A total claims solution


A total claims solution

Whatever its nature, it is important to be able to track the progress of a claim, select the right experts to handle it and measure their performance against budget. HRMR reports on LSG’s Advocator System®, an electronic claims management system that enables you to do all that and more.

As healthcare providers transition to electronic health records (EHRs), a parallel shift is taking place in the way in which claims are handled. Faced with the need to juggle multiple claims while ensuring that the organization’s budget stays on track, a growing number of providers are turning to electronic solutions that allow them to track claims, monitor the professionals working on each case and measure cost against budget.

Gary R Markham, chief executive of LSG, provides just such a solution. LSG’s Advocator System® handles selection and assignment of professionals to work on a case, budgeting and case planning, file storage and discovery, e-billing, litigation hold capabilities, and billing guideline compliance and measurement, all in one platform.

“The biggest tip I would give to healthcare providers is to try to remove as much of the paper from the process as possible. That is the key,” says Markham. “It’s not enough to move things to a scanned image or PDF environment: that’s still a photograph of a piece of paper, it’s basically a dumb document, so unless someone or some computer is going to be able to read that, the data on that piece of paper are pretty useless.

“On the other hand, if you operate in an electronic environment where some of the forms and some of the documentation are sitting in a system that is capable of recognizing the meaning of that information, that means you can set the system to behave in a certain way.”

A major advantage of LSG’s Advocator System® is that it allows you to track the spend on each case against the available budget, and triggers an alert if the budget has been eroded by a certain percentage. It can also send out prompts and reminders to ensure a case stays on track.

“It can help you foster the right behaviors, track things proactively and respond to any issues in a timely fashion,” says Markham.

It also gives the user the ability to review the performance of those involved in settling a claim.

“Without having this system in place you often have a very narrow perspective on performance, perhaps looking at whether you saved on your indemnity or on your legal bill; they are important but they don’t provide the full picture.

“In contrast, our system gives you an overarching holistic view—what I call ‘total outcomes’.”

“This view allows you to measure how quickly you are closing the claims, the relationships between the costs of managing the claim and the results, how you fared against budget, how reserves were impacted, plus the performance of professionals involved in the claim, the timeliness of their responses and the accuracy of their reporting. In workers’ compensation cases it can also monitor how the injured party’s return to work progresses.

“A number of the organizations we work with are interested not just in defending themselves in terms of a litigated claim but also in making sure that their employee—the injured party—returns to health and to work as quickly as possible,” says Markham.

A major issue reported by Markham’s healthcare clients, especially when dealing with medical malpractice litigation, has been the need to find the best qualified lawyer to handle the case and ensuring there is minimal ‘churn’—that is, that the law firm handling the case does not change the lawyer part way through.

“You need to make sure that you’ve got the right professional working on the file, that you’ve got the expertise. In our system we carry information about the various experts, right down to their post qualification level of experience, the types of skillsets they have, and their levels of expertise and experience across a different range of claims types.

“It carries the right information to ensure you have the right people to deal with a very complex medical malpractice claim.

“Once you have the right people, you don’t want the law firm to ‘churn’ the staff because it costs money for them to read into the file, and you can lose hold of the strategy for claims settlement. We can lock a staff plan against the budget that outlines which experts are going to be working on a particular file and a particular claim.

“If there is any movement away from these approved experts, the system can send out alerts to the client. We can even control it to the point that only the people on that staff plan are able to submit information.”

Cost efficiencies

Besides the advantages of streamlining the whole claims handling process and ensuring the best qualified experts are working on each case, using an electronic system such as Advocator System® can also bring cost savings.

“It generates efficiencies, and there are time and cost savings associated with that. Over the years we have seen that the use of this system brings about behavioral changes in those working on each claim. There is a greater level of visibility about what they are doing; hence there is a greater level of accountability around how they perform and that fosters a behavior that ultimately delivers cost savings, so there are measurable benefits around that.”

The Advocator System® platform also makes it possible to produce statistics, graphs and charts to track and gauge performance against target outcomes.

“It has sophisticated data analytics tools and reporting that enable clients and users to get their own perspective on what total outcome means for them. Everybody is different in terms of the outcomes they want to see and how they want those to be measured. They can require include different datasets and different types of performance metrics,” says Markham.

“That’s why we provide data-reporting tools that allow clients and others who have access to do their own thing. We also provide guidance and recommendations on a core set of performance metrics you might want to look at. If you look at these six to eight metrics, they are really going to give you 80 to 85 percent of the overall picture.

“Therefore, the ‘total outcome’ approach to claims settlement takes account of a wide spectrum of variables. The most important element is the injured party and returning them to health and the work environment as soon as is practicable.” n

Gary Markham is chief executive of LSG. He can be contacted at grm@lsg.com

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