Technology is changing the workers' compensation experience in a positive way from earlier, personalized care to better claim management and communication for all parties. Work-related injuries come with a lot of unknowns, but early intervention, accurate information and regular interactions can improve the experience and outcomes for workers and employers alike.
Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.
Patti Harman (00:07):
Good afternoon and welcome to our transformation forum re-imagining the workers' comp experience through technology. I'm Patti Harman, editor in chief of Digital Insurance, and I'll be your host for today. Technology is changing the workers' compensation experience in a positive way from providing earlier personalized care to better claim management and communication for all parties work-related injuries come with a lot of unknowns, but early intervention, accurate information and regular interactions can improve the experience and outcomes for workers and employers alike. Joining me today to discuss how carriers, TPAs and employers are utilizing technology as part of the workers' compensation process are Jean Feldman, director of Managed care for Sentry Insurance and Aaron Deering, chief Technology Officer at Sentry. Thank you both for being here today.
Jean Feldman (01:09):
Thank you.
Patti Harman (01:10):
Thank you. So let's start with an overview of workers' comp claims and Jean, you have a lot of expertise in this space. What have been some of the major challenges to effectively managing these claims from both the carrier and the employer perspectives?
Jean Feldman (01:29):
I think Patti, one of the key things that we've learned through the years, and it's something that we've been discussing for the past 10, 15 years, is that there's a lot of behavioral health that co-mingles with the injured worker and trying to bring that forward so that we're more empathetic with the injured worker that we can move them through the recovery process easier is really important. So what we found in our data, about 3% of our claims are about 35% of the costs. So what we're really looking at is our data and how can we do things differently. I think the other key thing from a claims perspective is that claims and employers are hesitant to treat behavioral health. They're afraid it's going to add a mental component to the claim, but we see it in the doctors' notes all the time. The injured worker has anxiety, they're stressed, they're afraid to go back to work where they got hurt on that piece of equipment, so that some of the things that we're bringing forward that we all need to do a better job and how can we manage things differently for that injured worker and help our claims people to do a better job interacting with that injured worker and make sure we have the right tools.
Patti Harman (02:44):
Do you find then that some of these injuries are maybe more disruptive than others, and if so, why is that the case?
Jean Feldman (02:53):
I think when you think about an injured worker and when they get hurt on the job, we don't make it easy. Every state is different and that we have different jargon when we're reaching out to them. There's different state forms, so even though the injury itself may not be as complex as a major catastrophic injury, these injured workers still require a lot of care and a lot of empathy in trying to help them through their recovery process. So when you think of a low back sprain strain that really should resolve within six to eight weeks, sometimes because of different things going on with that individual, it can lead into unfortunately three and four years down the road where they're dealing with chronic pain. We want to change that trajectory. We want these people to help our injured employees to get back into the workforce and to make a difference and use different tools that we have available for our claim representatives and nurse case managers to use with that individual to really help them through the process so that they don't turn into those three and four-year-old claims where people are stuck.
Patti Harman (04:01):
Wow. I had no idea that some claims could last that long. That's really interesting. So Sentry recently conducted an in-depth review of almost a decade's worth of workers' comp claims. Aaron, how important is this data in helping your team identify trends and focus on areas of improvement and how is technology even changing your ability to utilize the data that you have to make more informed decisions?
Aaron Deering (04:31):
Yeah, I think at Sentry, data is a fundamental part of every initiative that we take on, and so when we look at this, it helps us with not only how do we achieve better outcomes in the solutions that we put together, but it also helps us guide our technology investments and we can leverage this information to gain a better understanding of our environment and know where we can be more effective as we apply technology to some of our problems. You asked about how things are trending and where we see some other areas for improvements. I think that's that one of the things that you're seeing right now is with the granularity of data that we're able to start capturing and the fact that we are getting that data in a streaming fashion, it's no longer these long processing cycles, but you can look at it in more real time. I think there's an opportunity to bring that forward to our claim reps sooner and we can start to operationalize that information much more quickly as a part of the claims handling process.
Patti Harman (05:45):
Jean, from your perspective, what were some of the issues that this review highlighted for you and why was this so important?
Jean Feldman (05:53):
I think working closely with our data analytics team, the business needs to be joined at the hip with our data analytics team so that we can make sure that the models are functioning properly and bringing forward claims that we expected where we can identify where those issues, what the data tells us. If we could intervene sooner in the first year, we can make a difference with that injured employee and hopefully prevent them going down the wrong path where chronic pain sets in. So as you use the CDC definition for chronic pain, it usually sets at day 90, and so if we can intervene anytime around there to make a difference and bring things forward that the claim rep may not be that aware of, they may have discussions with the injured employee that they are having some pain, but there's other things our data is telling us, and so having that capability to do that data mining and bring it forward in a way that it's consumable by the claim rep, then we can intervene and do things differently.
Jean Feldman (06:57):
It may tell us we need to be talking to that injured employee more frequently or we need to have a nurse case manager on the claim if there isn't one already, to help advocate and educate that injured employee of what their recovery is going to look like, and then also to be able to bring in other tools that may be beneficial if they're really struggling with stress, anxiety, depression, their sleep is impacted by the injury itself, like with the shoulder injury, we can bring in virtual reality therapy technology, we can bring in other counseling that we have available for that injured employee. This is all without adding a psych diagnosis to the claim. So if we can help change the mindset of our claim reps, help educate all the stakeholders, we can have a better outcome for that injured employee and that's really what the data is helping us to move forward with and taking advantage of all the data that we have available is really key.
Patti Harman (07:58):
It's just amazing to me what a difference having access to this data and having access to it earlier and how it just allows you to intervene and it creates a better outcome for everybody involved. Jean, what are some of the barriers that can affect an employee's return to work and do comorbidities play a role in a worker's recovery?
Jean Feldman (08:21):
Yeah, so some of the key barriers that we see routinely, unfortunately, is that depending on the type of injury, they may be afraid to go back to work When an injury happens, their life changes when it's a little bit more complex, let's say it's not a laceration, but it's more complex. They've had injury to a shoulder, their activities of daily living, if they have young children or an infant, they cannot pick up that child anymore because of the impacted shoulder injury that they have now. So what we really need to be focused on is helping them through that to help them have better coping mechanisms. We have to accept the injured worker where they're at, and so sometimes diabetes might be impacted, so we have to get 'em back to their baseline. Smoking impacts recovery, sleep impacts recovery. If we don't have some of these things, we have to be able to talk to the injured employee about how we can help them. And so this is where some of the other tools, having a nurse case manager having virtual reality therapy that can really help that is sort of like a cognitive behavioral therapy in a condensed way that can help that individual move forward through the recovery process and have a better outcome. It teaches them skills that they may not have available and how to deal with pain, their anxiety, their stress level, improve their sleep quality, which are all key in that recovery process.
Patti Harman (09:54):
It's interesting the role that just being able to get a good night's sleep plays as part of the recovery process and just being able to process information and absorb what's going on and everything. Aaron, technology obviously plays such an important role in gathering and synthesizing information, communicating with customers and improving efficiency. How do you see companies adding technology, whether it's AI or chatbots or other types of tech, how are they effectively adding that to their operations and what are some of the key factors that they need to consider for a successful implementation?
Aaron Deering (10:38):
Yeah, I think obviously as our use of technology as a society continues to permeate everything we do, people have got their devices with them, they engage increasingly over digital channels and things like that, and so you see a rise of technologies that mirror that behavior and you're starting to see things on the chatbot front and things like that where you can start to engage more successfully with the injured worker or different parties in the claims process. And so obviously technology helps do that, I think, and there's a lot of interest in that because you want to be where the injured workers are and you want to be able to help accommodate their schedules and help them get in touch with the right people when they need to. But I think it's really important for that when you do that, you have to think about the experience that they're having very holistically because unlike a conversation where you get to kind of hear the feedback both ways, you can read their facial expressions sometimes in some of those mediums, you don't have that opportunity.
Aaron Deering (11:48):
And so really thinking carefully about those experiences and how you're stitching together all of the methods of digital engagement that exist is important. Making sure you're still very much cognizant of the accuracy of some of the information that comes, especially in scenarios where you might be thinking about introducing our AI or some type of response in that fashion, because I think that's really important in augmenting what your claim reps are already good at and making sure that you're bringing that information to them, allowing them to engage in those mediums is really, really effective to maintain that sense of empathy that you're trying to express as an organization and make sure that they understand that you're there for them and you're trying to help them recover as quickly as possible.
Patti Harman (12:38):
The relationship piece is still really important even though we're adding all of this technology to different operations, it's still that one-on-one in how people relate to other folks. Just a quick reminder for our audience. If you have any questions, please feel free to put them in the chat and we'll take a look at those at the end of our conversation here. So Aaron, why should companies be focusing on adopting new types of technology?
Aaron Deering (13:09):
Well, I think new technology enables new opportunity. It enables you to find new ways to bring your services to your customers, to the injured workers, and I think you have to stay relevant. You have to stay important. So not only is it about the newest technology that comes out, sometimes it's just keeping up with the technologies that you already have and that keeps you in a position to be agile and to be responsive. So when a new technology is introduced and you see an opportunity, you can seize that immediately instead of wading through a certain amount of legacy or old technology to get to the new capability. I know for us, that's been a big differentiator. We actually were able to retire our mainframe at the end of 2022, and that's allowed us to focus more investment into our newer systems and into the newer technologies to try and bring those experiences to our injured workers and to our customers.
Patti Harman (14:16):
Wow. That would be a huge difference because dealing with the legacy systems and what's been around for a while, that's a major undertaking. Aaron, are there certain types of technology that you think are going to have major implications in the workers' comp space going forward then?
Aaron Deering (14:36):
Yeah, I think in the workers' comp space in particular, you're dealing with a lot of medical information and things like that, and as Jean said, she talked about some of the things that they see in the notes and they see in these different places. And so you're dealing with a lot of unstructured information, information and sources that maybe isn't as readily available as what it is as other types of information might be. Some of the developments that you're seeing with large language models and AI technology and the ability to get that information and turn into something more actionable, I think is the potential to have a pretty big impact on the WC space.
Patti Harman (15:16):
Yes, that's true. I attended a large workers' comp conference last year, and I remember just hearing everyone talk and they were so excited about how they were going to be able to use new technology and AI and so many different opportunities that they were going to have going forward and how that was just going to have major implications in this space. So I'm glad we've had an opportunity to look and discuss some of those opportunities. We've covered a lot in the last 20 or 30 minutes or so, and I was wondering what's one takeaway or important thought that you want to leave with our audience? Aaron, I'll start with you and then we'll let Jean have the last word.
Aaron Deering (16:03):
Yeah. Well, I think that the environment right now and the technology is always changing very, very quickly, and we started this talking about data and how we make that available, and I think it kind of comes back around to that and that always keeping an eye out for the data that you're able to collect, how you're able to organize that and bring that forward and mine that for insights is fundamental and needs to be a part of every initiative and every project because that is where so many new capabilities and new opportunities start is in having the right information to be able to act more effectively at the right time. And so I guess that's what I would leave it with is kind of back to basics, really making sure that you've got an eye to the data that you're collecting and how you're going to mine that for insight.
Patti Harman (16:58):
And Jean, what's your takeaway that you'd like to leave with our audience?
Jean Feldman (17:03):
I think one of the key things, and Aaron touched on this, is that as we're using our data to guide us and to help us move faster, quicker on things with injured employees so they don't become problematic, it's really important that we keep empathy front and center and that we do a really good job of change management to all the stakeholders because the technology is moving fast, and so you want to make sure you're using the right AI technology where we can streamline some of the work for our claim reps to help them being able to spend more time with that injured employee because that relationship is so key, it can help prevent somebody from going out and getting an attorney from whether they're frustrated because they don't understand what's going going on, they may not understand how that's being impacted to their benefits and that kind of thing as well as their treatment plan. They may not understand that there is going to be some pain, but it is going to get better. So the more time we can spend with the injured employee and our customers to help them through this process and the recovery, that is really key. But it depends on our data. What is your data showing you? Then how can we use that data to help us do a better job to impact the injured workers' outcome, which by far impacts our customers and getting that injured employee back into the workplace.
Patti Harman (18:28):
Yes, very true. I'm going to ask you each one question, which I didn't give you ahead of time, but there's so much going on in this area. Is there anything that just really excites you that when you see it, it's like, wow, we can do this now and we weren't able to do this five years ago, or the implications of what this is going to mean for injured workers or employers or insurance carriers going forward? Is there anything that you just look at and you're like, wow, this is really cool, and I'll throw that to either one of you?
Jean Feldman (19:05):
Aaron, do you want me to go first?
Patti Harman (19:08):
Why don't you go first, Jean?
Jean Feldman (19:10):
Okay, so just quickly, so a couple things. Most everyone is texting now what that is, the mode of communication that has changed from five years ago. I mean, who would've thought that this is probably the preferable way of everyone of communicating, but we still have to have real people to help with that other communication because we still need in-person, emails, phones, conversations and that kind of stuff. But texting has become very important I think, for everyone in the work comp space because we can reach people faster. They don't have to respond to an email. Everyone's walking around with their smartphone and then the medical technology is changing so fast. What we have available today in three to five years, it's just it is light years of what we had a couple of years ago. When you think about virtual reality therapy and in the subjective data that we're getting back with our injured employees that have used that, it has improved sleep where they have an extra hour and 15 minutes of sleep per night.
Jean Feldman (20:15):
So they set goals with this therapy and being able to reduce their anxiety, decrease depression, decrease pain, trying to retrain their brain and how it can help them with different coping mechanisms that they may not have had previously. And so the subjective data is really exciting. Coming out of that, we're hoping to have more firm data as those claims closed, as those injured workers get back into the workforce and the claims resolved. But the medical technology along with the data and what we're going to be able to do is really exciting to me and how that's going to change how we manage claims better than what we've done in the past and have better outcomes for injured employees.
Patti Harman (21:02):
So many possibilities. Aaron, what excites you?
Aaron Deering (21:08):
I think for me, when I think about this, the thing that's most exciting to me is that there's now technology available to help you digest this information that is coming to you in, I'll say in almost a more human way, the way that people correspond, the way that they interact. Yes, we've trained ourselves over the years to do this point, click and typing things into a pc, but because of some of the things that are happening now to better understand natural language and to be able to harvest insights and things like that from there, I think it's an opportunity to find information in ways that we couldn't before. And I think that leads to insights and opportunities that we haven't had before. The ability to stitch a person's experiences together across so many different mediums, whether that's SMS, whether that's the web, whether that's the phone, whether that's email, there's ways you can bring all of that together and you can help the person that is really trying to assist the engine worker do the best that they can, and they have all of that information now available to them in a way that they couldn't previously.
Aaron Deering (22:28):
And I think that's really exciting. I think that anytime that the technology can become a bit more human, it allows us to get back to solving the real problems that we have, not the problems that are produced by the technology, but the problems that help the people. And I think that is what's most interesting to me.
Patti Harman (22:53):
Well, thank you both so much for sharing your insights today and for joining us and telling us how technology is transforming the workers' compensation space. I also want to thank our audience for joining us, and please join us for our next transformation forum when we look at how technology is being used for underwriting in life insurance. I'm Patti Harman for Digital Insurance, and please enjoy the rest of your afternoon.
