Sign of the times Featured

12:03pm EDT March 11, 2004
In 1965, an engineer named Gordon Moore postulated that the number of transistors in a microchip would grow exponentially with every year.

Today, what's known as "Moore's Law" has not only been proven true, it is impacting the world's industries in profound ways. Who could have imagined the effect it would have on health care management? As processing power advances, the impossible suddenly seems quite plausible.

Futuristic technologies such as Artificial Intelligence (AI) can be found even in claims management tools used by Managed Care Organizations. AI affects everything from bill review to workers' compensation administration to scheduling. Decisions that once took days, sometimes weeks, can be executed in seconds.

Smarter, faster, better

Artificial Intelligence uses new data to suggest steps of action or request further elaboration on issues. Every new bit of information creates a more complete picture of the claim.

AI alerts employers when simple claims become complicated claims and empowers them to be proactive with high severity cases. When a workers' compensation incident is first reported, the data is immediately analyzed by an advanced rules engine, helping claims professionals quickly decide the severity of the claim.

The fact is, most at-work incidents are solved by a visit to the doctor with the employee missing little or no work.

Every action brings the claim a step closer to resolution. Because information gathered is streamlined, employers can check the status of a worker's recovery at any time. Decision-making time can be reduced. Care can be conducted in a manner that's proactive, accelerating a patient's return to work. Ultimately, information empowers employers to manage their claims more efficiently and get people back on the job.

As more users take advantage of electronic technology, claim resolution accelerates. New features and functionality are helping case managers, employers, claims professionals and providers work together more fluidly and with greater efficiency.

The bottom line is that companies enjoy more accurate reporting and lower total cost of risk.

Technology empowers employers

Next-generation technology helps employers enjoy more control over their claims than ever before, beginning at the initial filing of an incident. The process is based on logic, and the results can be extraordinary.

Technology isn't just about improving the ways in which we communicate electronically. It's also about creating opportunities for human interaction.

Because case managers are always informed of a patient's status, they can work proactively to facilitate care. They can help schedule appointments for MRIs, Independent Medical Examinations (IMEs), and physical therapy, then follow up with improved reporting.

As the flow of information between unique systems increases, it's likely that more partnerships similar to this will develop. As company systems become connected, leveraging their strengths, processing times will accelerate and accuracy will improve.

A fundamental for the future of health care is the ability to give critical patient information to health care providers when and where they need it.

So much has changed in such a short amount of time. The future of health care management is wide open. Advances in technology continue to help the industry work toward the most important mission: Providing exceptional care for patients and ensuring the best possible outcomes. George C. Smith III is Ohio District vice president of CorVel Corp. He oversees and directs the efforts of Ohio CorVel offices and staff. He has more than 30 years experience in the management of Workers' Compensation systems and claims administration. CorVel is a BWC Managed Care Organization and national workers' compensation cost containment company providing case management, utilization management, medical bill review, ADR, group health and integrated disability management programs to employers. Reach Smith at (800) 275-6463 or contact CorVel at randy_porco@corvel.com.