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September 15, 2022
California Division of Workers' Compensation Announces Online Injured Worker Workshops

August 20, 2022
The 76th Annual Workers’ Compensation Educational Conference this August 21st – 24th 2022 with prominent role for Sedgwick

August 15, 2022
Debbie Wilson now director of sales for Insurance Education Association

August 9, 2022
California Division of Workers' Compensation Announces Return to In-Person Walk-Throughs



Benchmarking Study for Workers' Compensation Releases Ninth Annual Report Examining Operational Transformation Amongst High-Performing Claims Organizations
By Rising Medical Solutions LLC - September 1, 2022

As modern workplaces continue to evolve in light of the COVID-19 pandemic, so too must workers' compensation claims organizations in order to achieve optimal outcomes. Yet, standing in the way are deeply entrenched challenges that more than 3,300 claims leaders and frontline professionals have brought to the forefront in previous Workers' Compensation Benchmarking Study research.

"Eight years of data show—to succeed in the face of core claims challenges—organizations need to transform legacy processes, mindsets, semantics, and ingrained cultural practices. Specifically, our data shows that those claims organizations with superior outcomes are also those who are further along in this transformation process," said Rachel Fikes, chief experience officer and study program director at Rising Medical Solutions. "With this in mind, our latest research brought together claims leaders from diverse organizations to dig deeper into exactly how they are evolving to outpace their peers."

The ninth annual study draws upon first-person, focus group research for its latest report, with over 30 industry executives gathering this past December to examine what real-world strategies organizations are using to overcome the foremost barriers to claims management mastery. Participant companies represented a national cross-section of self-insured employers, regional and national carriers, state funds, and third party administrators.

With claims, clinical, and medical management perspectives, the research exercise generated expert guidance payers can use to drive success by: (1) surmounting the repeatedly ranked top obstacles to achieving desired claims outcomes, (2) moving from tactical to strategic, cultural change in the execution of employee-centric claims models, and (3) operationalizing social determinants of health (SDOH) best practices.

Focus group research topics were chosen based on prior study data and the resulting report contains three (3) concise lists of potent recommendations, including key claims strategies to:

  • Improve return-to-work options, drive incentives across stakeholders, and engage injured employees
  • Equip frontline professionals with optimal interventions, while addressing the stigma of psychosocial issues and mental health conditions
  • Overhaul communication practices to increase employee trust and reduce litigation
  • Redesign claims best practices to include an end-to-end, cultural focus on the employee-centric model
  • Utilize frontline claims professionals in employee-centric model design, implementation, and training to create ownership and accountability
  • Improve outcomes based on a total worker health model, including training on SDOH risk factors that go beyond the walls of the workplace, such as housing instability or food insecurity
  • Leverage community resources and social interventions for injured employees with potential health disparities

As in prior years, the new 2021 Report is available to all industry stakeholders without cost or obligation as a contribution to the workers' compensation industry. It may be requested here.

About the Workers' Compensation Benchmarking Study

The Workers' Compensation Benchmarking Study is a national research program examining the complex forces impacting claims management in workers' compensation today. The study's mission is to advance claims management in the industry by providing both quantitative and qualitative data. Through survey research with claims leaders and practitioners nationwide, the program generates actionable intelligence for claims organizations to evaluate priorities, challenges, and strategies amongst their peers. Conceived and directed by Rising Medical Solutions, the ongoing program is a collaboration of industry executives representing diverse organizational perspectives, including the Study's Principal Researcher and Advisory Council:

  • Denise Zoe Algire, Director of Risk Initiatives & National Medical Director | Albertsons Companies
  • Melissa Burke, PharmD, VP, Head of Claims Integrated Solutions | AmTrust Financial Services
  • Dr. Tyrone Spears, Chief, Workers' Compensation Division | City of Los Angeles
  • Ben Tebo, JD, VP | Creative Risk Solutions
  • Sharon Scott, VP, Medical Programs | ESIS
  • Freddy Mistry, AVP, US Claims Operations | Gallagher Bassett
  • Helen Weber, AVP, Head of Medical Strategy | The Hanover Insurance Group, Inc.
  • Adam Seidner MD, MPH, Chief Medical Officer | The Hartford
  • Victoria Kennedy, VP, Workers' Compensation | Linea Solutions
  • Scott Emery, Senior Director, Claims | Markel
  • Thomas Wiese, VP, Claims | The MEMIC Group
  • Michele Fairclough, Medical Services Director | Montana State Fund
  • Molly Flanagan, AVP, Workers' Compensation Claims | Nationwide
  • Marcos Iglesias MD, VP, Chief Medical Director | Travelers
  • Linda Butler, Director, Claims Management | Walt Disney World Resort
  • Brian Trick, Director of Claim Services | Wegmans Food Markets, Inc.
  • Thomas Stark, VP, Underwriting | Zenith Insurance Company


About Rising Medical Solutions

Rising Medical Solutions is a national managed care firm that provides medical cost containment and medical care management services to the workers' compensation, auto, liability, and group health markets. Rising also directs and publishes the annual Workers' Compensation Benchmarking Study, a national research program examining the complex forces impacting claims management in workers' compensation today.

SOURCE: Rising Medical Solutions LLC, Rachel Fikes, rachel.fikes@risingms.com with editor and journalist Lonce Lamonte, adjustercom magazine, lonce@loncelamonte.com

 
 

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