MANAGING HPL CLAIMS UTILIZING ADVANCED ANALYTICS

ABOUT THE SPEAKER Sharon Malloy –Origami Risk – Sales Executive »Implementation Specialist Origami Healthcare clients –Previously with Marsh ClearSight (STARS)

GOALS Reduce Claims Reduce Costs Promote Quality Care

KEY ELEMENTS Notifications Analysis and Comparison Attorney Scorecards Reports – Key Identifiers

NOTIFICATION Automate collection – immediate capture of adverse events –Workstation – limited time to capture events –Narrative fields to capture event –Pick lists to provide analysis Routing rules Scheduled tasks Supporting documentation Rules based communication tree

COLLECT AS MUCH DETAIL AS POSSIBLE…

ROUTING Routing rules –Multiple streams based on data collected at the time of the event –Communication tree

SCHEDULING Require follow up on scheduled time lines Send notification of due dates Regular schedule for attorney status reports Make it easy and quick

DOCUMENTATION AND COMMUNICATION Supporting documentation –Notes – security based on need to view –Files – security based on need to view –Templates Rules based communication tree Negative impacts of poor communication or flawed processes in responding to claims

ANALYSIS AND COMPARISON Analysis and Comparison –Use data to identify trends and drivers –Similar claims – what does history tell me –Expected outcomes

RATING Attorney Scorecards –Relate win/loss/settlement ratios to any factors tracked on claims –Distribute cases based on success rates –Overall score, communication –Adherence to guidelines and communication process

REPORTING Reports – Key Identifiers –Root Cause Analysis –Monitoring Analysis –Identify fraudulent claims early –Identify frequent flyers

BEST IN CLASS HPL CLAIMS MANAGEMENT Notifications Analysis and Comparison Attorney Scorecards Reports – Key Identifiers

THANK YOU See you at Annual Florida Society for Healthcare Risk Management and Patient Safety Annual Meeting & Education Conference will be held at the Embassy Suites Lake Buena Vista South August 12-15, 2015