2017 Work Comp Benchmark Study Releases Three-Year Industry Report Card for Claims Best Practices

December 4, 2017 – Chicago, IL – Now in its fifth year, the 2017 Workers’ Compensation Benchmarking Study reprises its 2014 survey questions to measure industrywide advancement in claims management these past three years. The study also continues its potent method of validating how and what higher performers are doing differently than lower performing peers to reveal a more robust profile of the successful claims organization. Findings from the just published 2017 study reflect the responses of 572 claims leaders reporting on their organizations’ operational priorities, challenges, and strategies.

To date, more than 1,700 claims leaders representing diverse payers nationwide have participated in the study’s quantitative surveys and qualitative focus group research. The 2017 study builds on the industry’s collective intelligence to provide a mature benchmarking tool, identify if emerging areas are becoming new industry norms, and expand on practices generating better claim outcomes.

Since 2014, industry shifts indicated by respondent data include:

  • Measuring best practices in top-three ranked core competencies is up
  • Investment in training and development is declining, while claims talent crisis intensifies
  • Work from home options and other flexible arrangements for claims staff are on the rise
  • Technology budgets are down, while leveraging predictive analytics grows
  • Use of evidence-based, outcome data is improving
  • Narcotic utilization measurement increases, though not at a rate consistent with the industry’s opioid reduction emphasis

Among the new claims differentiators identified in 2017, higher performing organizations are more likely to:

  • Measure core competency performance in real-time, improving service levels
  • Adopt and evaluate advocacy-based claims model with employee-centric metrics, focusing beyond cost containment
  • Revamp injured worker communications, emphasizing empathy and engagement
  • Integrate technology systems across multiple programs, removing innovation barriers
  • Employ a data warehouse, capitalizing on big data and claims intelligence
  • Gauge provider quality and outcomes, including a much more robust metric set
  • Use risk / reward strategies with medical management vendors, driving performance

The study’s direction continues to be guided by its expert Advisory Council and driven by a collaborative investigation with claims organizations. “For five years, the claims community has generously and liberally shared both their successes and struggles, allowing the entire industry to benefit from the resulting best practice guide,” says Rachel Fikes, Vice President and Study Program Director at Rising Medical Solutions. “This year’s report not only benchmarks data trends from prior study reports, it also distinguishes the level of differentiation between high and lower performers – be it modest, moderate, or major – for various best practices.”

Says principal study researcher, Denise Zoe Algire, “With decreasing budgets and escalating medical cost inflation, it’s critical that claims organizations know the extent to which a practice moves the needle, so they can optimally allocate resources.”

As in previous years, the 2017 Study Report is available to all without cost or obligation as a contribution to the workers’ compensation community. A copy may be requested from Rising Medical Solutions 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 research. Through surveys and interviews with claims leaders nationwide, the program generates actionable data 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
  • Raymond Jacobsen, Senior Managing Director, AON Benfield
  • Marcos Iglesias, M.D., Senior Vice President, Chief Medical Officer, Broadspire
  • Rich Cangiolosi, Vice President, Western Region, Cannon Cochran Management Services Inc. (CCMSI)
  • Pamela Highsmith-Johnson, RN, BSN, CCM, Director of Case Management, CNA Insurance
  • Cathy Vines, Director, Healthcare Cost Containment Strategy, CopperPoint Mutual Insurance
  • Daniel T. Holden, Manager, Corporate Risk & Insurance, Daimler Trucks North America LLC
  • Kelly Kuri, Claims Manager, Frank Winston Crum Insurance
  • Scott Emery, Senior Director, Claims, Markel
  • Trecia Sigle, Associate Vice President, Workers’ Compensation Claims, Nationwide Insurance
  • Tom Stark, Technical Director, Workers’ Compensation, Nationwide Insurance
  • Tom McCauley, Owner & Consultant, Networks by Design
  • David Price, President, POMCO Risk Management
  • Laura Crowe, Risk Management Director, Presbyterian Healthcare Services
  • Darrell Brown, Chief Claims Officer, Sedgwick
  • John Smolk, Principal Manager, Workers’ Compensation, Southern California Edison
  • Jim Kerr, Vice President of Claims Operations, TRISTAR
  • Linda Butler, Manager, Workers’ Compensation, Walt Disney World Resort
  • Kyle Cato, Associate Risk Manager, Workers’ Compensation & General Liability Claims, Williams-Sonoma, Inc.

About Rising Medical Solutions
Rising Medical Solutions is a national medical-financial solutions firm that provides medical cost containment and medical care management services to the workers’ compensation, auto, liability, and group health markets.