As is the case with so many vended services in the workers’ comp claims industry, you’ll need to justify the expense against improved outcomes. Predictive modeling is no exception to this. Also, like most other services, it is hard to measure the negative outcomes that are avoided by taking guidance from a predictive model. However, there are certain actions prompted by predictive modeling that can be assumed to lead to more positive outcomes and reduced expenses.
Early Nurse Case Management Assignment
Assigning nurse case management early and on a set of claims identified by predictive modeling means better utilization of those services. It may also be that the number of claims predicted to need case management is less than the number currently being assigned.
Early Employer Intervention for Return to Work
It’s never too soon to talk about RTW with an employer. Especially when a predictive model indicates a potentially difficult return to work situation.
Early Medical Provider Interventions
Predictive models are very useful in identifying good and bad matches between medical providers and injured workers. Although there will always be constraints involved in the direction of medical care, adjusters and nurse case managers alike can greatly benefit from an early warning about a provider and injured worker mismatch.
Claim Denial
Predictive models can also identify claims that are good candidates for denial. A a successful denial is an extreme example of potential cost avoidance and a good demonstration of how predictive modeling is a key part of avoiding costs in workers’ compensation claims.
Another worthwhile observation is that all of the benefits that come from predictive modeling come early in the life of a claim. In other words, the earlier you act on predictive modeling guidance, the greater potential for more positive outcomes.