Identifying claim drivers in the healthcare sector helps manage costs, allocate resources, and improve the quality of care. But by pinpointing issues that are most likely to result in claims, you also mitigate your risk while insulating your revenue stream and preventing higher insurance costs.
Even though identifying claim drivers can be complicated, by leveraging data and an integrated risk management (IRM) solution, you can surface your most likely claims and start reigning in risk.
Identifying Claim Drivers in Healthcare
While some healthcare organizations may have similar claim drivers, it’s important to establish a systematic claim analysis solution to avoid missing ones that may be unique to your facility.
For example, some organizations have to wrangle with claims associated with medication mistakes caused by human error in their prescription systems. Others may use automated tools that reduce the number of potential mistakes and the claims that result.
So figuring out which claim drivers apply to your company requires a customized system. Here’s how a platform like Ventiv IRM helps healthcare organizations identify claim risks.
Predictive Analytics
You can perform predictive analytics modeling, which involves using previous claim data to figure out which ones are most likely to arise in the future.
For instance, with Ventiv, you can automatically classify different types of claims, dividing them into specific categories. For example, you can surface all claims related to surgical procedures and then analyze how they’ve fluctuated over time. Using this kind of trend analysis, Ventiv enables you to predict surgery-related claims and how many you may get over a particular period.
Comprehensive Data Integration
With IRM software, you can unite all of your organization’s data sources, including your claims data. This gives you deep visibility into claim incidents and a number of contributing factors.
To illustrate, suppose you use Ventiv's integrated risk management software to collect and process both hospital-connected infection stats and claims data. You can then correlate data pertaining to infections people acquired in your facility with claim information. This will quickly surface a connection between these kinds of incidents and claims, calculate the average amount of each claim, as well as identify trends and outliers. If the correlation is strong enough, your staff can design systems and employee education programs to reduce the frequency of infections that originate on your campus.
Leveraging Metrics
By setting up claims-related key performance indicators (KPIs), you can automatically surface the most problematic drivers. For example, you can set up a metric for the costs of different kinds of claims. When the cost exceeds a certain amount over a given period, the system can flag this as a concern.
This is especially useful given the evolving nature of claims. By using Ventiv IRM to establish metrics for a wide range of claims, you enable your organization to catch the most powerful claim drivers as they surface. Using KPIs to flag claim drivers early saves money and empowers you to proactively reduce risk.
Preventing Unnecessary Litigation
Using a solution like Ventiv IRM, you can get a step ahead of litigation by harnessing data. For instance, you can use the platform to:
- Document the details of incidents to make it easier to drill down to the root cause of each event.
- Make sure you’re in line with data stewardship and other compliance standards. These tools also give you the ability to facilitate compliance reviews and audits to catch problems early.
- Collect and organize all documentation related to every incident within a single, searchable platform. This makes it easier for legal teams to identify potential cases and present alternative options to drawn-out litigation
- Track and report incidents. With this information at your fingertips, you can pinpoint incidents that could lead to litigation. You also have the option of tracking near-misses and then taking corrective action.
- Identify and resolve issues early in their lifecycle. With Ventiv, it’s easier to surface situations because you can see a wealth of data through a single-pane-of-glass. You can then use this information to de-escalate problems before they end up in front of lawyers.
Establishing a Compassionate Risk Management Culture
With a compassionate risk management culture, you can both reduce the chances of a disgruntled patient suing you and foster stronger relationships between patients and your staff.
With a risk management platform, you can set up a customized compassionate care infrastructure.
For instance, you can keep track of patient support programs and the patients they are impacting. In addition, you can set up an employee education management system. Using this, you can set up training to teach employees how to exude genuine compassion, connect effectively and appropriately with patients, and respond to patient feedback and surveys.
Ventiv IRM is a multi-faceted healthcare risk management solution that surfaces claim drivers and makes it easier to prevent litigation and establish a compassionate culture. Because Ventiv IRM centralizes your data, you’re in a better position to use it to make strategic decisions. Chat with an expert to see how Ventiv’s IRM Solution is right for your organization.
