January 12, 2016

From “Moneyball” to Medical Management:
The Takeover of Predictive Analytics

Claims Management
, Cost Containment

While it may not seem like there’s a connection between a professional football team and workers’ compensation, it’s all about the numbers.

Last week, the Cleveland Browns hired Paul DePodesta as their Chief Strategy Officer. DePodesta is notoriously known for his work as the MLB “Moneyball” executive for the Oakland A’s, and most recently served as the Vice President of Player Development and Scouting for the New York Mets.

The staffing change reflects yet another move of integrating “stats men” – and women – into new industries, specifically in the sports world. In the summer of 2015, Cynthia Frelund was introduced on ESPN as a SportsCenter Daily Fantasy Analyst, and most recently provider performance analytics websites like Pro Football Focus have become increasingly popular.

Big data, predictive analytics and data mining have inundated almost every industry – including workers’ compensation. From an individual injured worker’s vital information to endless amounts of company financial data, the pool of information is nearly limitless.

As such, integrated models provide the opportunity to incorporate and combine previously siloed stores of data to create new supersets of data, otherwise known as “big data.” The need for data mining is greater than ever, as is the need for the ability to translate workers’ compensation data into actionable analytics.

Strides are being made within the industry to create algorithms to help identify potentially costly claims and/or claims where the injured employee is at risk. The biggest challenge is determining how to harness and channel this data into effective workflows to increase efficiencies and promote better outcomes.

CorVel is constantly challenged to develop better methods for delivery of care and to put patients on a more effective path to wellness. However, an example that currently illustrates their use of data is clinical modeling.

With this service, CorVel is able to proactively identify significant cost-drivers in pharmacy utilization before they become high dollar claims through clinical modeling analysis of all bill review data. CorVel has developed a proprietary set of rules in our system to flag specific indicators such as high narcotics usage, multiple prescribers, and certain drug combinations that can contribute to rising costs or lead to harmful conditions such as addiction and prescription abuse. Integration with their bill review system provides CorVel with full visibility into a patient’s entire drug history including drugs obtained from retail, mail order and out-of-network pharmacies, third party billers and physician dispensed medications so CorVel can manage their clients’ entire pharmacy exposure.

Since CorVel has access to all client data within their integrated, single platform system, they can provide better program context and more effectively quantify actionable data, which ultimately results in better outcomes.

Learn more about CorVel’s services on their website.