Paduda: Gallagher Bassett Uses Data to Improve Care for WC Patients

Thursday, April 25, 2019 | 0

What passes for predictive modeling today is like Google maps, except the app tells you when to turn a half hour after you’ve passed the intersection.

Joe Paduda

By the time adjusters figure out a claim has gone off the tracks, it’s often too late to do anything but increase reserves. That’s because there’s no real-time monitoring, no way to clearly and definitively identify when — exactly — that happens.

A promising approach is in the works at Gallagher Bassett.

Building off research conducted by Johns Hopkins, GB has developed a tool that enables real-time monitoring of medical services delivered to its claimants. Using a proprietary platform, alerts are sent when patients’ quality of care is headed in the wrong direction.

The trigger is inappropriate medical treatments. GB matches medical bill data with evidence-based treatment guidelines, with each service, procedure or medication individually assessed. As the number of inappropriate treatments increases, alarm bells ring.

Of course, that doesn’t mean all treatment that is non-compliant is inappropriate. However, much is, and there’s a clear — and quite strong — correlation between bad medical care and lousy claim outcomes.

Those are clinical words and hide the real import of GB’s approach. Getting claims back on track means patients get better faster, and the risk of bad outcomes from inappropriate surgeries, injections, drugs and tests decreases.

What does this mean for you?

There’s lots of data out there — and far too little smart use of data. This is promising indeed.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.