Milliman
Nodal Medical Benchmarking For Workers Compensation
Realizing the potential benefit of comparing treatment costs in workers compensation to the group health setting spurred Milliman Inc. to launch its Nodal Medical Benchmarking for Workers Compensation program.
The product enables Milliman to measure the performance of providers in the comp sector against those treating similarly injured patients in group health.
Organizations are able to benchmark what they pay for services against peers using the same services, said Chicago-based Michael Paczolt, a principal and consulting actuary at Milliman.
“We’re able to drill down by differences in region, differences in terms of utilization and unit costs across different service categories,” he said.
The program uses a medical data set representing a third of all U.S. adults across all 50 states, Mr. Paczolt said. It’s a collaboration between Milliman’s property/casualty and health care teams.
Health care experts assembled medical data on diagnoses, procedures and treatments, and claims professionals helped identify injury and treatment medical codes, enabling a cost comparison between comp and group health.
Mr. Paczolt said the tool offers clients a way to compare comp and group health performance that can be updated as claims continue to mature.
“It’s an automated process where they’re able to see how things perform,” he said. “From there, they can use it tactically on a claim-by-claim basis to understand potential targets for different types of services and outcomes.”
The program provides a way to “dig into that information to understand what’s causing the differences,” he said.
Through the program, Milliman can help clients develop strategies to reduce comp claim costs by determining the “right treatment plan, the right provider, and at the right price.”
And while cutting costs is the primary driver, the program also gives clients tools to explore other strategies, such as bundled payments.
Medical data can be complex, and benchmarking can help simplify processes by summarizing information in an “easy to consume and understandable way where you don’t have to be a clinician in order to get value out of this,” Mr. Paczolt said.
“You’ll be able to see trends within your data cost differential,” he said. “It’s really sort of making sense out of all that messy data.”