Action area 5: Effective decision making supported by analytics and automation Satisfaction of person Premiums. Retained business. RTW metrics, claims on claim. costs and Satisfaction amongst Timeliness of subsequently Quality of decisions PoC, Employer, Staff decisions, end-to-end premiums. measured by PoC and Stakeholders. turnaround time health and of claims. social outcomes. Consistency in claims processing and decisions, including those relating to evidence-based care, which would improve efficiency and effectiveness. Fewer unnecessary referrals to health and medical advisors, which would reduce costs and unintended harm. Integrated claims processing amongst all parties, which would improve efficiency and effectiveness. This might also lead to improved relationships, which in turn might lead to greater capacity for upstream interventions to support people at time of need, rather than crisis. Data sources Data sources can be either quantitative or qualitative. It is important to have indicators that will show change in the short and medium term, and these are often derived from qualitative data, such as changes in attitudes, knowledge and practice, and changes in satisfaction, as well as outcome indicators that will give the hard facts, in terms of improved costs, productivity measures and claims’ health outcomes, but take much longer to be measured. Do’s and don’ts Here are some and in recording progress. basic do’s don’ts Things to do: Monitor and evaluate at all stages of the claims management process. Recognise that although monitoring and evaluation have significant cost, time and human resource implications, they are essential for successful programs. Make sure those involved in the monitoring and evaluation are appropriately trained and understand the importance of monitoring and evaluation.
Action area 5: Effective decision making supported by analytics and automation Satisfaction of person on claim. Quality of decisions measured by PoC health and social outcomes. Premiums. Satisfaction amongst PoC, Employer, Staff and Stakeholders. Retained business. Timeliness of decisions, end-to-end turnaround time of claims. Consistency in claims processing and decisions, including those relating to evidence-based care, which would improve efficiency and effectiveness. Fewer unnecessary referrals to health and medical advisors, which would reduce costs and unintended harm. Integrated claims processing amongst all parties, which would improve efficiency and effectiveness. This might also lead to improved relationships, which in turn might lead to greater capacity for upstream interventions to support people at time of need, rather than crisis. RTW metrics, claims costs and subsequently premiums. Data sources Data sources can be either quantitative or qualitative. It is important to have indicators that will show change in the short and medium term, and these are often derived from qualitative data, such as changes in attitudes, knowledge and practice, and changes in satisfaction, as well as outcome indicators that will give the hard facts, in terms of improved claims’ costs, productivity measures and health outcomes, but take much longer to be measured. Do’s and don’ts Here are some basic do’s and don’ts in recording progress. Things to do: Monitor and evaluate at all stages of the claims management process. Recognise that although monitoring and evaluation have significant cost, time and human resource implications, they are essential for successful programs. Make sure those involved in the monitoring and evaluation are appropriately trained and understand the importance of monitoring and evaluation.
taking-action-framework-2018.docx