Cost Containment Analytics for Workers Compensation Claims

Cost containment analytics empower your ability to assess risk and improve your response.

Connect™ Outcomes Based Provider Validation

This outcomes-based provider evaluation and selection application measures peer-to-peer performance of workers’ compensation providers using a range of return-to-work and financial metrics. Top-performing physicians are identified regardless of network affiliation— giving payers access to providers with the best overall outcomes in care, quality and service expediency. Successful outcomes and medical care go hand in hand with workers’ compensation analytics. Connect targets the best occupational primary care physicians and specialists in the industry and puts them into the hands of nurse adjusters and return-to-work managers.

SCORE™ At-Risk Claims Analysis

This predictive workflow management application increases the effectiveness of clinical intervention and the allocation of clinical resources. It also signals the adjusting team to adverse claim development. Output includes easily identifiable interactions for triage, telephonic case management or field case management and is based on all data received on each open claim.

SCORE Rx™ Pharmacy Claims Analysis

This unique pharmacy decision-support tool evaluates elements with known correlations to drug use – past and current claims, injury data and medical service utilization metrics (frequency of prescriptions, physician prescribing patterns and prescribing facilities) – to deter excessive drug utilization, addiction and subsequent downstream costs brought on by over-utilization. Pre-determined workflow indicators highlight potential medication usage dangers so that clinical resources can intervene before a claim reaches excessive risk status and threatens the injured worker’s safety and recovery.