Work Comp Benchmark Study Releases Annual 2018 Report on Advancing Medical Management

December 18, 2018 – Chicago, IL – Since the Workers’ Compensation Benchmarking Study launched in 2013, claims leaders have consistently ranked medical management as the core competency most critical to claim outcomes. With medical costs representing more than 60 percent of claims costs in many jurisdictions, the study’s Advisory Council recommended the 2018 study further investigate how high performing claims payers are surmounting this top industry challenge.

“Five years of data shows the claims community ideologically agrees on what’s most critical to successful claims resolution,” says Rachel Fikes, Vice President and Study Program Director at Rising Medical Solutions. “However, the data does not show that medical performance management is a critical industry priority, in practice” she says. “It’s important that we don’t become desensitized to the persistent medical challenges that have become the ‘new norm.’ We must continue to pursue and deploy viable strategies on the frontlines.”

The sixth annual study draws upon first-person, focus group research for its 2018 Report, with over 40 industry executives examining forefront topics. These topics were chosen based on data results from the five prior annual studies, and include:

  • Focusing on a Triple Aim model to improve claim outcomes
  • Employing a medical concierge model and moving away from discount methodologies
  • Integrating behavioral health into programs
  • Using predictive and prescriptive modeling to effectively manage treatment and interventions
  • Enabling employee self-reporting
  • Leveraging technology to enhance employee resilience and recovery
  • Incorporating employee wellness and patient-centered outcomes
  • Enhancing employer education around employee advocacy and communication
  • Utilizing universal provider scorecards and publishing results
  • Measuring provider outcomes by using existing benchmarking data and tools more effectively
  • Leveraging value-based payment and Accountable Care Organization models

The 2018 focus group participants include a national cross-section of self-insured employers, national and regional carriers, state funds, third party administrators, brokerages, and industry consultancies. Participants were segmented into two focus groups of 1) claims leaders, and 2) clinicians / managed care leaders. This segmentation allowed the study to identify commonalities in the groups’ medical management priorities and approaches, as well as variances to expose gaps that may need to be bridged to improve outcomes.

To date, more than 1,800 claims leaders nationwide have contributed their collective intelligence to the study’s research. Their insights have helped build a robust profile of the successful claims organization and established a mature benchmarking tool by which to measure industry advancement.

As in previous years, the 2018 Study Report is available to all without cost or obligation as a contribution to the workers’ compensation community. The 2018 Report 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 quantitative and qualitative research that identifies what high performing claims payers are doing differently than their peers. Through surveys and interviews with claims leaders nationwide, the program generates actionable data for claims organizations to evaluate their priorities, challenges, and strategies. 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
  • Daniel T. Holden, Risk Operations Manager | BBSI
  • Marcos Iglesias, MD, SVP, Chief Medical Officer | Broadspire
  • Rich Cangiolosi, VP, Western Region | CCMSI
  • Trecia Sigle, VP, Enterprise TPA & Multinational Claim | CNA
  • Kelly Kuri, Claims Manager | Frank Winston Crum Insurance
  • Helen Weber, AVP, Head of Medical Strategy | The Hanover Insurance Group, Inc.
  • Adam Seidner, MD, MPH, Chief Medical Officer | The Hartford
  • Scott Emery, Senior Director, Claims | Markel
  • Tom Stark, Technical Director, Workers’ Compensation | Nationwide Insurance
  • Tom McCauley, Owner & Consultant | Networks by Design
  • Darrell Brown, Chief Claims Officer | Sedgwick
  • John Smolk, Principal Manager, Workers’ Compensation | Southern California Edison
  • Jim Kerr, VP of Claims Operations | TRISTAR
  • David Price, VP, Risk Management | UMR, Inc.
  • Linda Butler, Director, Claims Management | Walt Disney World Resort
  • Brian Trick, Senior Manager of Claims | Wegmans Food Markets, Inc.
  • Kyle Cato, Workers’ Compensation & Safety Manager | 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.