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Integration lacking but needed in claims systems, survey shows
Ask an executive of a workers' comp payer if the company's claims system is electronically linked to bill review and medical management applications and he'll probably say yes. Ask the same question to the company's front line system users and the answer will likely be no.
That's the most glaring disconnect in a new survey on workers' comp claims systems. Health Strategy Associates questioned purchasers and users of claims systems at nearly 150 companies to provide information on claims system requirements, processes, and technology. "What we discovered is the average system has been in place for five or six years and companies are looking to make changes in the next two to three," said Sandy Blunt, coauthor of the survey and vice president of insurance services for Medata. "When people go to market, we want them to have a tool, such as this survey, to use to assist them in thinking about issues such as 'what are your integration points, and your expectations.'"
The two groups differed in their opinions on several questions. On the question of whether their current systems were fully integrated with their bill review and utilization review systems, about 60 percent of the executives said they were while more than 80 percent of the users said there was no full integration. Blunt believes the disconnect occurs because executives assume that since the work is getting done, the system must be integrated. "There are so many things [executives] are focused on, such as how to get premiums in the door, keeping the legislature from getting too deep in the system," he said. "Everything gets done because employees put their heads down and make it happen." The survey also showed that both groups -- executives and front line users -- want claims systems that improve productivity and work flow management. "You can't do that unless the systems are integrated fully," he said. The lack of integration in the systems occurred despite vendors' assurances to the contrary. That may be due to the enormous cost associated with matching the systems to environments with many databases that have grown up over time. "I haven't seen it yet. Full seamless integration doesn't exist," Blunt said. "Vendors want to. They mean to. But it's expensive, very expensive. In this economic climate, you won't see a lot of vendors investing significant amounts of money if customers aren't asking for it." The views of executives and front line users also differed on the desired benefits of new systems. Executives generally wanted the system to control/automate/enforce consistent claims handling through forms generation, business rules, engines, and similar functionality; front line users wanted more flexibility and integration with external systems. The two groups had similar views on some aspects of their current systems. Almost half the executives and more than half the users said their current application was missing key business functionality. They also both cited high maintenance costs and high costs of integration with other applications. The survey shows the market is wide open for companies that provide claims systems. No vendor was universally recognized as the industry leader, and many were unknown to a large percentage of respondents. "The workers comp claims system industry is fragmented; system purchasers don't clearly understand what their own users want, need and expect from their system, and no one provider or set of providers has any appreciable leadership position based on the responses from the two respondent pools," the study said. "Clearly this is an immature market. Just as clearly, it will not remain an immature market forever." Read more at the WorkersComp Forum homepage. March 28, 2011 Copyright 2011© LRP Publications |
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