Sunday, June 12, 2016

A Cooperative of Information

One of the main points of discussion at the recent Summit in Dallas regarded the wealth of information in this market. In my early days, I became used to the plethora of paper workers' compensation forms, completed with attention to detail, and focus. Various signposts in the path of a Worker's Compensation claim called for the completion and submission of a form.

There were forms to report injuries, forms to memorialize first or last payment of indemnity, forms to provide annual summation of expenditures, and more and more. They were all set forth, once upon a time, in Rule 38F-3.025. We used a vernacular of abbreviations; the department of Labor and Employment Security was "LES," and the Division of Workers' Compensation was "DWC." Thus, the "Notice of Injury" was "LES form DWC-1," the wage statement was "LES form DWC-1a," and there was no "DWC-2." That always made me curious; there was also no 5, 6, 7, or 8 (perhaps they existed historically and disappeared before my time). The list in Rule 38F-3.025 skipped from "DWC-4" to "DWC-9," which coincidentally was the "Health Insurance Claim Form."

The parade of data was assembled around the country in various offices of various companies on various forms, and shipped to Tallahassee. And there, a great deal of data was selectively examined for use an analytical and statistical pursuits. Selected, because the sheer volume of forms and data might allow all to be viewed, but it did not allow all to be input into databases and analyzed. So, analytics relied upon "sampling," a statistical process. In a similar process, it is impossible to ask every American who they support for President, and so poll managers pick a group, a "sample," and call them to ask. Based upon the responses of the sample, the poll operators predict the support likely from the whole. This "sampling" method was similarly used for workers' compensation data in the day of paper forms, post offices, and letter carriers. 

Then the digital age dawned. Of course the digital age had dawned long before that in the business world, but technology costs money. In the late part of the 20th Century, technology began to become pervasive in the world of worker's compensation. And those paper forms were replaced with PDF image forms, and then were replaced by electronic forms.

With electronic forms, the data entry function became unilateral. In the paper form era, data was entered into the paper form by the carrier, and mailed to Tallahassee where the Division then paid employees to take portions of that information and insert it into various database programs. Thus the data entry occurred on both sides of the transaction, i.e. "bilateral."

With the birth of the computer form, the carrier input the data, and submitted it to the division in electronic form. Therefore no further data entry was necessary on the Division side of the equation. And all incoming data, rather than statistical samples, we're easily and inexpensively subject to examination, study, and use.

Carriers are still performing the data entry function. And they seem to dream of a day in which this will no longer be required. In the meantime, however, carriers would be interested in some measure of agreement across jurisdictional lines, regarding what data is relevant, how often it is submitted, and the format thereof. If such consistency were achieved, an insurance company in the worker's compensation market could design a single computer-based document, which would automatically retrieve and assimilate data from the carrier database, for submission to each of the jurisdictions in which it does business. 

Instead of 52 or more individual "claim status report" forms (documentation of total payment of benefits), a single format could be devised for the submission of data and information to the state regulatory agencies. This consistency across state lines would reduce effort and thus cost at the carriers. The simplification would benefit all. No one has convincingly described to me who this process would harm. 

Fantasy? Some would've said the same about medical reporting. And yet the HCFA 1500 is a reality. This is a "super form" that was developed by the federal government (Health Care Financing Administration) and has been in use for a number of years. It allows the submission of data, seeking payment for medical services, in a uniform format. 

A great many entities have adopted this form and accept it. And, more impressive, is the "Superbill" that provides simple data entry for medical billing. 

These forms provide a wealth of data, in a consistent format. With the age of electronic medical billing upon us. The insurance carrier is no longer doing all of the dreaded data entry. In this context, there was historically a similar "bilateral" data entry, with a doctor's staff entering data on a paper form and sending it to the carrier. The carrier was then entering that data, or some of that data, into a database for further study or use. With the electronic submission of bills, and electronic payment, that data on medical services and costs is all collected with the doctor's office data entry. If the billing is electronic, the carrier then merely uses the data. It generates reports of that data in electronic form and submits it to the state. Data entry is streamlined, minimized, information is maximized, and there is a wealth of information to study.

The logic and benefit of electronic medical billing is clear. Certainly, the transition to this new paradigm will present some cost on the front end, but the benefit of singular data entry is obvious (except to those whose living depends on repetitive data entry from paper forms, but then that could be said of the buggy whip makers also). 

Could there be a workers' compensation data "super form?" No, not some Utopian agreement as to what information is relevant, important, imperative. States will have different needs and uses for information. But in the age of computers harvesting data from databases and transmitting electronic summations, what if all the information potentially relevant was consistently harvested and transmitted to all states in an electronic form. This would allow carriers to have one form, one process, for all states. 

The states could then program their computers to accept this mass of data, but to only use the categories (which boxes to look at) of data that each itself deems relevant. In the modern age of data, the state could tell its programs to ignore data it deems irrelevant. States would get the data they deem relevant and important. Carriers would get simplification and consistency. Costs would be saved and lives simplified.


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