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Gallagher Bassett Services Inc. saw a need for a system to look beyond an injured worker’s risk profile to determine which strategies produce the best care outcomes. When Jeffrey Austin White, senior vice president and product manager of workers compensation, joined the third-party administrator in 2017, he brought with him knowledge from co-authoring studies with Johns Hopkins Medicine that connected improved outcomes to compliance with evidence-based care guidelines.
This strive to create a better system for monitoring claim trajectory and ensuring treatment provided to workers is evidence-based led to the creation of the patent-pending Treatment Quality Index, which enables Gallagher Bassett’s staff to understand and evaluate medical treatments faster than ever before, Mr. White said, earning the group the Business Insurance 2020 U.S. Insurance Award for Insurtech Initiative of the Year.
“We do not have a good understanding within our industry of what’s appropriate and necessary (treatment) given a specific type of injury,” he said. “There is a lot of diversity in the way providers treat injured workers,” which can vary by state, locale and even the education levels of providers.
By monitoring medical treatments based on best practices, Gallagher Bassett’s TQI can flag anomalies so that nurses can review to see if the treatment is inappropriate or unnecessary and make recommendations to adjusters for the best course of care if it falls outside evidence-based guidelines, Mr. White said.
The platform also flags workers who have disability durations that exceed what would be anticipated based on the injury type so that case managers can investigate the reasons behind the lag in improvement, said Jennifer Cogbill, vice president of GBCare.
If the physician is providing treatment that doesn’t align with evidence-based medicine, a field case manager can offer direction or recommend a substitute provider if the worker is receiving “disruptive treatment,” she said.
With the implementation of the TQI, about 90% of Gallagher Bassett’s claimants are now being treated based on evidence-based guidelines about 90% of the time, Mr. White said.
The TQI has also led to a 25% drop in indemnity claims requiring nurse intervention as well as a double-digit reduction in average pay per claim, Ms. Cogbill said.
“It’s our responsibility to make sure the injured worker gets back to work and their family and a normal life, and we’re making sure physicians follow evidence-based medicine … and acting in the injured worker’s best interest,” Mr. White said.
The TQI also can identify early treatments that aren’t evidence-based or appropriate for the claim, Ms. Cogbill said. For instance, the system may flag prescriptions of opioids, compound medicines or topicals if they aren’t proven to provide a benefit for a particular injury, she said.
• kWh Analytics Inc. — The firm’s development of Solar Revenue Put helps solar investors reduce the cost of capital with an insurance-based production guarantee of a percentage of expected energy output.
• Marsh LLC — The brokerage’s Blue[i] Claims analytics platform helps workers compensation clients to better manage their comp spend and improve worker outcomes.
• American Association of Insurance Services — The association developed its openIDL platform in 2018. The blockchain platform streamlines regulatory reporting processes by enabling the secure and permission-based collection and sharing of statistical data.
• Corvus Insurance Holdings Inc. —The insurtech managing general underwriter’s Corvus Scan identifies cyber risks through a non-invasive scan of an organization’s web-facing assets, then rates risks based on their severity.
This year, the Business Insurance U.S. Insurance Awards, like many other awards presented during 2020, took on a different format.