Panel Discussion Cross Fertilisation Opportunities for - PDF document

Panel Discussion: Cross Fertilisation Opportunities for CTP, WC and Medical Indemnity Claims ManagementLori Callahan (convenor), Sarah Butler, Mary Maini, Len Boehm, Lisa Clarke • Findings From International Best Practices Research– Must Haves– Choices– Cross-Fertilisation• Discussion– Lessons Learnt– Opportunities– Obstacles and ChallengesToday’s Agenda There are some “must haves” in claims management Greater focus on client outcomes, as managementEarly interventionDynamic, recognisingrisk factor People are as or simple, low-risk claims More sophisticated use of datahosocial factors managementtions –seek “win-win” There are also some choices Choices Implications Claim Pathway Service Delivery Capabilities and Decision Rights Providers One-size fits all processCustomised processSingle file ownershipMultiple ownership with specialisationLow touch High touch Centralised and standardised decision makingDecentralised, non-standard decision makingInstitutionalised triggers and guidelinesReliance on individual staff skillActive provider management and directionFull client provider choiceNumber/types of segments, number of teams, specialisation within teamsTeam structure, staff skill sets, systems requirementsProvider management approach, client expectations managementPortfolio loads, staffing footprint, staff skill sets, triggersSystems requirements, staff roles and responsibilities, use of injury coding and automated triggers There are opportunities for cross-fertilisation, but also obstacles Opportunities Provider managementSystemsPaymentsClaims management (for some, but not all types of claims)Data and analysis Obstacles Different regulatory environment between products and statesDifferent points of leverage in claims managementDifferent stakeholdersDifferent injury mix