical Solutions, released its third annual workers' compensation benchmarking study, echoing many of the same themes being explored at the conference. Specifically, the study highlighted how managing medical performance is a major operational challenge for claims professionals.

The 2015 qualitative research study—whereby 40 industry executives analyzed data from prior 2013 and 2014 quantitative studies of more than 600 claims leaders—identified a few key issues impacting medical performance management, including how to measure provider outcomes and how to address the effect of pharmacy on overall medical costs.

The industry executives who participated in the study suggested several key strategies that could positively impact outcomes—a couple of which tied back to the importance of evidence-based treatment guidelines like the Official Disability Guidelines (ODG).

The guidelines are a set of widely used standards that provide guidance on medical treatment protocols and normative expectations for disability duration. They are based on national data that reflects an average person’s response to treatment and return-to-work timeframe based on his or her given diagnosis and other confounding factors.

The guidelines are most often used as a reference to forecast problematic claims early on; to project how much in reserves will be needed to pay a claim; and to ensure injured workers receive care, pharmacy benefits and time off that are proven to be effective—rather than offered just for the sake of being offered.

In addition, many organizations rely on ODG as a decision support tool to prioritize which claims need early intervention and to spur activity that might take a claim ODG has benchmarked as high hazard and transform it into a less severe claim with lower medical and pharmacy costs, and a faster return-to-work timeframe.

Organizations that use ODG in this capacity often benefit greatly when they are able to integrate the data with their organization-specific claims data that is already housed in their Risk Management Information System (RMIS). As a result, they are able to streamline how they track and act on this data to get results.

With all the industry knowledge and best practices floating around at this week’s conference, I hope what happens in Vegas won’t stay here, and claims professionals will be able to bring what they learned back to the field—especially how to better manage medical performance with evidence-based treatment.