Technology Increases Effectiveness for Self-administered Organizations
Although none of these pain points have a simple or single solution, in all cases leveraging technology can vastly improve outcomes for self-administered organizations. Despite this, many lack access to the latest and best technology. Even though moving to newer, more robust technology platforms requires time, effort, and investment, the benefits can be significant.
One basic, but sometimes overlooked fact is that quality data is the foundation for highly effective claims administration. "Today's technology can support the maintenance of accurate data and assure quality during ongoing collection efforts," says Dawn Zoppa, Executive Director and Senior Vice President of Commercial Business at CS STARS LLC, the business unit of Marsh Inc. that delivers integrated software and services for claims administration and risk and compliance management.
Zoppa explains that the old adage "garbage in, garbage out" holds true in the claims administration and risk management arenas. "Poor data quality will cause issues from day one with not only claim and transactional information, but also with all types of data critical in the administrative process including policy, medical, employee, property, etc."
"Without the commitment to capture and maintain the appropriate level of quality data, outcomes will be questionable at best," Ms. Zoppa says. "The value of CS STARS' applications builds on the strength of our proven data transformation processes."
Consistent and efficient claims intake and claims handling is an area where technology can bring significant value to organizations. Advances in applications, platforms, and access have greatly altered what is possible, yet many organizations have yet to take advantage of these changes. "When organizations are looking for technologies to manage claims and control costs, they often find legacy systems that are more than 10-years old," Ms. Zoppa says. "In many cases, the technology is simply not current enough to deliver a truly optimized administration process."
One of the biggest concerns for any firm administering claims is controlling "claims leakage" -- the dollars wasted by inefficiencies in the claims administration process. This is especially true with systems that are poorly designed and lack the proper ongoing technology support. Newer technology solutions offer better ways to quantify and understand leakage and make the adjustments necessary to achieve improved results.
Today's technology can have a big impact in the early reporting of injuries in workers' compensation cases, the so-called "Holy Grail" of minimizing overall claim costs. For example, claims can easily be input via the Web or mobile devices today resulting in more timely and complete reporting of claims.
"Studies clearly show the relationship between early reporting and lower costs," Ms. Zoppa said, adding that intake technology applications allowing managers and other end users to report an incident 24/7 can significantly help control upfront claim costs. "In the age of Facebook and Twitter, access to instantaneous information has become the norm," she says. "At CS STARS, we have found that the majority of organizations prefer self-service tools to live operator interaction."
CS STARS' Interview Entry is a customizable tool that facilitates accurate self-service input of data. "It's very dynamic," Ms. Zoppa says. "The more streamlined and user friendly we have made the tool, the more effective it has become. Interview style entry allows for an intuitive and efficient intake process that assures the swift collection of necessary data."
Marla Shone, Director of Strategic Relationships in the Commercial Business unit at CS STARS, says that regardless of the amount of claims or whether the firm is self-administered, efficiency and decision support tools are critical.
"Clients strive to have the most efficient claims adjudication process possible," she says. "We created STARS with a task-driven workflow that can be adapted to the specific business parameters and processes of an organization. A technology solution must be configurable to meet changing client needs."
The user interface must be intuitive throughout the adjudication process, Ms. Shone explains, Features such as drop down menus, auto-population of , and validation rules are merged with larger workflow process to increase efficiency. Any effective system should be configurable to support a company's data requirements, escalation paths, notification, and approval scenarios. "Specific claim types or scenarios can be routed for review, action and approval automatically," she says. "By automating and standardizing the administrative aspects of the process, seasoned adjustors can focus on high value aspects of their roles."
Additionally those that self-administer must have an effective way to ensure continued adherence with mandatory reporting requirements, particularly in workers' compensation. "The regulatory aspects of claims administration have and continue to become more complex and organizations need to be able to meet current and new requirements" Ms. Zoppa says. Medicare set asides, CMS Section 111 reporting, state-mandated FROIs and SROIs, and state-specific forms and letters are all areas that must be addressed and where technology solutions can vary greatly in their robustness and value to the process.
Medical treatment remains the primary expense component in workers' compensation, and a myriad of solutions and vendors exist to help self-administered organizations control these rising costs. These include such services as medical bill review, nurse case management, and utilization review. Each of these mechanisms has a framework and associated set of technologies to achieve the desired cost control outcomes. To maximize the impact of these solutions, self-administered organizations should ensure that the relevant data associated with these processes is integrated with their claims administration system. "A comprehensive view of this data assures the most effective claims handling and supports the best decisions at the claim and business level," Ms. Shone says.
Similarly, incorporating litigation data (i.e. area of specialization, jurisdiction, and counsel success rate) at both the claims and attorney level allow solutions to aid in the selection and management of litigation resources. The ability to review and enhance claims and adjustor notes in a robust claim platform enables collaboration across the organization and, where appropriate, with outside counsel to ultimately result in better informed decisions and faster claims resolution.
The ongoing value of any technology is represented by a firm's ability to leverage new system features and functionality. The level of effort and impact to an organization can vary greatly from system to system. Cloud technologies and Software as a Service (SaaS) models that facilitate seamless user access to a company's newest tools are becoming more popular. By leveraging a SaaS delivery model, companies like CS STARS can deliver the most current versions of their applications to clients without disruption.
"Clients continuously benefit from improvements we make to our overall product suite," Ms. Zoppa says. "They want and need the latest enhancements and, with a SaaS model, it's much easier for us to meet that demand easily and transparently."
In the end, Ms. Zoppa says rapidly changing technology is helping self-administered entities and TPAs to have a much greater success in managing claims effectively and reducing costs.
"It's very expensive to maintain a fully insured/administered program, so self-administration is a growing and important trend to minimize these escalating costs," she says. "But for a firm that has never done it before or is looking to do it better, it is important to understand how technology is essential to the program's success. To drive down costs, technology is the critical lynchpin.
"The best advice is to work with a partner that has expertise, robust technology, and a proven track record for supporting this business," Ms. Zoppa adds. "To put the right application in place requires patience and commitment, but using the most effective technology will definitely yield successful results."
CS STARS' primary software platform, STARS?
Enterprise, supports comprehensive risk management, claims administration, enterprise risk management (ERM) and compliance and safety management. CS STARS has approximately 500 employees worldwide and serves more than 1,000 clients. For more information, visit csstars.com.
(The above piece is part of our continuing Insights series designed to highlight key products and services to our readers. This paid-for Insights was written and edited by Risk & Insurance®
on behalf of our marketing partner. Additional Insights can be found on our Web site at www.riskandinsurance.com/.)
November 7, 2011
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