Achieving Better Outcomes with Predictive Modeling

19th October 2021

We’ve all heard the old saying: “You need to work smarter, not harder.” Although it is very important to retain knowledgeable, proactive adjusters that know their jurisdictions very well, it is becoming imperative that we use the sophisticated technology to our benefit so that we can achieve better workers’ comp outcomes.

Davies has partnered with Genex to deliver the predictive modeling technology to achieve the best outcomes possible for our clients. This is accomplished in a couple ways:

  • Early Intervention using Referral Expert®; a proprietary “predictive modeling tool” which provides a risk score, low/medium/high. The advanced algorithm of Referral Expert® analyze 10 claim data points, providing a risk score when the claim is reported, day one. This typically triggers 18-23% of all NEW losses for a clinical review or “Triage”. This insures clinical telephonic expertise working in tandem with the claim specialist, promoting “Quality Care” and a successful “Return to Work”.
  • Deferred intervention using RiskID®. Sometimes certain claims can seem like an easy resolution and then take a turn for the worst incurring higher medical and indemnity costs. RiskID® monitors treatment patterns throughout the life of the claim and will trigger clinical alerts when provider treatment patterns fall outside of guidelines for physical medicine service types.

Early risk prediction (Referral Expert) combined with a continuous data mining for emerging risk (RiskID) enables a focused strategy to maximize claim outcomes while efficiently utilizing resources to support this goal. This dual strategy not only improves outcomes and decreases costs but improves the program efficiency. The number one goal is to return the worker back to their pre-injury status. This can only be achieved with knowledgeable, proactive adjusters with an excellent retention rate. Coupled with the use of sophisticated technology, Davies has assembled a state-of-the-art workers’ comp program designed with successful outcomes in mind.

 

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