Genex’s Paul Neff, senior vice president, discusses how insurance companies can better prepare for some of the changes they’ll likely face as states continue to push workers’ comp reform legislation.
Tom Kerr (TK): I’m Tom Kerr. The new year brings many challenges to the workers’ comp industry, especially for carriers. Today, we have Paul Neff here to talk about these issues and offer some solutions. Paul, thanks for joining us.
Paul Neff (PN): Tom, thanks for having me.
TK: What programs should carriers have in place to deliver the best treatment and care for injured workers?
PN: Well, Tom, for the carrier market, whether you are a top 10 or top 100 carrier, there are jurisdictional differences, but essentially, they are all trying to get engaged as early as possible, manage the medical and use strategic capabilities to give the claims and early intervention staff more information to make better decisions.
And what we find is the byproduct of that for the managed care market is to continue to reinvent itself to bring these capabilities to the carrier world more proficiently, without adding complex and additional effort to their claims process. Which is really key to them moving forward in the claims area.
So, the innovation, efficiency and cost, really these are the market areas that are key to the carriers. And finally, you add all that up and what do they need? They need data, they need reporting that needs to be actionable, and they want us to have tools and give them information that can be measurable. Current/past trends, comparing and contrasting; these key performance indicators, or KPIs, are becoming the norm in the industry and it’s a big part of being successful.
TK: IMEs are certainly a hot topic in the industry right now. What type of factors should carriers look for when considering an IME provider?
PN: I think one of the things across the spectrum of all managed care services, the buyers at the carrier level are really looking for organizations that can manage the corporate governance aspect of getting through their procurement department, as well as giving them outcomes and information, globally and across their information and their data.
I think that's really key. And it's not just data, but it's actionable data, and that's something that we've talked about in prior podcasts, that's becoming even more important.
To be successful and to have a long partnership with them, you've got to continually adapt and look at ways to give them better information so that they can do their jobs more efficiently, and be able to react more real‑time versus the way we've traditionally done it. Which is we’re down the road in this process, "Hey, do you have information? How much have I saved? How much have I spent? What type of cases am I referring?"
So, when you look at the IME side, the ability to look at that data and create information that can help them to reduce their costs even further and manage it better, is really key.
TK: How can carriers improve the use of evidence based guidelines to ensure appropriate care and reduce cost?
PN: Well this is really, in our industry, one of those areas that's even on the forefront for the large carriers, all the way through and to the carrier number 99 and down.
Evidence‑based guidelines, they're trying to find a way to use them more globally across their claim population by state. States either have mandated rules around evidence‑based guidelines, they support evidence‑based guidelines, or they don't support it. It varies by state.
So, what the carriers are trying to do, and there's some that are early adopters on this, they're really trying to create a consistent evidence‑based guideline approach across all claims, across all jurisdictions, to be able to manage the medical upfront, the necessity upfront, and utilize those guidelines to better adjudicate claims.
TK: Thanks, Paul. In our next Inside Workers’ Comp, we’ll look at future market projections and how to best handle the coming changes. Until then, thanks for listening.