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Predictive analytics + medical knowledge = improved outcomes for injured workers

July 24, 2018

Bringing medicine and predictive models together helps deliver better results for injured workers and their employers.

Nina McIlree

Vice President, Medical Management

Her areas of responsibility include Zurich Care Plus, Medical Bill Review, Medical Professional Case... About this expert

hospital admin
Getting the right care to an injured worker at the right time is at the heart of Zurich’s commitment to deliver the exceptional workers’ compensation services and claims response our customers and their employees deserve.

Prompt reporting is key to driving better outcomes for employees and businesses. With Zurich, you can report the claim on-line, or through the Zurich’s Care Center.

Zurich’s award winning Customer Care Center is staffed by a team of specialists trained on how to match the complexity of the claim to the right claims professional.

Zurich’s Workplace Injury Triage program takes it a step further offering the injured employee and supervisor or manager nurse intervention at the point of injury. In the event of a serious injury, the Workplace Injury Triage specialist will advise the employer to seek immediate emergency medical intervention. In less urgent cases, the triage specialist will offer alternatives that can help save the employee from becoming caught up in an unnecessarily involved, complicated and potentially costly medical intervention.

If an injury is determined to be serious enough to require off-site treatment (up to and including hospitalization and rehab services), an experienced Zurich nurse case manager will be assigned to help the worker navigate the sometimes complex journey of recovery and return to work.

Nurse case managers can have a positive impact by promoting quality care, reducing medical expenses and enabling faster returns to work, with a variety of benefits to both workers and employers:

  • Medical knowledge to address health and wellness issues
  • Encouragement and guidance to injured employees
  • Assistance in facilitating timely recovery and locating quality care
  • Guidance in navigating a complex medical environment

Merging medicine and mathematics

 

Zurich’s approach is a blend of experienced medical knowledge and cutting-edge predictive analytics modalities. Together, claims, nurse case management and predictive analytics specialists set the stage for optimal outcomes – first identifying when the assignment of a nurse case manager may be of benefit, and then by crafting a medical management program that will help both the injured employee and employer achieve a best-case outcome.

Zurich has gathered data which also shows that the timing of a nurse case management referral can have a significant, positive result on the total costs and closing rates of workplace injury claims. A Zurich analysis looked at nearly 28,000 workers’ compensation claims and the elapsed time between first report and nurse case manager assignment:

  • 4-30 days
  • 31-90 days
  • Over 90 days

The results of the study confirmed that referral of eligible workplace injury claims to a nurse case manager within no more than 90 days can mean significant reductions in total medical and disability costs. When nurses are engaged very early in eligible cases, the results can average from $6,000 to $26,000 in savings per claim – with nearly 50% reduction in overall costs.

Keep in mind that the benefits are not limited to the employer’s reduction in total cost of risk. Injured workers benefit by having an experienced guide and advisor throughout the recovery process, supporting a quicker return to work, regaining a regular income and a better quality of life.

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