A Case Study (excerpted from a full data analysis completed by Keystone Risk Partners)
Client: A national company with unbundled self funded insurance program.
The focal point of the review was to determine whether the adoption of strategic early intervention medical management services (Kingstree) and claims oversight in conjunction with the services performed by a national third party administrator materially changed the claims outcomes when measured against past performance or industry benchmarks.
Keystone Risk Partners provided certain analytical and benchmarking services as part of an overall review of claims and payment data for losses under the Kingstree client’s workers compensation program.
This program has specific functional elements that drive results. The agent provides the claim oversight and quarterbacks the efforts of most of all the other vendors used in claims management, including medical case management and the TPA services. It also encompasses other services such as surveillance use, attorney selection and other special service providers. Kingstree Group provides the medical care coordination and drives care into the applicable PPO networks and looks for every opportunity to return the injured employees to work.
Keystone’s analysis concentrated on reviewing outcomes or outcome indicators at various stages in the life cycle of a set of claims. The metrics analyzed are described below:
Goal: Implement an innovative, customized strategic medical management platform that will directly reduce workers compensation losses. This results driven approach will dramatically impact your claims.
- Average Indemnity Costs: Kingstree’s collaborative approach on early medical and return to work strategies reduce average indemnity costs up to 50% per claim.
- Average Medical Costs: Kingstree’s collaborative approach involving ongoing medical management has proven to reduce medical utilization and duration. Average medical costs on indemnity claims are reduced by up to 50% per claim.
- Identify Hidden “Benefit Delivery” Costs: Benefit Delivery services such as out of network medical management and legal related costs can be up to 25% of the total loss. Drive down average costs per claim up to 20% for benefit delivery services and target proactive management strategies.
- Medical/Indemnity Claim Split: Early claim and medical management initiatives reduce claims paying lost time benefits up to 25%.
- Claims Closure Rates: Early medical and return to work strategies increase the percent of claims closed up to 20%, reducing both medical and indemnity costs on high dollar claims.
