• PDI

Predictive analytics emerges as workers comp best practice



High-performing workers compensation claims organizations use predictive modeling eight times more frequently than firms with less success in closing claims, according to recent research on a practice that experts say has grown swiftly over the past decade.

“I think we are at a tipping point, at least in terms of using predictive analytics to improve claims management and claims practices,” said David Huth, Boston-based chief operating officer for Chicago-based Rising Medical Solutions, which provides medical cost containment and medical care management services to the workers comp industry. “I think it’s the future of the industry for a variety of reasons … we are in a data-rich industry, but we haven’t leveraged that data historically to make better and smarter decisions.”

Experts say data such as injured-worker demographics, injury data, timelines of claims and information on claims that end up in litigation can all help claims managers guide future outcomes.

Rising, which released a white paper Aug. 1, surveyed 1,700 claims professionals and narrowed down best practices among what it referred to as top-tier claims organizations: the top 24% of claims organizations that close claims at the same pace as opening them.

The survey found that such practices as measuring success and outcomes, investing in claims professionals and using an advocacy-based model for claims management lead to better outcomes and faster claims resolution. Advanced technology is also at the top of the list: warehousing data on injured