Reducing Your Claim Spend. It s Possible!
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1 Reducing Your Claim Spend It s Possible!
2 Reducing Your Claims Spend It s Possible! Starla Mabin Director of Human Resources, Watts Healthcare Corp Christopher Schaffer CEO, Insurance Support Services, Charles Taylor Americas
3 Agenda 1. First and foremost, culture 2. Quick review of loss triangles 3. Developing a claims strategy 4. Implementing a claims strategy 5. What success looks like
4 Workforce Culture Employer Culture Lead through positive change Consistency Manage Expectations Of employees Of supervisors Of senior management Employee Culture Maintaining employee trust Providing safe work environments Promoting a caring, collaborative, environment Taking care of employees when injured Showing concern
5 Agenda 1.First and foremost, employee culture 2.Quick review of loss triangles 3.Developing a claims strategy 4.Implementing a claims strategy 5.What success looks like
6 What is a loss triangle? It is the primary method in which actuaries organize claims data used in actuarial analysis It is a table of total losses for a certain period at various, regular valuation dates, reflecting the change in amounts as claims mature
7 Claim strategies should be grounded in data Policy Year , Development (in months)
8 Claim strategies should be grounded in data Policy Year , , , Development (in months)
9 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , ,
10 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , ,
11 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , , , , , , , , , , , , ,
12 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
13 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
14 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
15 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
16 Claim strategies should be grounded in data Policy Year Development (in months) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,000
17 Incurred Let s look at it another way 800, , ,000 Typical WC Policy Year Development 500, , , , Months
18 Agenda 1. First and foremost, employee culture 2. Quick review of loss triangles 3. Developing a claims strategy 4. Implementing a claims strategy 5. What success looks like
19 Insights from loss data should inform strategy Statistically, the longer claims and policy years remain open the more they will cost Consequentially, a claims strategy to shorten the life of claims should result in better outcomes
20 Implementing a program-wide claims strategy Improving outcomes, one claim at a time
21 Claims strategy & goals Investigation Medical Care Professionalism Cost Containment Litigation Prompt Resolution Investigate injury thoroughly to determine compensability Ensure quality medical treatment, efficiently delivered Treat injured employees professionally and empathetically Implement programs and strategies to lower claim costs Litigate to win. Choose cases we can win or need to win Deliver claims services efficiently to quicken claim resolution
22 Agenda 1. First and foremost, employee culture 2. Quick review of loss triangles 3. Developing a claims strategy 4. Implementing a claims strategy 5. What success looks like
23 Investigation Collaboration between employer, employee & medical provider Determine compensability Assess third party liability Document nature and cause of injury
24 Medical care EMPLOYER Establishing an Occ-Med Clinic Relationship Ensure prompt medical care Determine if accommodations can be met (continuing) Engineer a path of least resistance to quality physicians CLAIMS ADMINISTRATOR Engineer a path of least resistance to quality physicians Monitor treatment plans, manage delays, use evidence-based medicine Utilize peer reviews, IMEs, FCEs and UR strategically to challenge unrelated, unnecessary, and/or prolonged treatment
25 Professionalism All parties should: Treat the employee respectfully and professionally Show empathy Accommodate restrictions as able Pay benefits timely and respond promptly Because: It is the right thing to do It sets the right tone for a positive outcome It minimizes lawyer involvement It reduces the average cost per claim
26 Cost containment Effective programs should address claim cost drivers
27 Cost containment Effective programs should address claim cost drivers In a way that: Drives down unit cost Manages utilization, and Reduces administrative burdens for adjuster
28 Litigation 1. Avoid litigation when possible 2. Choose cases to litigate carefully a) Cases you can win, and b) Cases you need to win 3. Litigate to win
29 Prompt resolution improves outcomes EMPLOYER Communicate employer level information Respond to requests quickly CLAIMS ADMINISTRATOR Apply proactive claims handling by experienced adjusters Drive the pace and cadence of claims activity Utilize automated diaries, workflows and controls Invest in quality assurance Incentivize positive outcomes
30 Agenda 1. First and foremost, employee culture 2. Quick review of loss triangles 3. Developing a claims strategy 4. Implementing a claims strategy 5. What success looks like
31 Incurred Incurred Success bending the curve 800,000 Typical WC Policy Year Development 800,000 Improved WC Policy Year Development 700, , , , , , , , , , , Months 200, Months
32 Case study APM Terminals
33
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